Ankle and Leg Injuries
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Transcript of Ankle and Leg Injuries
Ankle and Leg Injuries
ROP SPORTS MEDICINEStacy Camou
Skeletal Anatomy• Talus• Tibia
– Medial aspect– Larger of the two leg bones– Second longest bone in body– Primary weight bearing bone in leg
• Fibula– Lateral aspect– Functions to provide muscle attachments– Non-weight bearing
Skeletal Anatomy
Articulations• Talocrural joint = Ankle joint
– Made up of the tibia, fibula, and talus– Talus is wedge shaped– Lateral malleolus extends more distally than the
medial malleolus • Proximal to Distal tibiofibular joint is connected
by– Syndesmosis Joint (HIGH ANKLE SPRAIN)
Articulations- Talocrural Joint
Articulations
Musculoskeletal Anatomy• 4 Compartments of the leg
– Anterior compartment (most commonly Injured)• Tibialis anterior• Extensor hallicus longus• Extensor digitorum longus• Peroneus tertius• Anterior tibial artery and vein• Deep peroneal nerve
– Lateral compartment• Peroneus longus• Peroneus brevis• Superficial peroneal nerve
Musculoskeletal Anatomy• Compartments of the leg
– Deep posterior compartment• Tibialis posterior• Flexor hallucis longus• Flexor digitorum longus• Posterior tibial artery and vein• Tibial nerve• Superficial posterior• Gastrocnemius• Soleus• Plantaris
Musculoskeletal Anatomy
Ligamentous Anatomy
• Ankle– Medial aspect
• Deltoid ligament• Thick and strong
– Lateral aspect• Anterior talofibular • Posterior talofibular • Calcaneofibular
• Leg– Proximal and distal anterior and posterior
tibiofibular ligaments
+ Interosseous membrane=Syndesmosis Ligaments
Ligamentous Anatomy
Gastrocnemius
Soleus
Achilles Tendon
Tibialis Anterior
Peroneus Longus Peroneus Brevis
Fractures• Avulsions
– Piece of tibia/fibula is pulled off by ligament– Fairly common– X-rays for all ankle sprains
Fractures
Fractures• Tibia
– Traumatic fractures are serious due to size of bone– Stress fractures
• Medial tibial stress syndrome• “shin splints”
• Fibula– Fairly common– Non-weight bearing; competition possible– Stress fractures
• Reasonably common due to muscle attachments• Both bones
– Usually requires surgery to stabilize
Fractures
Strains• Gastrocnemius/Soleus strain occurs:
– Muscle belly– Musculotendinous junction
• Anterior extensors strain– Often called “shin splints” (lateral to tibial ridge)– M.O.I = Hill, climbing, or speed work– May lead to chronic compartment syndrome
• Toe flexors– Often called “shin splints” (medial to tibial ridge)– M.O.I = Pronation increases odds
• Achilles tendon– Strain vs tendonitis ( can lead to rupture )
Strains• Achilles tendon rupture
– Most common over 30 years old– Chronic history of inflammationor– Acute Sudden push off– Signs and symptoms
• “I was kicked in the back of the leg!!”• Immediate pain• Palpable defect• Positive Thompson’s test
STRAINS
Thompson’s Test
Sprains• Lateral ankle sprains
– M.O.I = Inversion/plantar flexion mechanism– Most common injury in body– 90-95% of all ankle sprains occur to lateral
ligaments…..Why?• Strong medial ligaments• Fibular block
– Ligaments involved• Anterior talofibular or ATFL• Calcaneofibular or CFL• Posterior talofibular or PTFL
– Mild to severe grades (1°-3°)
Lateral Ankle Sprain
Sprains• Medial ankle sprains
– M.O.I = Eversion mechanism– Rare (5%) occur medially….WHY????
• Strong deltoid ligament• Fibular block
– Deltoid ligaments Injured– Graded Mild to severe (1°-3°)
• Syndesmosis sprain– M.O.I = Forced dorsiflexion and/or eversion– “High ankle sprain”– Slow to heal– Anterior tibiofibular (ATFL) ligament and interosseous
membrane are the ligaments injured
Medial Ankle Sprain
Other Conditions
• Achilles tendonitis/tenosynovitis– Inflammation of the tendon or sheath
surrounding the tendon– Causes hypertrophic scarring
Achilles Tendon Rupture
Achilles Tendonitis
ACHILlES TENDON RUPTURE
Other Conditions• Compartment syndrome
– Typically anterior or deep posterior compartments– Acute
• Caused by direct blow or injury within fascial compartment• Medical emergency• Taut, shiny appearance of skin• Foot drop if advanced• Requires surgical decompression
– Chronic• Muscle hypertrophy during exercise
– Decreased space in compartment• Slow, continual rise in temperature
– Treatment???
If pressure is too high surgery will be required.