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Injuries to the Lower Leg, Injuries to the Lower Leg,

Ankle and FootAnkle and Foot

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Bony AnatomyBony Anatomy

Bony Anatomy includes: Tibia, Fibula, Tarsals, Metatarsals, Phalanges

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Bony AnatomyBony AnatomyMedial view: tarsals and metatarsals

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Medial Ligaments of AnkleMedial Ligaments of Ankle

Deltoid LigamentDeltoid Ligamentrarely injured in rarely injured in sportssports

mechanism of mechanism of injury typically injury typically eversion with eversion with dorsiflexiondorsiflexion

longer time to longer time to heal than lateral heal than lateral ankle ligamentsankle ligaments

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Lateral Ligaments of AnkleLateral Ligaments of Ankle

3 primary 3 primary ligaments:ligaments:

anterior talofibularanterior talofibular

posterior posterior talofibulartalofibular

CalcaneofibularCalcaneofibular

– NOT as large & NOT as large & strong as the strong as the deltoid.deltoid.

– Mechanism of Mechanism of injury is inversion injury is inversion associated with associated with plantar flexion.plantar flexion.

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Lower Leg AnatomyLower Leg Anatomy

3 Compartments3 Compartments– Anterior, Lateral, & PosteriorAnterior, Lateral, & Posterior

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FracturesFractures– MechanismMechanism

most often caused by direct trauma to the most often caused by direct trauma to the tibia, fibular or bone(s) of the foottibia, fibular or bone(s) of the foot

repeated “microtrauma” can result in a stress repeated “microtrauma” can result in a stress fracturefracture

growth plate injures can occur in the growth plate injures can occur in the adolescent -- known as “Salter-Harris” fracturesadolescent -- known as “Salter-Harris” fractures

– Signs/symptoms:Signs/symptoms:swelling/deformity, discolorationswelling/deformity, discolorationbroken bone end protrudingbroken bone end protrudingathlete reports a snap/popathlete reports a snap/popinability to bear weightinability to bear weightstress fractures often become more painful at stress fractures often become more painful at nightnight

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FracturesFractures– First Aid:First Aid:

treat for shocktreat for shock

apply sterile dressing to any open apply sterile dressing to any open woundswounds

carefully immobilize using appropriate carefully immobilize using appropriate splinting techniquesplinting technique

contact EMS and arrange for transportcontact EMS and arrange for transport

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Ankle FractureAnkle Fracture

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Ankle FractureAnkle Fracture

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Ankle DislocationAnkle Dislocation

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Ankle SprainsAnkle Sprains

DetailsDetailsone of the most one of the most common injuries to common injuries to this regionthis regionDue to skeletal and Due to skeletal and ligamentous ligamentous variables, lateral variables, lateral sprains are more sprains are more common.common.80-85% of all ankle 80-85% of all ankle sprains are to the sprains are to the lateral ligaments --lateral ligaments --inversion sprainsinversion sprainsEversion sprains, Eversion sprains, while less frequent, while less frequent, are often severe.are often severe.

Syndesmosis Sprain: Sprain of the Syndesmosis Sprain: Sprain of the ligaments connecting the tibia and ligaments connecting the tibia and fibula.fibula.

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Signs/symptoms:Signs/symptoms:– 1st deg. -- pain, 1st deg. -- pain,

mild disability, pt. mild disability, pt. tenderness, little or tenderness, little or no swellingno swelling

– 2nd deg. -- pain, 2nd deg. -- pain, mild to moderate mild to moderate disability, pt. disability, pt. tenderness, loss of tenderness, loss of function, some function, some laxity, swellinglaxity, swelling

– 3rd deg. -- pain & 3rd deg. -- pain & severe disability, pt. severe disability, pt. tenderness, loss of tenderness, loss of function, laxity, function, laxity, severe swellingsevere swelling

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Ankle SprainsAnkle Sprains

First Aid:First Aid:ice, compression and ice, compression and elevationelevation

apply a horseshoe - or apply a horseshoe - or doughnut-shaped paddoughnut-shaped pad

use crutches, partial use crutches, partial or full weight bearingor full weight bearing

any questions any questions regarding severity, regarding severity, refer to a physician refer to a physician for further evaluation for further evaluation and diagnosisand diagnosis

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Ankle SprainAnkle SprainPrevention Prevention

– Research indicates Research indicates that taping is only that taping is only good for a short good for a short period of time. period of time. Braces may be as Braces may be as effective as tape and effective as tape and at a much lower costat a much lower cost

– Best prevention is to Best prevention is to strengthen the strengthen the muscles of the lower muscles of the lower leg as well as develop leg as well as develop proprioception.proprioception.

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Two examples of rigid ankle Two examples of rigid ankle bracesbraces

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Tib/Fib Syndemosis SprainTib/Fib Syndemosis Sprain– Signs and SymptomsSigns and Symptoms

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

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Achilles TendonAchilles Tendon– Achilles tendon commonly injured -- more Achilles tendon commonly injured -- more

often in older (30+) male athleteoften in older (30+) male athlete– can be either an acute or chronic, overuse can be either an acute or chronic, overuse

injuryinjury– acute injuries often associated with blunt acute injuries often associated with blunt

traumatrauma– chronic injuries often associated with sudden chronic injuries often associated with sudden

increase in training intensityincrease in training intensity

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Common InjuriesCommon InjuriesSigns/symptomsSigns/symptoms– swelling and swelling and

deformitydeformity– pop or snappop or snap– pain in lower legpain in lower leg– loss of function, loss of function,

especially in especially in plantar flexionplantar flexion

First Aid:First Aid:– immediate immediate

application of ice application of ice and compressionand compression

– immobilize with immobilize with appropriate appropriate splintsplint

– arrange for arrange for transport to a transport to a medical facilitymedical facility

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Torn TendonTorn Tendon

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Achilles SurgeryAchilles Surgery

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Compartment SyndromeCompartment Syndrome

– usually involves the anterior usually involves the anterior compartment of the lower legcompartment of the lower leg

– Chronic form is related to Chronic form is related to overuse of the muscles of the overuse of the muscles of the compartmentcompartment

– Trauma, such as being kicked in Trauma, such as being kicked in the leg, can result in swelling the leg, can result in swelling within the compartment as well.within the compartment as well.

– In either case, swelling puts In either case, swelling puts pressure on vessels and nerves.pressure on vessels and nerves.

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Compartment SyndromeCompartment Syndrome

Signs/symptoms/First Aid:Signs/symptoms/First Aid:– pain/swelling and loss of sensation pain/swelling and loss of sensation

and/or motor control in the lowerand/or motor control in the lower– loss of pulse in the footloss of pulse in the foot– inability to extend the big toe or inability to extend the big toe or

dorsiflex the foot apply ice & elevate -- dorsiflex the foot apply ice & elevate -- do NOT apply compressiondo NOT apply compression

– loss of pulse or sensation -- medical loss of pulse or sensation -- medical emergency - transport to medical emergency - transport to medical facilityfacility

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Shin SplintsShin SplintsSigns/symptoms:Signs/symptoms:– lower leg pain -- typically a chronic injury lower leg pain -- typically a chronic injury

that progressively worsensthat progressively worsens– pain is often bilateralpain is often bilateral– ““Shin splints” is generic pain in the lower Shin splints” is generic pain in the lower

legs, typically caused by change in surface legs, typically caused by change in surface or workout.or workout.

First Aid:First Aid:– apply ice and have the athlete restapply ice and have the athlete rest– use of NSAIDs may be helpfuluse of NSAIDs may be helpful– seek a professional to identify the causeseek a professional to identify the cause

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Foot DisordersFoot DisordersPlantar FasciitisPlantar Fasciitis– plantar fascia spans plantar fascia spans

from the metatarsal from the metatarsal heads to the calcaneal heads to the calcaneal tuberosity tuberosity

Ball of foot to heel.Ball of foot to heel.

– this tissue can this tissue can become inflamed and become inflamed and painfulpainful

– painful in the morning painful in the morning when first rising from when first rising from bedbed

– point tenderness in point tenderness in the region of the the region of the calcaneal tuberositycalcaneal tuberosity

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Common InjuriesCommon InjuriesHeel SpursHeel Spurs– often related to chronic plantar often related to chronic plantar

fasciitisfasciitis– involves ossification at the site of involves ossification at the site of

attachment to the calcaneusattachment to the calcaneus

Treatment of Plantar Treatment of Plantar Fasciitis and Heel Fasciitis and Heel SpursSpurs– rest and NSAIDsrest and NSAIDs– stretching of the Achillesstretching of the Achilles– doughnut pad beneath the heel doughnut pad beneath the heel

spurspur

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Common InjuriesCommon InjuriesMorton’s NeuromaMorton’s Neuroma– growth (enlargement) growth (enlargement)

of the interdigital of the interdigital nerve usually between nerve usually between the 3rd and 4th the 3rd and 4th metatarsal headsmetatarsal heads

– pain will radiate into pain will radiate into the 3rd and 4th toesthe 3rd and 4th toes

– tight fitting shoes tight fitting shoes have been identified have been identified as a major causative as a major causative factorfactor

– going barefoot often going barefoot often relieves the symptomsrelieves the symptoms

– the neuroma may the neuroma may have to be treated have to be treated surgicallysurgically

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Common InjuriesCommon Injuries

Care for NeuromaCare for Neuroma– Teardrop pad can Teardrop pad can

be placed be placed between met between met heads to increase heads to increase space, decreasing space, decreasing pressure on pressure on neuromaneuroma

– Shoes with wider Shoes with wider toe box would be toe box would be appropriateappropriate

– the neuroma may the neuroma may have to be treated have to be treated surgicallysurgically

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Common InjuriesCommon Injuries

Foot disordersFoot disorders

Arch problemsArch problems– two groups of arch problems: pes planus two groups of arch problems: pes planus

and pes cavusand pes cavus– Pes Planus = flat archPes Planus = flat arch– Pes Cavus = high archPes Cavus = high arch

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Common InjuriesCommon Injuries

– corrective taping may provide corrective taping may provide temporary support for the archtemporary support for the arch

– In some cases, the athlete may benefit In some cases, the athlete may benefit from a properly constructed orthosis.from a properly constructed orthosis.

– Orthotics should be constructed by a Orthotics should be constructed by a trained professional.trained professional.

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Common InjuriesCommon Injuries

Blisters & callusesBlisters & calluses– very common formations, result from very common formations, result from

friction between layers of skinfriction between layers of skin– when a blister forms, fluid collects when a blister forms, fluid collects

between skin layers, occasionally the between skin layers, occasionally the fluid will contain bloodfluid will contain blood

– if the blister is large, it should be drainedif the blister is large, it should be drained– When draining a blister, use sterile When draining a blister, use sterile

instruments, latex gloves and eye instruments, latex gloves and eye protectionprotection