Lower Leg and Ankle

Walking Gait Stance Phase

• Heel-strike• Midstance• Toe-off

Swing Phase

Walking Gait

HEE- STRIKE TOE-OFF

Walking Gait Heel strike the foot lands in an

inverted (supinated) position. Mid-stance it moves to

eversion (pronation) so the medial longitudinal arch can absorb the impact.

Moves back to inversion (supination) during toe-off.

Walking Gait

Walking Gait Problem occur

when the foot is too rigid and does not invert (pronate) adequately or when the foot remains inverted (pronated) past midstance.

Excessive pronation or supination can be prevented with proper shoes.

Running Gait Running differs from walking in that

during walking, one foot is always in contact with the ground.

During running there is a point when neither foot is in contact with the ground.

Shin SplintsMedialAnterior

Medial Tibial Stress Syndrome Tenderness is usually found between 3 and

12 centimeters above the tip of the medial malleolus at the posterio-medial aspect of the tibia.

Inflammation of the periostium (periostitis) Most frequently involved is the Tibalis

Posterior tendon and muscle, but the Flexor Digitorum Longus and Flexor Hallucis Longus may also be involved.

Stress fractures can also occur in this area.

Anterior Compartment Syndrome Soft tissue injuries at the muscular origin and

bony or periosteal interface of the bone and muscle origin.

Due to micro tears of the Tibialis Anterior either at the origin or in the fibers themselves.

Or microtrauma to the bone structure itself. Stress fractures can also occur in this area.

Exertional Compartment Syndrome Caused by the muscles swelling within a closed

compartment with a resultant increase in pressure in the compartment.

The blood supply can be compromised and muscle injury and pain may occur.

Abnormal compartment pressure:• A resting pressure greater than 20 mm Hg; or• An exertional pressure greater than 30 mm Hg; or• A pressure of 25 mm Hg or higher 5 minutes after stopping

exercise. This may require surgical decompression of the

compartment.

Causes - FYI

Tight posterior muscles Imbalance between the

posterior and anterior muscles Running on concrete or other

hard surfaces Improper Shoes - inadequate

shock protection Overtraining

Treatment (FYI)

Rest. The sooner you rest the sooner it will heal. Apply ice 10-15 minutes for 2-3x per day in the

early stages when it is very painful. Anti inflammatory drugs Wear shock absorbing insoles in shoes. Maintain fitness with other non weight bearing

exercises. Apply heat and use a heat retainer after the initial

acute stage, particularly before training.

Stress Fractures Bone remodeling Repetitive stress weakens the bone 10-20% of injuries to athletes Most common locations: tibia, fibula and

metatarsals. Tibial and fibular stress fractures can

develop from “shin splints”

Causes of Stress Fractures - FYI Training errors Abnormal limb length Low body weight (< 75% of ideal) Eating disorders Previous inactivity White race Female

Diagnosis (FYI)

X-ray MRI CT scans

Ankle Sprains - FYI Most common athletic injury. 25% of all injuries. The risk of ankle sprains varies with the sport

• 21-53% basketball, 17-29% soccer, 25% volleyball. Ankle sprains account for 10% to 15% of all lost

playing time

Ankle Sprains The medial malleolus is shorter than the

lateral mallelous so there is naturally more inversion than eversion.

Greater inversion increases the potential for over-stretching of the lateral ligaments.

Most sprains involve the lateral ligaments from excessive inversion.

Deltoid ligament is sprained less often (25% of ankle sprains)

Lateral Collateral Ligament

Ankle Sprains

Classification of Sprains 1st Degree:

• Stretching of the ATFL• little or no edema• tenderness• maintain function.

2nd Degree• Partial tear of the ATFL

and/or CFL• moderate edema• some function loss

3rd Degree• Complete tear ATFL,

CFL, and/or PTFL• total loss of function• significant edema

Ankle Sprains by Grade

Sign/symptom Grade I Grade II Grade IIITendon

Loss of functional ability

Pain

Swelling

Ecchymosis

Difficulty bearing weight

No tear

Minimal

Minimal

Minimal

Usually not

No

Partial tear

Some

Moderate

Moderate

Frequently

Usually

Complete tear

Great

Severe

Severe

Yes

Almost always

Treatment (FYI)

AAFP (see table 3)

R.I.C.E. Ice for 20 minutes on and 20 minutes off for the first

two hours. After that, 20 min intervals over the next 48-72

hours, Compression wrap with donut or horse shoes to fill

in gaps around malleolus from 24-36 hours; after 48-72 hours contrasts baths with ROM exercises for 4 minutes in warm and 1 min in ice water.

Plantar Fasciitis

The plantar fascia runs from the calcaneus to the metatarsals.

This tight band acts like a bow string to maintain the arch of the foot.

Plantar fasciitis refers to an inflammation of the plantar fascia.

Plantar Fasciitis Inflammation is usually

due to repeated trauma to where the tissue attaches to the calcaneus.

The trauma results in microscpic tears at the calcaneus attachment site.

This may produce heal spurs

Plantar Fasciitis Pain is worse in the morning

or after a period of inactivity Causes

• High arch• Excessive pronation• Footwear (worn out, stiff)• Increase in intensity

Turf Toe Turf toe is really a bruise or sprain that occurs at the base

of the big toe at the joint called the metatarsal phalangeal joint.

It usually occurs when the toe is jammed forcibly into the ground or, more commonly, when the toe is bent backward too far (hyperextended)

It causes significant pain and swelling at the base of the big toe.

It can be a significant problem because players use the toe when they run and plant and push off.

Achilles Tendonitis - FYI Causes

• Rapidly increasing training effort• Adding hills or stair climbing to

training• Starting too quickly after a layoff• Poor footwear• Excessive pronation• Tight posterior leg muscles

If left untreated, it may progress to a complete rupture.

Achilles Tendon Rupture - FYI Most frequently ruptured tendon Complete ruptures are due to

eccentric loading during abrupt stopping, landing from a jump.

Usually a popping sound is heard with a complete tear.

There may or may not be an obvious gap 2 to 6 cm from the calcaneus attachment.

Treatment may or may not include surgery but both require immobilized for 3 months.

Ankle Exercises Calf stretch Soleus stretch Resisted dorsal

and plantar flexion Heel raises Step-up Jump rope

Ankle ExercisesWobble Boards