Injuries to the Lower Leg,

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• Injuries to the Lower Leg,
• Ankle and Foot

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Bony Anatomy
Bony Anatomy includes Tibia, Fibula, Tarsals,
Metatarsals, Phalanges
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Bony Anatomy
Medial view tarsals and metatarsals
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Medial Ligaments of Ankle

• Deltoid Ligament
• rarely injured in sports
• mechanism of injury typically eversion with
  dorsiflexion
• longer time to heal than lateral ankle ligaments

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Lateral Ligaments of Ankle

• 3 primary ligaments
• anterior talofibular
• posterior talofibular
• Calcaneofibular
• NOT as large strong as the deltoid.
• Mechanism of injury is inversion associated with
  plantar flexion.

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Lower Leg Anatomy

• 3 Compartments
• Anterior, Lateral, Posterior

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Fractures

• Mechanism
• most often caused by direct trauma to the tibia,
  fibular or bone(s) of the foot
• repeated microtrauma can result in a stress
  fracture
• growth plate injures can occur in the adolescent
  -- known as Salter-Harris fractures
• Signs/symptoms
• swelling/deformity, discoloration
• broken bone end protruding
• athlete reports a snap/pop
• inability to bear weight
• stress fractures often become more painful at
  night

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Fractures

• First Aid
• treat for shock
• apply sterile dressing to any open wounds
• carefully immobilize using appropriate splinting
  technique
• contact EMS and arrange for transport

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Ankle Fracture
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Ankle Fracture
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Ankle Dislocation
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Ankle Sprains

• Details
• one of the most common injuries to this region
• Due to skeletal and ligamentous variables,
  lateral sprains are more common.
• 80-85 of all ankle sprains are to the lateral
  ligaments --inversion sprains
• Eversion sprains, while less frequent, are often
  severe.

Syndesmosis Sprain Sprain of the ligaments
connecting the tibia and fibula.
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• Signs/symptoms
• 1st deg. -- pain, mild disability, pt.
  tenderness, little or no swelling
• 2nd deg. -- pain, mild to moderate disability,
  pt. tenderness, loss of function, some laxity,
  swelling
• 3rd deg. -- pain severe disability, pt.
  tenderness, loss of function, laxity, severe
  swelling

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Ankle Sprains

• First Aid
• ice, compression and elevation
• apply a horseshoe - or doughnut-shaped pad
• use crutches, partial or full weight bearing
• any questions regarding severity, refer to a
  physician for further evaluation and diagnosis

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Ankle Sprain

• Prevention
• Research indicates that taping is only good for a
  short period of time. Braces may be as effective
  as tape and at a much lower cost
• Best prevention is to strengthen the muscles of
  the lower leg as well as develop proprioception.

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Two examples of rigid ankle braces
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Tib/Fib Syndemosis Sprain

• Signs and Symptoms
• Often treated as lateral ankle sprain, which is
  inappropriate, hindering recovery.
• The difference is the mechanism of injury.
  Tib-fib sprains involve dorsiflexion followed by
  axial loading with external rotation of the foot.
• Symptoms positive sprain test, but athlete is
  in great pain.
• Slower healing
• Sometimes physicians will cast.

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Achilles Tendon

• Achilles tendon commonly injured -- more often in
  older (30) male athlete
• can be either an acute or chronic, overuse injury
• acute injuries often associated with blunt trauma
• chronic injuries often associated with sudden
  increase in training intensity

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Common Injuries

• Signs/symptoms
• swelling and deformity
• pop or snap
• pain in lower leg
• loss of function, especially in plantar flexion

• First Aid
• immediate application of ice and compression
• immobilize with appropriate splint
• arrange for transport to a medical facility

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Torn Tendon
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Achilles Surgery
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Compartment Syndrome

• usually involves the anterior compartment of the
  lower leg
• Chronic form is related to overuse of the muscles
  of the compartment
• 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.

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Compartment Syndrome

• Signs/symptoms/First Aid
• pain/swelling and loss of sensation and/or motor
  control in the lower
• loss of pulse in the foot
• inability to extend the big toe or dorsiflex the
  foot apply ice elevate -- do NOT apply
  compression
• loss of pulse or sensation -- medical emergency -
  transport to medical facility

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Shin Splints

• Signs/symptoms
• lower leg pain -- typically a chronic injury that
  progressively worsens
• pain is often bilateral
• Shin splints is generic pain in the lower legs,
  typically caused by change in surface or workout.
• First Aid
• apply ice and have the athlete rest
• use of NSAIDs may be helpful
• seek a professional to identify the cause

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Foot Disorders

• Plantar Fasciitis
• plantar fascia spans from the metatarsal heads to
  the calcaneal tuberosity
• Ball of foot to heel.
• this tissue can become inflamed and painful
• painful in the morning when first rising from bed
• point tenderness in the region of the calcaneal
  tuberosity

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Common Injuries

• Heel Spurs
• often related to chronic plantar fasciitis
• involves ossification at the site of attachment
  to the calcaneus
• Treatment of Plantar Fasciitis and Heel Spurs
• rest and NSAIDs
• stretching of the Achilles
• doughnut pad beneath the heel spur

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Common Injuries

• Mortons Neuroma
• growth (enlargement) of the interdigital nerve
  usually between the 3rd and 4th metatarsal heads
• pain will radiate into the 3rd and 4th toes
• tight fitting shoes have been identified as a
  major causative factor
• going barefoot often relieves the symptoms
• the neuroma may have to be treated surgically

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Common Injuries

• Care for Neuroma
• Teardrop pad can be placed between met heads to
  increase space, decreasing pressure on neuroma
• Shoes with wider toe box would be appropriate
• the neuroma may have to be treated surgically

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Common Injuries

• Foot disorders
• Arch problems
• two groups of arch problems pes planus and pes
  cavus
• Pes Planus flat arch
• Pes Cavus high arch

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Common Injuries

• corrective taping may provide temporary support
  for the arch
• In some cases, the athlete may benefit from a
  properly constructed orthosis.
• Orthotics should be constructed by a trained
  professional.

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Common Injuries

• Blisters calluses
• very common formations, result from friction
  between layers of skin
• when a blister forms, fluid collects between skin
  layers, occasionally the fluid will contain blood
• if the blister is large, it should be drained
• When draining a blister, use sterile instruments,
  latex gloves and eye protection