Transcript ANKLE AND LOWER LEG - Doral Academy Preparatory

FOOT, ANKLE AND LOWER
LEG
Care and Prevention
Bony Anatomy
• Toes=phalanges
– Have 3 joints, except big toe
has only 2
• Metatarsals-long bones in
the foot
– Joins with phalanges to
make MTP joint
• Talus & Calcaneus bigger
bones in foot & ankle
• Tibia and fibula
– Form medial & lateral
malleolus
Arches of the Foot
• Arches are found on
plantar aspect
• Shock absorbers
• Transverse: front of
heel to 5th metatarsal
• Longitudinal:
calcaneus to
metatarsals
• Metatarsal: across
distal metatarsals
Muscles and Tendons
• Peroneal muscles
– Perform eversion
• Gastrocnemius and
soleus attach via
achilles tendon
– Perform plantarflexion
• Tibialis anterior,
extensor digitorum,
and extensor hallucisTDH muscles
– Perform dorsiflexion
Ligaments
• Lateral ankle:
– Anterior talofibular
(ATF)
• *Most commonly
sprained
– Posterior talofibular
(PTF)
– Calcaneofibular (CF)
• Medial ankle:
– Deltoid ligament
• Stronger than all the
lateral ligs combined
INJURIES
•
Bone injuries:
– Jones Fx
– Tibia/Fibula Fx
– Stress Fx
•
Muscle/Tendon injuries:
– Medial tibial stress syndrome (Shin splints)
– Achilles Tendinitis
– Achilles Tendon Rupture
•
Ligament Injuries
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Great Toe sprain (Turf toe) (check this)
Plantar fasciitis
Lateral/Medial ankle sprains
Ankle dislocation
Tissue Injuries
– Contusions
– Toe abnormalities
– Anterior compartment syndrome
Jones Fracture
• What is it?
– Avulsion fx of peroneus
brevis tendon
• MOI: Inversion
– Perenous brevis muscle
contracts quickly and
forcefully to stabilize ankle
– Direct impact
• Signs and Symptoms:
– Pain, ttp over 5th
metatarsal,swelling
– HIGH reinjury rate
• Why?
– Immobolize in boot and use
crutches along with rehab
Tibia/Fibula Fractures
• MOI: direct or indirect impact
• Fibular fractures are most
common
• Signs and symptoms:
– Obvious deformity
(sometimes)
– Loss of function
– Severe pain
– Swelling
• Management:
– EMS for displaced tibia
fracture
– Casting and in severe cases
surgery to reduce fracture
Stress Fractures
• Hairline fx
• Common areas:
– Tibia, fibula, metatarsals
• MOI: repetitive stress i.e.
running
• S&S:
– Pain and swelling
– TTP over stress fx site
– Pain with walking, running,
night pain
• Management:
– Xrays
– Rest
– If not diagnosed in time can
lead to complete fx
Medial Tibial Stress Syndrome
A.K.A. Shin Splints
• What is it?
– Tiny tears of the muscle from
the tibia on the medial aspect
of the lower leg.
• MOI:
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overuse
Tight calves
Old shoes
Low arches
• Management:
– Rest, ice massage
– Change running shoes, add
arch supports if needed
– Tape lower leg to pull muscle
towards the tibia
– Stretch calves & strengthen
tibialis anterior muscle
Achilles Tendonitis
• Connects Gastroc muscle
to calcaneus
• MOI: overuse from
running and jumping
• Signs & Symptoms:
– TTP, swelling, crepitus
– ↓ strength in PF
– Visible thickened tendon
• Management:
– Rest, ice, antiinflammatories
– Stretch calves
– Strengthening calves
– Complications?
Achilles Tendon Rupture
• MOI:
– Forced DF
– Blow over achilles tendon
– Sudden, strong contraction
of gastroc
• Signs & symptoms:
– Ath c/o….
– Pain
– Obvious
deformity/depression
– Unable to complete PF
• Management:
– Splint, ice, crutches
– Refer to MD for surgery
Great Toe Sprain
• A.K.A. “Turf Toe”
• MOI: forced hyperextension
– Sprains lig of MTP joint
– Happens more on artificial turf
than real grass
• Signs & Symptoms:
– Pain, swelling, ttp
– Inability to DF/ “push off”
– Discoloration
• Management:
– Rest, ice
– Ice in bucket rather than
w/bag
– Rehab
– Taping
PLANTAR FASCIITIS
•
What is it?
– Inflammation of fasica (thick
band/layer) on plantar asepct of
foot.
•
MOI:
– Overuse, tight calves
•
Signs & Symptoms:
– Pain on calcaneus, moves
towards the toes
– Pain when taking the first steps in
the morning
– Pain with excessive DF
•
Management:
– Rest, ice
– Stretch calves
– Provide orthotics/arch supports if
necessary
– Anti-inflammatory (oral vs
injection)
Lateral/Inversion Ankle Sprain
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85% of ankle sprains are inversion sprains
2 reasons:
– Deltoid ligament is stronger than lateral ligs
– Fibula prevents excessive eversion
MOI: Plantarflexion and excessive inversion
– Some examples?
Severity depends on force, strength of muscles, protective devices worn
Signs & Symptoms:
– Pain, swelling, discoloration
– TTP over ATF ligament typically
– Loss of ROM and strength (depends on severity)
Management:
– RICE
– Anti-inflammatories
– Stretching and strengthening
– Bracing
– Balance exercises
– Refer for XRAYs if rapid swelling occurs or TTP over bone
Medial/Eversion Ankle Sprains
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Only account for 15% of ankle injuries.
More severe than inversion sprains
Longer recovery time
MOI: Excessive eversion
Signs & Symptoms:
– Pain, swelling, TTP over deltoid ligament
– Bruising
– Loss of ROM and strength especially eversion
• Management:
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RICE
NWB
XRays to rule out fracture of fibula
Rehab and balance activities
ANKLE DISLOCATION
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Can occur either anteriorly or
posteriorly.
MOI:
– Anterior: Forceful heel strike
against the ground.
– Posterior: Direct blow to the
anterior portion of the lower leg
when ankle is in PF.
•
Signs & Symptoms:
– Obvious deformity and severe
pain
– Swelling
•
Management:
– Activate EMS
– Emergency because nerves and
blood vessels can be damaged
– Splint lower leg and ankle and
transport to ER
TOE ABNORMALITIES
TOE ABNORMALITIES
Toe Abnormality
MOI and
Description
Signs & Symptoms Management
Hammertoes
When PIP is flexed
Callus on PIP joint,
and MTP and DIP
blisters, swelling,
are extended.
pain
Congenital or from
wearing small shoes
frequently
Wearing larger
shoes, padding over
callus, shaving
callus. Surgery to fix
toes
Hallux valgus
a.k.a.bunions
Wearing shoes that
are too tight which
force the big toe
towards the smaller
toes
Tenderness,
swelling, and
enlarged joint
Wearing shoes
w/larger toe box,
padding the bunion,
or surgery to align
toe(s).
Ingrown toenail
Trimming nail too
short, trimming nails
in a rounded way
rather than straight
across.
Nail grows into skin
Swelling, redness,
pain, infection
Antibiotic ointment,
trim nail straight
across. If severe dr.
takes out side of nail.
Anterior Compartment Syndrome
• Muscles are covered by fascia.
• Pressure can accumulate
between the fascia and muscle.
• MOI: Overuse or direct impact
• Signs & Symptoms:
– Severe pain that doesn’t go
away after activity
– Heat, redness
– Hardness of area
– Loss of ROM/Strength
• Management:
– Refer to Dr. immediately
– Increased pressure places
pressure on blood vessels and
nerves
– Surgery to relieve pressure
• Fasciotomy: Remove piece of
fascia
References
• Cartwright AL, Pitney AW, Fundamentals
of Athletic Training. 3rd edition. Human
kinetics. Champaign, IL.