Transcript Chapter 16

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.5
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 at7
night
– First Aid:
Fractures
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
Morton’s 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
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