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Chapter 16 Injuries to the Lower Leg, Ankle, and Foot – PowerPoint PPT presentation

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Title: Injuries%20to%20the%20Lower%20Leg,


1
Chapter 16
  • Injuries to the Lower Leg,
  • Ankle, and Foot

2
Anatomy Review
Bones and Ligaments of the Ankle and Foot

Note the subtalar joint that is responsible
for inversion and eversion of the foot
3
Anatomy Review (cont.)
  • Foot Bones (medial view)

4
Ligaments
  • The deltoid ligament is the _________ _________of
    the medial side of the talocrural (ankle) joint.

5
Ligaments (cont.)
  • Ligaments of the Ankle (lateral view)
  • The three primary ligaments are

6
The Lateral Ankle
  • These ligaments are NOT as large or strong as the
    deltoid.
  • The talocrural joint is strongest in dorsiflexion
    and weakest in plantar flexion.

7
Anatomy Review
  • The innervation of the three compartments is
    supplied by the tibial, superficial, and deep
    peroneal nerves.
  • The illustration shows the ______
    _______________ _____________________________.

8
Common Sports Injuries
  • Fractures
  • Most often caused by direct trauma through
    contact. Contact causes most fractures to the
    lower leg and foot.
  • Avulsion fracture of 5th metatarsal can occur
    with a lateral ankle sprain.

9
Fractures
  • Signs and symptoms include
  • Swelling and/or deformity at the site of
    fracture.
  • Possible broken bone end projecting through skin.
  • Inability to bear weight on the affected leg.
  • For a stress fracture or growth plate fracture
    that did not result from traumatic event, the
    athlete complains of extreme point tenderness and
    pain at the site of injury.

10
Fractures (cont.)
  • First Aid
  • Watch and treat for shock, if necessary.
  • Carefully immobilize the foot and leg using a
    splint.

11
Soft Tissue Injuries
  • Ankle Injuries
  • Ankle sprains are one of the most common injuries
    to this region.
  • Eversion sprains, while less frequent, are often
    severe.

12
Ankle Injuries Sprains
  • Signs and symptoms depend on degree of sprain.
  • 1st degree Pain, mild disability, point
    tenderness, little laxity, little or no swelling
  • 2nd degree
  • 3rd degree Pain and severe disability, point
    tenderness, loss of function, laxity, moderate to
    severe swelling

13
Ankle Injuries Sprains (cont.)
  • First Aid

Courtesy of Brent Mangus
14
Ankle Injuries Sprains (cont.)
  • First Aid (cont.)
  • If there is any question regarding the severity
    of the sprain, refer athlete to a medical
    facility for physicians evaluation.

15
Ankle Injuries Sprains (cont.)
  • Tibiofibular (tib-fib) Sprains
  • These injuries are often treated inappropriately
    as lateral ankle sprains, hindering recovery.
  • Symptoms include a positive sprain test, but
    athlete is also in great pain. Squeeze test
    elicits pain in syndesmosis area.

16
Ankle Injuries Sprains (cont.)
  • First Aid
  • Immediately apply ice and compression, and
    elevate the leg.
  • Have athlete rest and use crutches for first 72
    hours, followed by wearing a walking boot for 3
    to 7 days.

17
Preventing Ankle Injuries
  • Prophylactic adhesive taping supports the ankle
    only for a short time.
  • Bracing combined with some high-top shoes may be
    helpful.

Courtesy of McDavid
18
Tendon-Related Injuries
  • Achilles tendon is commonly injured by
    long-distance runners, basketball players, and
    tennis players.
  • Athletes who dramatically increase workout times
    or running distances, or who run on hard, uneven,
    or uphill surfaces are prone to Achilles
    tendonitis.
  • The injury can be either acute or chronic. Acute
    injuries often associated with explosive jumping
    or blunt trauma.

19
Achilles Tendon Injuries
  • Signs and symptoms include
  • Swelling and deformity at site of injury.
  • Athlete reports a pop or snap associated with the
    injury.
  • Loss of function, mainly in plantar flexion.
  • First Aid
  • Immediately apply ice and compression.
  • Arrange for transport to nearest medical
    facility.

20
Compartment Syndrome
  • Compartment syndrome usually involves the
    anterior compartment of the lower leg.
  • Chronic form is related to overuse of the
    compartments muscles that causes swelling of
    tissues.
  • Acute trauma, such as being kicked in the leg,
    can result in swelling within the compartment as
    well.
  • In either case, swelling puts pressure on vessels
    and nerves.
  • Properly sized shin guards can protect lower leg
    in soccer.

21
Compartment Syndrome (cont.)
  • Signs and symptoms include
  • Pain and swelling in the lower leg.
  • Athlete may complain of chronic or acute injury
    to the area.
  • There can be loss of pulse in the foot.
  • First Aid
  • Apply ice and elevate. Do _____ apply
    compression.
  • If there is numbness, loss of movement, or loss
    of pulse to the foot, seek medical advice
    immediately this is a true medical emergency.

22
Shin Splints
  • Shin splints is a very common disorder of lower
    leg. Term describes exercise-induced leg pain.
  • The types of activities that produce this problem
    and the manifestations of the injury vary
    depending on the athlete.

23
Shin Splints (cont.)
  • Signs and symptoms include
  • Lower leg pain either medially or
    posteromedially.
  • Pain can be unilateral or bilateral.
  • First Aid
  • Apply ice and have the athlete rest.
  • Athlete may need to have his or her gait analyzed
    for biomechanical deficiencies.
  • If problem worsens, athlete should seek medical
    advice.

24
Plantar Fasciitis
  • The plantar fascia is a dense collection of
    tissues that traverses from the plantar aspect of
    the metatarsal heads to the calcaneal tuberosity.
  • If this tissue becomes tight or inflamed by
    overuse or trauma, it can produce pain and
    disability.
  • Athlete also has point tenderness in the region
    of the calcaneal tuberosity.

25
Plantar Fasciitis (cont.)
  • Treatment is typically conservative and includes
  • Rest.
  • Anti-inflammatories.
  • Applying cold and heat alternatively to enhance
    healing.
  • A heel pad and stretching the Achilles tendon
    complex can assist in recovery.
  • Use of semirigid orthoses is also effective, but
    some athletes find it difficult to participate
    with such an orthotic in their shoes.
  • Re-aggravating the injury increases the healing
    time.

26
Heel Spurs
  • Heel spurs can be related to chronic plantar
    fasciitis.
  • Chronic inflammation can result in ossification
    at the site of attachment on the plantar aspect
    of the calcaneus.
  • Treatment of Heel Spurs
  • Athlete should consult a physician if spurs
    become incapacitating.
  • Applying a doughnut-shaped pad beneath the heel
    spur may help but rarely do they ameliorate the
    problem.

27
Mortons Foot
  • Mortons foot
  • The result shifts weight bearing to the 2nd
    metatarsal instead of along the 1st metatarsal.
  • Results in pain throughout the foot during
    ambulation.

28
Mortons Foot
  • Mortons foot may result in Mortons neuroma.
  • The problem is usually with the nerve between the
    3rd and 4th metatarsal heads.
  • A neuroma is an abnormal growth on a nerve.
  • Tight-fitting shoes may be the cause. Going
    barefoot may help.

29
Arch Problems
  • There are two groups of arch problems pes planus
    and pes cavus.
  • Pes planus (_______) related to pronation.
  • Excessive pronation can cause difficulties in the
    navicular bone and some of the joints around the
    ankle.
  • Arch taping has limited effectiveness.
  • Corrective arch orthoses may be beneficial.
  • Pes cavas (_________) associated with plantar
    fasciitis and clawing of the toes.
  • Athlete may benefit from orthotic device.

30
Bunions
  • Bunions are uncommon in high school and college
    athletes.
  • Can be caused by improperly fitting shoes.
  • Chronic bunion should be evaluated by physician.

31
Blisters Calluses
  • Blisters and calluses are very common formations,
    resulting from friction between layers of skin.
  • When a blister forms, fluid collects between skin
    layers, occasionally the fluid will contain
    blood.
  • When draining a blister, it is best to leave top
    layer of skin in place.
  • Use sterile instruments and wear latex gloves or
    some other barrier to avoid contact with
    athletes body fluid.

32
Blisters Calluses (cont.)
  • NSC First Aid Procedures
  • Wash area with soap and warm water sterilize
    area with rubbing alcohol.
  • Use sterile needle to puncture the base of the
    blister and drain by applying light pressure.
    Process may need to be repeated during the first
    24 hours.
  • Apply antibiotic ointment to the top and cover
    with sterile dressing.
  • Check daily for signs of infection (redness or
    pus).
  • After 37 days, remove the top of blister and
    apply antibiotic ointment and sterile dressing.

33
Toe Injuries
  • Common injuries are torn-off nails or hematoma
    formation under the nail.
  • Use commercially available nail bore to drill
    small hole in nail to release blood.
  • Ingrown toenails may result from improperly
    fitting shoes.
  • Elevate toenail by placing a small cotton roll
    under it and leave in place as nail grows.
  • Have athlete obtain shoes that fit more
    comfortably.

34
Basic Taping
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35
Basic Taping (cont.)
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6.
36
Basic Taping (cont.)
7.
8.
9.
37
Basic Taping (cont.)
10.
11.
12.
38
Basic Taping (concluded)
13.
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14.
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