Download Chapter 16 Powerpoint - McKinney High School Sports Medicine

Chapter 16
Injuries to the Lower Leg,
Ankle, and Foot
Bones of Ankle/Lower Leg
Structures of the TaloCrural
(Ankle) Joint
•Tibia
•Medial Malleolus
•Fibula
•Lateral Malleolus
•Talus
•Interosseous Membrane
Bones of Foot
Foot Bones
(top/superior view)
Three Major Sections
• Phalanges 1-5
• Proximal, distal, and
intermediate
• Metatarsals 1-5
• Styloid Process of 5th
metatarsal
• Tarsals
• Calcaneus, Talus,
Navicular, Cuboid,
Medial Cunieform,
Intermediate
Cunieform, and
Lateral Cunieform
Medial Ligaments
Ligaments of the Medial
Ankle
Primary ligament is:
• Deltoid Ligament
The deltoid ligament is the
primary stabilizer of the
medial side of the
talocrural (ankle) joint.
Lateral Ligaments
Ligaments of the Lateral
Ankle
Primary ligaments are:
•
•
•
•
Anterior talofibular (ATF)
Posterior talofibular (PTF)
Calcaneofibular (CF)
Anterior Tibiofibular
(Ant TibFib)
• Posterior Tibiofibular
(Post TibFib)
Lateral Ligaments
• These ligaments are NOT as large or
strong as the deltoid.
• Additional lateral stability is provided by the
length of the fibula on the lateral side of the
ankle.
• The talocrural joint is strongest in
dorsiflexion and weakest in plantar flexion
(cause of many ankle sprains).
Lateral Ligaments After Sprain
Range of Motion (ROM)
Motions of the Ankle
• Dorsiflexion
• Forcing foot up towards
tibia
• Plantarflexion
• Forcing foot down
away from tibia
• Eversion
• Forcing foot towards
midline
• Inversion
• Forcing foot away from
midline
Muscles of Lower Leg/Ankle
Four compartments
and muscles of the
lower leg/ankle
• Anterior Compartment
• Anterior Tibialis
• Extensor Digitorum Longus
• Extensor Hallicus Longus
• Lateral Compartment
• Peroneus Longus
• Posterior Compartment
• Gastrocnemius
• Soleus
• Plantaris
• Deep Posterior Compartment
• Tibialis Posterior
• Flexor Digitorum Longus
• Flexor Hallicus Longus
Common Sports Injuries
Fractures
• Most often caused by direct trauma
through contact. Contact causes most
fractures to the lower leg and foot.
• Repeated micro trauma can result in a
stress fracture.
• Avulsion fracture of 5th metatarsal can
occur with a lateral ankle sprain.
Fractures
Fractures
Signs and symptoms include:
• Swelling and/or deformity at the site of
fracture.
• Discoloration at the site.
• Possible broken bone end projecting through
skin.
• Athlete reports a snap or pop was heard or
felt.
• Inability to bear weight on the affected leg.
For a stress fracture or growth plate fracture
that did not result from traumatic event, the
athlete complains of extreme point
tenderness and pain at the site of injury.
Fractures (cont.)
First Aid
• Watch and treat for shock, if necessary.
• Apply sterile dressing to any open wounds.
• Carefully immobilize the foot and leg using
a splint.
• Arrange for transport to a medical facility.
Soft Tissue Injuries
Ankle Injuries
Ankle sprains are one of the most common
injuries to this region.
• Lateral sprains are more common; 80%
to 85% of all ankle sprains are to the
lateral ligaments (inversion sprains).
• Eversion sprains, while less frequent,
are often severe.
Ankle Injuries: Sprains
Ankle Injuries: Sprains
Signs and symptoms depend on degree of
sprain.
• 1st degree: Pain, mild disability, point
tenderness, little laxity, little or no swelling
• 2nd degree: Pain, mild to moderate
disability, point tenderness, loss of
function, some laxity, swelling (mild to
moderate)
• 3rd degree: Pain and severe disability, point
tenderness, loss of function, laxity,
moderate to severe swelling
Ankle Injuries: Sprains (cont.)
First Aid
• Apply ice and
compression.
• Elevate.
• Apply a horseshoeor doughnut-shaped
pad.
Courtesy of Brent Mangus
Ankle Injuries: Sprains (cont.)
First Aid (cont.)
• Have athlete use crutches with three- or
four-point gait if a second- or thirddegree sprain has occurred.
• If there is any question regarding the
severity of the sprain, refer athlete to a
medical facility for physician’s
evaluation.
Ankle Injuries: Sprains (cont.)
Tibiofibular (tib-fib) Sprains
• These injuries are often treated
inappropriately as lateral ankle sprains,
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 include a positive sprain test,
but athlete is also in great pain. “Squeeze
test” elicits pain in syndesmosis area.
Ankle Injuries: Sprains (cont.)
First Aid
• Immediately apply ice and compression,
and elevate the leg.
• Apply a doughnut-shaped pad kept in
place with an elastic bandage to provide
compression.
• Have athlete rest and use crutches for first
72 hours, followed by wearing a walking
boot for 3 to 7 days.
Preventing Ankle Injuries
• Taping or bracing will
reduce the number of ankle
injuries.
• Prophylactic adhesive
taping supports the ankle
only for a short time.
• Bracing may be better than
taping.
• Bracing combined with
some high-top shoes may
be helpful.
Courtesy of McDavid
Tendon-Related Injuries
Achilles tendon is commonly injured by longdistance runners, basketball players, and
tennis players.
• Onset of tendonitis may be slow among
runners, but more rapid among basketball
and tennis players.
• Athletes who dramatically increase workout
times or running distances, or who run on
hard, uneven, or uphill surfaces are prone to
Achilles tendonitis.
The injury can be either acute or chronic.
Acute injuries often associated with explosive
jumping or blunt trauma.
Achilles Tendonitis
Achilles Tendon Injuries
Signs and symptoms include:
• Swelling and deformity at site of injury.
• Athlete reports a pop or snap associated
with the injury.
• Pain in lower leg that ranges from mild to
extreme.
• Loss of function, mainly in plantar flexion.
First Aid
• Immediately apply ice and compression.
• Immobilize with air cast or splint.
• Arrange for transport to nearest medical
facility.
Compartment Syndrome
Compartment syndrome usually involves the
anterior compartment of the lower leg.
Chronic form is related to overuse of the
compartment’s muscles that causes swelling of
tissues.
• Acute 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.
• Properly sized shin guards can protect lower
leg in soccer.
Compartment Syndrome (cont.)
Signs and symptoms include:
• Pain and swelling in the lower leg.
• Athlete may complain of chronic or acute injury to the
area.
• There may be loss of sensation or motor control to
the lower leg and/or foot.
• There can be loss of pulse in the foot.
• Inability to extend the big toe or dorsiflex the foot.
First Aid
• Apply ice and elevate. Do NOT apply compression.
• If there is numbness, loss of movement, or loss of
pulse to the foot, seek medical advice immediately;
this is a true medical emergency.
Shin Splints
• “Shin splints” is a very common disorder of
lower leg. Term describes exerciseinduced leg pain.
• The types of activities that produce this
problem and the manifestations of the
injury vary depending on the athlete.
• The etiology and pathology of this disorder
are unclear.
Shin Splints (cont.)
Signs and symptoms include:
• Lower leg pain either medially or posteromedially.
• Typically, the athlete reports a chronic problem that
progressively worsens.
• Pain can be unilateral or bilateral.
First Aid
• Apply ice and have the athlete rest.
• Use of NSAIDs may be helpful.
• Athlete may need to have his or her gait analyzed for
biomechanical deficiencies.
• If problem worsens, athlete should seek medical
advice.
Plantar Fasciitis
The plantar fascia is a dense collection of tissues
that traverses from the plantar aspect of the
metatarsal heads to the calcaneal tuberosity.
• If this tissue becomes tight or inflamed by
overuse or trauma, it can produce pain and
disability.
• Typical symptom is extreme pain in the plantar
aspect of the foot with the first steps taken
after getting out of bed in the morning. Pain
eases with subsequent steps.
• Athlete also has point tenderness in the region
of the calcaneal tuberosity.
Plantar Fasciitis
Plantar Fasciitis (cont.)
Treatment is typically conservative and includes:
• Rest.
• Anti-inflammatories.
• Applying cold and heat alternatively to enhance
healing.
• A heel pad and stretching the Achilles tendon
complex can assist in recovery.
• Use of semirigid orthoses is also effective, but
some athletes find it difficult to participate with
such an orthotic in their shoes.
Re-aggravating the injury increases the healing
time.
Heel Spurs
• Heel spurs can be related to chronic plantar
fasciitis.
• Chronic inflammation can result in
ossification at the site of attachment on the
plantar aspect of the calcaneus.
• Heel spurs result in long-term disability for
many athletes.
Treatment of Heel Spurs
• Athlete should consult a physician if spurs
become incapacitating.
• Applying a doughnut-shaped pad beneath
the heel spur may help but rarely do they
ameliorate the problem.
Heel Spurs
Morton’s Foot
Morton’s foot typically involves either a shortened 1st
metatarsal or an elongated 2nd metatarsal bone.
• The result shifts weight bearing to the 2nd metatarsal
instead of along the 1st metatarsal.
• Results in pain throughout the foot during
ambulation.
Morton’s Foot
Morton’s Foot
Morton’s foot may result in Morton’s neuroma.
• The problem is usually with the nerve between the
3rd and 4th metatarsal heads.
• Pain radiates to 3rd and 4th toes.
• A neuroma is an abnormal growth on a nerve.
• Tight-fitting shoes may be the cause. Going barefoot
may help.
• This condition is best cared for by a physician.
Arch Problems
There are two groups of arch problems: pes
planus and pes cavus.
• Pes planus (flat feet) related to pronation.
• Excessive pronation can cause
difficulties in the navicular bone and
some of the joints around the ankle.
• Arch taping has limited effectiveness.
• Corrective arch orthoses may be
beneficial.
• Pes cavas (high arches) associated with
plantar fasciitis and clawing of the toes.
• Athlete may benefit from orthotic device.
Bunions
Bunions are uncommon in high school and
college athletes.
• Can be inflamed bursae or bone or joint
deformities.
• Can be caused by improperly fitting shoes.
• Chronic bunion should be evaluated by
physician.
Bunions
Blisters & Calluses
Blisters and calluses are very common formations,
resulting 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 and
the area padded to prevent further friction.
• When draining a blister, it is best to leave top
layer of skin in place.
• Use sterile instruments and wear latex gloves or
some other barrier to avoid contact with
athlete’s body fluid.
Blisters & Calluses (cont.)
NSC First Aid Procedures
• Wash area with soap and warm water; sterilize area
with rubbing alcohol.
• Use sterile needle to puncture the base of the
blister and drain by applying light pressure. Process
may need to be repeated during the first 24 hours.
• Do not remove the top of the blister.
• Apply antibiotic ointment to the top and cover with
sterile dressing.
• Check daily for signs of infection (redness or pus).
• After 3–7 days, remove the top of blister and apply
antibiotic ointment and sterile dressing.
• Watch for signs of infection. Pad area with gauze
pads or moleskin.
Toe Injuries
Common injuries are torn-off nails or hematoma
formation under the nail.
• Collection of blood under nail needs to be released.
• Use commercially available nail bore to drill small
hole in nail to release blood.
Ingrown toenails may result from improperly fitting
shoes.
• Soak affected toe in warm antibacterial solution.
• Elevate toenail by placing a small cotton roll under
it and leave in place as nail grows.
• Have athlete obtain shoes that fit more comfortably.
Basic Taping
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Basic Taping (cont.)
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Basic Taping (cont.)
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Basic Taping (cont.)
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Basic Taping (concluded)
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