Leg Problems : Outline

2. Leg Problems : Outline • Gross Anatomy • Achilles Problems • Compartment Syndromes • Shin Splints (MTSS)

3. LEG PROBLEMS CON’T • Stress Fractures • Signs, Symptoms and Treatments • Prevention programs

4. GAIT CYCLE  25% stance

5. Pronation Supination

6. Pronation: is the impact absorption phase of gait. We either pronate too much, not enough or just right.

7. As weight is transferred from the outside of the foot to the inside of the foot, the leg internally rotates. As weight shifts from inside to out, external rotation of the leg occurs.

8. Reminder – Muscles of the leg.

11. Flex. Hallucis Longus Achilles Tendon Flex. Digitorum Longus P. Longus Tib. Posterior P. Brevis P. Tertius Tib. Anterior Ext. Digitorum Longus Ext. Hallucis Longus

12. COMPARTMENT SYNDROMES Traumatic and Exertional

13. Volume demands in Compartment. Pressure in comp. Muscle swells and dumps fluid. Compromise of capillary profusion.

14. Muscles are attempting in work in a hypoxic environment. Not only is this difficult, it is painful and muscles continue to swell in a hypoxic environment.

15. Nerves are the first structures to show signs of hypoxia

16. SENSATION

17. Compartment Evaluation • Test strength x 10 • Stretch muscle • Palpate for firmness • Examine skin.

18. Anterior Left Leg

19. Anterior Compartment Area of Sensory Deprivation

20. LATERAL Left Leg

21. Deep Posterior Pain on palpation middle to lower third of postero-medial tibia. Sensory deprivation to plantar foot.

22. Measuring Compartment Pressures

27. It is not how high the pressure is during running; it is how long it takes to return to normal. Bad Ideal 20 Insertion

28. GENERAL TREATMENT GUIDELINES Stretching, gradual motion before activity. Icing after activity. Stretching, stretching Modification of activity

29. SHIN SPLINTS

31. PERIOSTITIS: an inflammation of the outer covering of the bone. FASCIITIS: and inflammation of the fascial covering of the muscle.

32. Shin Splints and M.T.S.S…..History of excessive weight bearing (jumping,running, or standing for prolonged periods of time, in combination with improper shoes.

33. Shin Splints and M.T.S.S. Associated with varus alignment (bowlegs) of the lower extremity and excessive pronation. Improper footwear may be a factor.

34. GENERAL TREATMENT • Icing • Stretching • Strengthening • Motion Control of foot.

35. SHIN SPLINTS Tibialis Posterior is eccentrically working to slow down the internal rotation of the leg on the foot during pronation of the foot. Muscle thought to pull away from bone.

36. MEDIAL TIBIAL STRESS SYNDROME Soleus muscle slows down the internal rotation of the tibia on the foot during pronation. Pain in lower medial third.

38. Postero-medial Tibia

39. ACHILLES TENDON Gastrocnemius, Soleus, Plantaris Tendon and Paratenon

40. ACHILLES TENDONITIS

41. Grade I No discomfort prior to activity. No limitations. Stiffness after activity.

42. Grade II Discomfort before activity. Pain during activity. Pain and tightness after. Nodules

43. Grade III Pain and stiffness before activity. Pain limits quality and quantity of activity. Very painful after.

44. ACHILLES THICKENING

45. Achilles Tendon Rehab

48. DEEP POSTERIOR COMPARTMENT

49. ICING BEFORE AND AFTER ACTIVITY

50. Stretching of Achilles. Squeezing lump out of tendon. Curtail injurious activity and substitute other fitness activities. Heel lifts in shoes.