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Leg Problems : Outline
Gross Anatomy
Achilles Problems
Compartment
Syndromes
Shin Splints (MTSS)
LEG PROBLEMS
CON’T
Stress Fractures
Signs, Symptoms
and Treatments
Prevention
programs
GAIT CYCLE
 25% stance
Supination
Pronation
Pronation: is the
impact absorption
phase of gait.
We either pronate
too much, not
enough or just
right.
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.
Reminder – Muscles
of the leg.
Achilles
Tendon
P. Longus
Flex. Hallucis
Longus
Flex. Digitorum
Longus
P. Brevis
Tib. Posterior
P. Tertius
Tib. Anterior
Ext. Digitorum
Longus
Ext. Hallucis
Longus
COMPARTMENT
SYNDROMES
Traumatic and
Exertional
Volume demands
in Compartment.
Muscle
swells and
dumps
fluid.
Pressure
in comp.
Compromise of
capillary
profusion.
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.
Nerves are the
first structures
to show signs of
hypoxia
SENSATION
Compartment Evaluation
• Test strength x 10
• Stretch muscle
• Palpate for firmness
• Examine skin.
Anterior
Left Leg
Anterior Compartment
Area of Sensory
Deprivation
LATERAL
Left Leg
Deep Posterior
Pain on
palpation
middle to
lower third
of posteromedial tibia.
Sensory deprivation
to plantar foot.
Measuring Compartment
Pressures
It is not how high the
pressure is during running;
it is how long it takes to
return to normal.
Bad
Ideal
Insertion
20
GENERAL TREATMENT
GUIDELINES
Stretching, gradual
motion before activity.
Icing after activity.
Stretching, stretching
Modification of activity
SHIN
SPLINTS
PERIOSTITIS: an
inflammation of the
outer covering of the
bone.
FASCIITIS: and
inflammation of the
fascial covering of the
muscle.
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.
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.
GENERAL TREATMENT
• Icing
• Stretching
• Strengthening
• Motion Control
of foot.
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.
MEDIAL TIBIAL
STRESS SYNDROME
Soleus muscle slows
down the internal
rotation of the tibia on
the foot during
pronation. Pain in
lower medial third.
Postero-medial
Tibia
ACHILLES TENDON
Gastrocnemius,
Soleus, Plantaris
Tendon and Paratenon
ACHILLES
TENDONITIS
Grade I
No discomfort
prior to activity.
No limitations.
Stiffness after
activity.
Grade II
Discomfort
before activity.
Nodules
Pain during
activity.
Pain and
tightness after.
Grade III
Pain and stiffness
before activity.
Pain limits quality
and quantity of
activity.
Very painful after.
ACHILLES THICKENING
Achilles Tendon Rehab
DEEP POSTERIOR
COMPARTMENT
ICING BEFORE
AND AFTER
ACTIVITY
Stretching of Achilles.
Squeezing lump out of
tendon.
Curtail injurious activity
and substitute other
fitness activities.
Heel lifts in shoes.
Achilles Paratenonitis
Irritation of the paratenon.
Caused by overuse.
Rubbing of paratenon on
the achilles tendon.
Pain, crepitation.
STOP! Icing, stretching.
ACHILLES RUPTURE
Previous multiple
minor trauma.
Passive stretch plus
active contraction
TEAR!
EXAMINATION
History
Palpation
Thompson Test
Strength Testing
Thompson’s Test
Ruptured Achilles Tendon
Tear 1” above heel or at
musculotendinous junction.
Palpate for gaps.
Manually test for strength.
Have athlete do single leg
toe raise.
ACHILLES RUPTURE
Impact
absorbed by
shoe, muscles,
bones (joints).
Too strong of
a muscle pull on
one side of the bone
ACTIVITY PAIN
Pain at onset, reduced
s.p.
on warm-up, after pain
Pain
escalates
as
c.s.
activity continues.
s.f. Pain before activity,
same during and the
same after.
NIGHT PAIN
s.p. No night pain.
c.s. No night pain.
s.f.
Deep aching pain
that wakes athlete.
REPEATED MUSCLE
CONTRACTIONS
s.p. No effect.
c.s. Cause a slowing
and a weakening of
contraction (x10)
s.f. No effect.
SENSORY CHANGES
s.p. No Changes.
c.s
Potential changes
corresponding to
compartment.
s.f.
No Change.
MUSCLE STRETCH
s.p. No change.
c.s. Stretching a
muscle within the
affected compart.
will increase pain.
s.f.
No change.