2Lower leg and ankle ankle injuries most frequent in sports tibia is major weight bearing bone of the lower legfibulaassists minimally with weight bearing aprrox 2 % , serves as a site for muscle attachment and contributes to the stability of the ankle
3Crural Bones med / lat. malleolus and talus Talocrural Joint (ankle joint)is a uniaxial modified hinge joint - (talus, tibia and fibula)plantar flexion and dorsiflexion occur heretalus wider ant vs post - stability
4Lateral Ankle Support ATF, PTF , CF (static) (AITF) b) peroneals (dynamic)the lateral ligaments of the ankle joint are relatively weaker than the medial ligamentshence the larger number of lateral ankle sprains
16Inversion Ankle Sprain more common than eversion because of ligament and bony supportstress is applied to the lateral side of the foot during plantar flexion and inversionmost often injuring the Anterior Talofibular ligament (ATF)if stress is continued the Calcaneal Fibular Lig (CF) may be injured as well
17individual will report cracking or tearing sound at time of injury swelling and ecchymosis will be rapid and diffusepoint tenderness over ATF may extend over CFRx - PIER, modalities -horseshoe padShould probably xray to rule out any possible fractures
23Eversion Ankle Sprainless common than lateral ankle sprains because of strong deltoid ligament, thus many are associated with fibular fracturesmild to moderate pain with ankle eversionslower and less evident swellingpoint tenderness over deltoid ligamentRx – X-ray, PIER, modalities -horse shoe
27First Aid Care Immediately apply ice, compression and elevate Apply a horseshoe or doughnut pad, keep it in place with a elastic wrap.Have athlete rest , use crutchesIf needed refer to physician or hospital for x-rays .
28Syndesmotic ankle sprain AKA: high ankle sprainApproximately 10 – 15% of all ankle sprains involve the syndesmosis30 % for collision sports ( football etc)MOI – almost always involves a direct blow to the lateral aspect of the leg with foot planted in external rotation
30s/s Min lateral swelling Possible med swelling Pain in anterolateral lower legPoint tenderness over the AITF lig , the interosseus membranePont tenderness over the ATF and possibly the sup ATF ligDisomfort /pain with DF ( AROM )Loss of ankle function
31First Aid Care Immediately apply ice, compression and elevate Apply a horseshoe or doughnut pad, keep it in place with a elastic wrap.Have athlete rest , use crutches , may want to put in walking boot or cast for short period of timeIf needed refer to physician or hospital for xrays .
32Achilles Tendon Strain or Rupture probably the most severe acute muscular problem in lower leg75% seen in males between yearsmechanism of injury - usually pushing off of the forefoot while knee is extending (racquet sports )
33most ruptures occur 1 to 2 inches proximal to the distal attachments of the tendon on the calcaneus individual experiences sharp pain and hears or feels a POP in the tendon region - often described as a gun shot sounda common sensation is one of being hit in the back of the legvisible defect in the tendon
34inability to actively extend the foot (especially against resistance) swelling - bruising and a palpable defect in the tendonimmediate referral to physician
35First Aid Care Immediately apply ice, compression and elevate Immobilize the area in a splint or walking boot.Have athlete rest , use crutchesSend to hospital or nearest medical facility.
36Achilles Tendinitis most common in lower leg tight heel cord – hyper-pronation - repetitive heel running - a recent change in shoes or running surfaces - increase in distance or intensitypain present during and after activity
37increases with passive dorsiflexion and resisted plantar flexion point tenderness - diffuse or localized swellingaching or burning in the posterior heeloccasionally fine crepitation can be palpated in the tendon with movementRx - PIER, Modalities, NSAIDS-heel lifts - reduced activity (rest) - especially running
38Lower Leg Contusion usually gastroc results in immediate pain and weakness and loss of functionhaemorrhage and muscle spasm quickly lead to a tender firm mass that is easily palpableice on a mild stretchcare must be taken for myositis ossificans
39Exercise Induced Compartment Syndrome 50-60% are anterior – characterised by exercise induced pain and swelling that is relieved by restexercise induced aching leg pain and a sense of fullness, both over the involved compartmentsymptoms are almost always relieved with rest, usually with in 20 minutes
40exercise will produce swelling and tenderness to confirm a intra-compartmental pressure must be measuredRX involves stretching and strengthening , PIER, and NSAIDSIf symptoms persist , surgery is recommended
41Muscle Spasms and Cramps fatigue , loss of fluids or electrolyte,acute treated with ice , pressure and slow static stretchprevention - adequate water intake (electrolyte solution) - regular stretching program
42Lower Leg Strain may be acute or chronic acute may be result of tearing followed by the inability to walk without painpoint tenderness, swelling and muscle weakness will be presentRx - PIER, modalities, depends on severity
43Medial Tibial Stress Syndrome AKA : Shin splintsMicroscopic tears in the muscle attachment site on posterior medial borderpain along the posterior-medial tibial borderusually in the distal third
44Possible factors - excessive pronation , prolonged pronation , recent training changes (speed, form , running surface , distance)pain usually present at start of activity ,but decreases with activity only to return after activity, later stages pain present at all times - may restrict activityRX - PIER, NSAIDS, (modalities) activity modification (rest) - low impact - non impact - stretching and strengthening of intrinsic muscle of the footReal key is to find cause ….