1 / 27

Chapter 5

Chapter 5. The Ankle and Lower Leg Continued. Stress Fractures. Evaluation Findings Table 5-9, page 169 Predisposing factors Narrow tibial shaft, hip external rotation, pes cavus Diagnostic testing Bump Test (Box 5-9, page 170) Treatment (Figure 5-26, page 169) Table 5-10, page 171.

kalin
Download Presentation

Chapter 5

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Chapter 5 The Ankle and Lower Leg Continued

  2. Stress Fractures • Evaluation Findings • Table 5-9, page 169 • Predisposing factors • Narrow tibial shaft, hip external rotation, pes cavus • Diagnostic testing • Bump Test (Box 5-9, page 170) • Treatment (Figure 5-26, page 169) • Table 5-10, page 171

  3. Os Trigonum Injury • Evaluation Findings • Table 5-11, page 173 • Steida’s process (figure 5-27,page 172) • Formation of an os trigonum (Fig 5-28, p172) • Os trigonum syndrome (talarcompression syndrome) • Inflammation of posterior joint • Inflammation of surrounding ligaments • Fracture of the os trigonum • Pathology involving Steida’s process

  4. Os Trigonum Injury cont. • Inversion/plantarflexion • posterior talocalcaneal ligament tightens against os trigonum or Steida’s process • Eversion of calcaneus • os trigonum or Steida’s process to become compressed between tibia and calcaneus • Treatment

  5. Achilles Tendon Pathology • Association with gastrocnemius and soleus • Decreased plantarflexion strength • Changes in gait; ability to walk, run, jump

  6. Achilles Tendinitis • Evaluation Findings • Table 5-12, page 174 • Poorly vascularized structure • Limited blood supply - posterior tibial artery • Distal avascularized zone – 2 to 6 cm proximal to insertion on calcaneus • Delayed healing

  7. Achilles Tendinitis cont. • Paratenon • Highly vascularized structure, surrounds tendon • Peritendinitis • Tendinosis • Degeneration of tendon’s substance • Peritendinitis Tendinosis Tendon Rupture

  8. Achilles Tendinitis cont. • Factors leading to achilles tendon pathology • Tibial varum • Calcaneovalgus • Hyperpronation • Tightness of triceps surae, hamstring groups • Running mechanics, duration and intensity of running, type of shoe, running surface • Biomechanics of foot and ankle • Acute Onset

  9. Achilles Tendinitis cont. • Age and gender • Pain characteristics • Treatment/Return to activity

  10. Achilles Tendon Rupture • Evaluation Findings • Table 5-13, page 176 • Forceful, sudden contraction = large amount of tension developing in tendon • Theories • Chronic degeneration of tendon • Failure of inhibitory mechanism of musculotendinous unit • Rupture tends to occur in distal 2-6 cm

  11. Achilles Tendon Rupture cont. • Age and gender • Previous or current tendinosis, age-related changes in tendon, deconditioning • Corticosteroid injections • Characteristics of rupture • Figure 5-29, page 175 • Thompson Test • Box 5-10, page 177 • Treatment

  12. Subluxating Peroneal Tendons • Evaluation Findings • Table 5-14, page 178 • Forceful, sudden DF/EV or PF/INV = stretch or rupture of superior peroneal retinaculum • Tendon alignment • Figure 5-30, page 176

  13. Subluxating Peroneal Tendons cont. • Predisposing factors • Flattened fibular groove • Pes planus • Hindfoot valgus • Recurrent ankle sprains • Laxity of peroneal retinaculum • Characteristics • Treatment

  14. Neurovascular Deficit • Disruption of blood or nerve supply to or from lower leg • Acute trauma • Overuse conditions • Congenital defects • Surgery • Dermatomes, reflexes, pulses

  15. Anterior Compartment Syndrome • Evaluation Findings • Table 5-15, page 179 • Increased pressure in compartment threatens integrity of lower leg, foot, and toes • Obstructs neurovascular network • Deep peroneal nerve • Anterior tibial artery

  16. Anterior Compartment Syndrome cont. • Bony posterolateral border and dense fibrous fascial lining = poor elastic properties • Cannot accommodate for expansion of intracompartmental tissues • Increased pressure = lack of oxygen to local tissues • Leads to ischemia and possibly cell death

  17. Anterior Compartment Syndrome cont. • 3 classifications • Traumatic • blow to anterior or anterolateral portion of lower leg • Exertional • acute or chronic; during or after exercise (or both) • Chronic (recurrent or intermittent claudication) • Occurs secondary to anatomic abnormalities obstructing blood flow to exercising muscles • Increased thickness of fascia inhibits venous outflow • Other anatomic factors – page 178

  18. Anterior Compartment Syndrome cont. • Associated with • Tibial fractures • Anticoagulant therapy • Diabetes • Knee braces • High-heeled shoes • Signs and Symptoms • 5 P’s • Pain, pallor, pulselessness, paresthesia, paralysis

  19. Anterior Compartment Syndrome cont. • Drop foot gait • Dorsalis pedis pulse (Figure 5-31, pg 180) • Most important clinical finding • Severe pain with passive muscle stretching • Medical emergency • Decreased pulse, paresthesia, paralysis • Compartmental pressure • Treatment

  20. Deep Vein Thrombophlebitis • Inflammation of veins with associated blood clots • Common in postsurgical patients • May be secondary to trauma to lower extremity • Pain and tightness in calf during walking • Inspection – swelling in calf • Palpation – warmth, tightness, pain • Homan’s sign • Box 5-11, page 181

  21. On-Field Evaluation of Lower Leg and Ankle Injuries • Goals • Rule out fractures and dislocations • Determine weight-bearing status • Removal methods

  22. Equipment Considerations • Footwear Removal • Rule out fracture/dislocation and then remove shoe • Figure 5-32, page 181 • Apprehensive athletes – remove themselves • If fracture is suspected – check pulses • Tape and Brace Removal • Similar to shoe removal • Tape is cut on opposite side of injury

  23. On-Field History • Mechanism of injury • Inversion • Eversion • Rotation • Dorsiflexion • Plantarflexion • Associated sounds and sensations

  24. On-Field Inspection • On-Field Palpation • Bony palpation • Soft tissue palpation • On-Field Range of Motion Tests • Willingness to move involved limb • Willingness to bear weight

  25. Initial Management of On-Field Injuries • Ankle Dislocations (talocrural joint) • Excessive rotation combined with INV or EV • Disruption of capsule/ligaments, fractures of malleoli, long bones, talus • Pain, loss of function, audible sounds • Figure 5-33, page 183 • Confirm presence of pulses • Lower Leg Fractures • Signs/symptoms (Figure 5-34, page 183) • Fibula – may be able to walk • Bump/squeeze tests

  26. Management of Lower Leg Fractures and Dislocations • Immediately immobilized • Moldable or vacuum splints • Leave shoe on until emergency room • Figure 5-35, page 183 • Compound fracture • Control bleeding • Treatment • Figure 5-36, page 184

  27. Anterior Compartment Syndrome • Avoid compression • Acute gross hemorrhage or absent dorsalis pedis pulse – immediate refer to physician • Educate athletes

More Related