Chapter 16 Chapter 16 Injuries to the Lower Leg

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Chapter 16 Chapter 16 Injuries to the Lower Leg Powered By Docstoc
					    Chapter 16
Injuries to the Lower Leg,
      Ankle, and Foot        1
        Anatomy Review
                                                 Bones and
                                                 Ligaments of the
                                                 Ankle and Foot
                                                   •Tibia
                                                   •Fibula
                                                   •Tarsals
                                                   •Metatarsals
                                                   •Phalanges

Note the subtalar joint that’s responsible for
inversion and eversion of the foot

                                                                  2
 Anatomy Review (continued)
Foot Bones (medial
  view)
   • Tarsals
   • Metatarsals




                              3
Anatomy Review (continued)




                     The deltoid ligament is the
                       primary stabilizer of the
                       medial side of the
                       talocrural (ankle) joint.




                                            4
Anatomy Review (continued)

                   Ligaments of the Ankle
                     (lateral view)
                      The three primary
                         ligaments are:
                           • Anterior
                             talofibular.
                           • Posterior
                             talofibular.
                           • Calcaneofibular.


                                            5
Anatomy Review (continued)


    • 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.

                                                    6
 Anatomy Review (continued)
The innervation of the
three compartments is
supplied by the tibial,
superficial, and deep
peroneal nerves.
The illustration shows
the anterior, lateral,
and posterior leg
compartments.



                              7
 Common Sports Injuries

Fractures
   • Most often caused by direct trauma
     through contact. Contact causes most
     fractures to the lower leg and foot.
   • Repeated microtrauma can result in a
     stress fracture.
   • Avulsion fracture of 5th metatarsal can
     occur with a lateral ankle sprain.

                                               8
   Fractures (continued)

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.
If the stress fracture or growth plate fracture did not
    result from traumatic event, the athlete complains of
    extreme point tenderness and pain at the site of
    injury.

                                                            9
    Fractures (continued)

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.


                                                   10
   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.

                                                11
  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
                                                        12
      Ankle Injuries: Sprains
           (continued)

First Aid
     • Apply ice and
       compression.
     • Elevate.
     • Apply a
       horseshoe- or
       doughnut-
       shaped pad.
                                13
 Ankle Injuries: Sprains
      (continued)
First Aid (continued)
     • Have athlete use crutches with three- or
       four-point gait if a second- or third-
       degree sprain has occurred.
     • If there is any question regarding the
       severity of the sprain, refer athlete to a
       medical facility for physician’s
       evaluation.
                                                14
   Ankle Injuries: Sprains
        (continued)

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.
                                                        15
   Ankle Injuries: Sprains
        (continued)
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.
                                              16
   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.
                               17
  Tendon-Related Injuries

Achilles tendon is commonly injured by long-distance
  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.

                                                         18
 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.

                                                          19
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.
   • 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.




                                                              20
    Compartment Syndrome
        (continued)
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.

                                                                     21
       Shin Splints

• “Shin splints” is a very common disorder or
  lower leg. Term describes exercise-
  induced 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.
                                                22
    Shin Splints (continued)

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.

                                                                23
      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
     following steps.
   • Athlete also has point tenderness in the region of the
     calcaneal tuberosity.

                                                           24
Plantar Fasciitis (continued)
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.
Aggravating the injury increases the healing time.

                                                           25
            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.

                                                            26
            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 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.

                                                                      27
          Arch Problems
There are two groups of arch problems: pes planus and pes cavus.

   • Pes planus 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 associated with plantar fasciitis and clawing of the
     toes.

       • Athlete may benefit from orthotic device.


                                                                   28
         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.

                                              29
     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.
                                                             30
Blisters & Calluses (continued)
 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.
                                                                  31
            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.

                                                         32
     Basic Taping


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     Basic Taping (continued)


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                                     34
     Basic Taping (continued)

7.               8.             9.




                                     35
      Basic Taping (continued)

10.             11.              12.




                                       36
  Basic Taping (concluded)
13.            14.           15.




                                   37

				
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