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Ankle & Lower Leg

QuestionAnswer
- most common injury in physically active people - caused by sudden inv or ev moments Ankle sprain
Ligaments that can be sprained with inversion moment - ant talofibular by inv, PF, and IR - rotary ankle instab (talus rotates about long axis in transverse plain) - post talofibular & calcaneal (with increased force) - avulsion fracture at lat mall - deltoid lig can impinged & contused
- occurs with inv PF - stretches ant talofibular lig - mild pain, disability, minimally impaired WB - point tenderness over lig with no laxity Grade I ligament sprain
- moderate inv force causing great deal of disability - feel or hear pop or snap - moderate pain with difficulty WB - tenderness & edema present Grade II ligament sprain
- relatively uncommon but extremely disabling - caused by significant inv force resulting in subluxation & reduction - damage ant/post talofibular & calcaneofibular lig and capsule - severe pain, swelling, hemarthrosis, discoloration - unable to WB Grade III ligament sprain
- represent 5-10% of all ankle sprain bc bony protection & lig strength decrease likelihood - pain may be severe, unable to WB, pain ABD/ADD Eversion sprains
Ligaments that can be sprained/common injuries with eversion moments - deltoid lig - possible fracture to fibula
- injury to the dist tibiofibular jt, ant/post tibiofibular lig - increased ER or DF - med & lat collateral ligs injured in conjunction - severe pain (usually located anterolaterally), loss of function - passive ER & DF causes pain Syndesmotic sprain
Develops following 1/3 of all acute ankle sprains Chronic ankle instability
Laxity that physically allows for mvmt beyond the physiologic limit of ankle’s ROM Mechanical Instability
A subjective feeling that the ankle is unstable. Attributed to proprioceptive and/or neuromuscular deficits that negatively impacted postural control = stability & balance Functional Instability
- caused by a number of mechanisms - avulsion & bimalleolar fractures - swelling & pain may be extreme with possibly no deformity Ankle fractures/dislocations
- used to determine need for radiograph: - pain in malleolar or midfoot - inability to WB for 4 steps at time of injury & examination - tenderness over inf/post pole of either malleoli, base of 5th MT, navicular bone Ottawa Ankle Rules
- occurs in sup med articular surface of talar dome - one/several fragments of articular cartilage w/ underlying subchondral bone partially/completely detached & moving within jt space - single or repeated trauma - pain, effusion, catching, locking, givi Osteochondritis Dissecans
- common in sports, often occurs with sprains or excessive DF - pain may be mild to severe - most severe injury is partial/complete avulsion or rupture of Achilles Injury to the Achilles
(1/2) - inflammatory cond to tendon or its sheath (paratendon); referred to as tenosynovitis - causes fibrosis & scarring that can restrict motion in sheath; may lead to tendinosis - typically no inflammation present, lost normal appearance, cell disorg/ Achilles Tendinosis
(2/2) - tendon overloaded to extensive stress - decreased flexibility exacerbates cond - generalized pain/stiffness, localized prox to calcaneal insertion - limited strength, restricted mvmt (esp in morning) - crepitus with active PF & passive DF - chron Achilles Tendinosis
- occurs with sudden stop & go (eccentric load!!), forceful PF with knee moving into full ext - common in athletes 30 yr & older - predisposition: history of chronic inflam - immediate pain which rapidly subsides (window shade) - point tenderness, swelli Achilles Tendon Rupture
- occurs with dynamic forces applied to ankle - dramatic blow to post lat mall - mod/severe inv sprain resulting in tearing of fibularis retinaculum; potential for tendon rupture - complain of snapping in & out of groove with activity - ev against manua Peroneal (fibularis) Tendon Subluxation/Dislocation
- commonly occurs after extensive down-hill running (eccentric!) - point tenderness over ant tib tendon Anterior Tibialis Tendinitis
- direct blow to lower leg (impacting periosteum anteriorly) - intense pain & rapidly forming hematoma with jelly-like consistency Shin Contusion
- common overuse injury in runners with foot hypermobility or over pronation - repetitive microtrauma - pain & swelling in med mall - edema, point tenderness, & increased pain during resistive inv & PF Posterior Tibialis Tendinitis
- contusion of leg, particularly in gastroc region - bruise may develop causing pain, weakness, & partial loss of limb func - palpation will reveal hard, rigid, inflexible area due to internal hemorrhaging & muscle guarding Muscle Contusions
- susceptible to strain near musculotendinous attachment - caused by quick start, stop, or jumping - variable amount of swelling, pain muscle disability - may feel like being “hit in the leg with a stick” - edema, point tenderness, and func loss of s Gastrocnemius Strain
- fibula has highest incidence of fracture in middle third - tibia fractures occur predominately in the lower third - result of direct blow or indirect trauma - pain, swelling, soft-tissue insult - leg will appear hard & swollen Acute Leg Fractures
- pain in ant shin - accounts for 10-15% of all running injuries & 60% of leg pain in athletes - caused by repetitive microtrauma - weak muscles, improper footwear, training errors, varus foot, tight heel cord, hypermobile or pronated feet, and forefoot Medial Tibial Stress Syndrome (MTSS)/Shin-splints - stress fractures - muscle strains - ant compartment syndrome
Four Grades of Pain of MTSS - pain after activity - pain before & after activity, not affecting performance - pain before, during, & after activity, affecting performance - pain so severe performance is impossible
- complain of deep aching pain & tightness due to pressure & swelling - reduced circulation & sensation - must be recognized & treated early Compartment Syndrome
Type of Compartment Syndrome that occurs secondary to direct trauma or medical emergency Acute Compartment Syndrome
Type of Compartment Syndrome that evolves with minimal to moderate activity Acute Exertional Compartment Syndrome
Type of Compartment Syndrome where symptoms arise consistently at a certain point during activity Chronic Compartment Syndrome
- common overuse cond, in those with structural/biomechanical insufficiencies - Runners = lower third, Dancers = middle third - often occurs in nonconditioned & inexperienced individuals, training errors - component of female athlete triad - pain more in Stress Fracture of Tibia or Fibula
Created by: natamccl