Injuries to the Lower Leg, Ankle and Foot

Injuries to the Lower Leg, Ankle and Foot

Bony Anatomy Bony Anatomy includes: Tibia, Fibula, Tarsals, Metatarsals, Phalanges

Bony Anatomy Medial view: tarsals and metatarsals

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

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.

Lower Leg Anatomy • 3 Compartments • Anterior, Lateral, & Posterior

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 at night Fractures

Fractures • First Aid: • treat for shock • apply sterile dressing to any open wounds • carefully immobilize using appropriate splinting technique • contact EMS and arrange for transport

Ankle Fracture

Ankle Dislocation

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.

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

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

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.

Two examples of rigid ankle braces

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.

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 Achilles Tendon

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 Common Injuries

Torn Tendon

Achilles Surgery

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. Compartment Syndrome

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

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 Shin Splints

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 Foot Disorders

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

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

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

Common Injuries Foot disorders • Arch problems • two groups of arch problems: pes planus and pes cavus • Pes Planus = flat arch • Pes Cavus = high arch

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.

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

Injuries to the Lower Leg, Ankle and Foot