SPORT INJURIES: ANKLE AND LOWER LEG Presenter: Nazri Azeli Mohd Sharul Azrin Jeff Fakhruddin Shamsudin Azham Afzanizam Hamzah Mohd Razmi Rozan
Jun 20, 2015
SPORT INJURIES: ANKLE AND LOWER LEG
Presenter:Nazri Azeli
Mohd Sharul AzrinJeff Fakhruddin ShamsudinAzham Afzanizam Hamzah
Mohd Razmi Rozan
BONES OF LOWER LEG
LATERAL VIEW OF FOOT BONES AND LIGAMENTS
MEDIAL VIEW OF FOOT BONES AND LIGAMENTS
MUSCLES OF THE LOWER LEG AND FOOT
Muscles of the Lower Leg and Foot
ANATOMY: MUSCLESAction Muscles
Ankle dorsiflexion
Extensor Digitorium longus, extensor hallucis longus, tibialis anterior
Ankle plantarflexion
Soleus, gastrocnemius
Ankle inversion Tibialis posterior, flexor digitorium longus, flexor hallucis longus
Ankle Eversion Peroneus longus, peroneus brevis
Functional Tests
While weight bearing the following should be performed Walk on toes (plantar flexion) Walk on heels (dorsiflexion) Walk on lateral borders of feet (inversion) Walk on medial borders of feet (eversion) Hop on injured ankle Start and stop running Change direction rapidly Run figure eights
ANKLE SPRAIN Ankle Injuries: Sprains
Single most common injury in athletics caused by sudden inversion or eversion moments
Inversion SprainsMost common and result in injury to the lateral
ligamentsAnterior talofibular ligament is injured with
inversion, plantar flexion and internal rotation
• EVERSION- ANKLE SPRAIN
-The foot is twisted outwards.
-The inner ligament, called the
deltoid ligament, is stretched too far.
-Patients will have pain on the inner
side of the ankle
HIGH ANKLE SPRAIN injury to the
ligaments around the ankle
ligaments above the joint, syndesmosis ligaments injured
Graded Ankle Sprains Signs of Injury
Grade 1Grade I ankle sprains cause stretching of the
ligament. The symptoms tend to be limited to pain and swelling. Most patients can walk without crutches, but may not be able to jog or jump.
Grade 2A grade II ankle sprain is more severe partial
tearing of the ligament. There is usually more significant swelling and bruising caused by bleeding under the skin. Patients usually have pain with walking, but can take a few steps.
Grade 3Grade III ankle sprains are complete tears of the
ligaments. The ankle is usually quite painful, and walking can be difficult. Patients may complain of instability, or a giving-way sensation in the ankle joint.
SEVERITY OF ANKLE SPRAINS BY GRADE
Sign/symptom Grade I Grade II Grade III
Tendon No tearPartial
tearComplete
tear
Loss of functional ability Minimal Some Great
Pain MinimalModerat
e Severe
Swelling MinimalModerat
e Severe
EcchymosisUsually
notFrequentl
y Yes
Difficulty bearing weight No UsuallyAlmost
always
Care Must manage pain and swelling Apply horseshoe-shaped foam pad
for focal compression Apply wet compression wrap to
facilitate passage of cold from ice packs surrounding ankle
Apply ice for 20 minutes and repeat every hour for 24 hours
Continue to apply ice over the course of the next 3 days
Keep foot elevated as much as possible
Avoid weight bearing for at least 24 hours
Begin weight bearing as soon as tolerated
Return to participation should be gradual and dictated by healing process
FOOT FRACTURE
YOU MAY HAVE FRACTURED A BONE IN YOUR FOOT, DO
REALIZE IT? There are 2 common type of bone
fracture in your feet:i. Hairline stress fracturesii. Traumatic fractures
Ankle Fractures/Dislocations Cause of Injury
Number of mechanisms – often similar to those seen in ankle sprains
Signs of Injury Swelling and pain may be extreme with possible
deformity Care
Splint and refer to physician for X-ray and examination RICE to control hemorrhaging and swelling Once swelling is reduced, a walking cast or brace may be
applied, immobilization lasting 6-8 weeks Rehabilitation is similar to that of ankle sprains once
range of motion is normal
HAIRLINE STRESS FRACTURES(HSF)
Tiny litle hairline cracks in bones. Some fractures are Straight and spiral in
nature. This tiny cracks from excessive
pounding, twisting and repetitive actions during activities.(own explainations)
TRAUMATIC FRACTURES(TF) Cause from blow, impact or accident are much
more obvious. TF are very painful and related with pain and
swelling. If skin broken, the injury susceptible to
infection.(need medical)
FIBULAR FRACTURE
Tibial and Fibular Fracture
Acute Leg FracturesCause of Injury
Result of direct blow or indirect trauma Fibular fractures seen with tibial fractures or as the result
of direct traumaSigns of Injury
Pain, swelling, soft tissue insult Leg will appear hard and swollen (Volkman’s contracture) Deformity – may be open or closed
Care X-ray, reduction, casting up to 6 weeks depending on the
extent of injury
INTERNAL FIXATION
Stress Fracture of Tibia or FibulaCause of Injury
Common overuse condition, particularly in those with structural and biomechanical insufficiencies
Result of repetitive loading during training and conditioning
Signs of Injury Pain with activity Pain more intense after exercise than before Point tenderness; difficult to discern bone and soft
tissue pain Bone scan results (stress fracture vs. periostitis)
Care Eliminate offending activity Discontinue stress
inducing activity 14 days Use crutch for walking Weight bearing may return
when pain subsides After pain free for 2 weeks
athlete can gradually return to activity
Biomechanics must be addressed
Medial Tibial Stress Syndrome (Shin Splints)Cause of Injury
Pain in anterior portion of shin Stress fractures, muscle strains, chronic anterior
compartment syndrome, periosteum irritation Caused by repetitive microtrauma Weak muscles, improper footwear, training errors, varus
foot, tight heel cord, hypermobile or pronated feet and even forefoot supination can contribute to MTSS
May also involve stress fractures or exertional compartment syndrome
Shin Splints (continued) Signs of Injury
Diffuse pain about disto-medial aspect of lower leg As condition worsens ambulation may be painful, morning
pain and stiffness may also increase Can progress to stress fracture if not treated
Care Physician referral for X-rays and bone scan Activity modification Correction of abnormal biomechanics Ice massage to reduce pain and inflammation Flexibility program for gastroc-soleus complex Arch taping and orthotics
LOCATIONS OF PAIN
Compartment SyndromeCause of Injury
Rare acute traumatic syndrome due to direct blow or excessive exercise
May be classified as acute, acute exertional, or chronic
Signs of Injury Excessive swelling compresses muscles, blood
supply and nerves Deep aching pain and tightness is experienced Weakness with foot and toe extension and
occasionally numbness in dorsal region of foot
Care If severe acute or chronic case, may present as
medical emergency that requires surgery to reduce pressure or release fascia
RICE, NSAID’s and analgesics as needed Avoid use of compression wrap = increased
pressure Surgical release is generally used in recurrent
conditionsMay require 2-4 month recovery (post surgery)
Conservative management requires activity modification, icing and stretchingSurgery is required if conservative management
fails
Achilles Tendonitis Cause of Injury
Inflammatory condition involving tendon, sheath or paratenon
Tendon is overloaded due to extensive stress Presents with gradual onset and worsens with continued
use Decreased flexibility exacerbates condition
Signs of Injury Generalized pain and stiffness, localized proximal to
calcaneal insertion, warmth and painful with palpation, as well as thickened
May progress to morning stiffness
Care Resistant to quick resolution due to slow healing
nature of tendon Must reduce stress on tendon, address structural
faults (orthotics, mechanics, flexibility) Aggressive stretching and use of heel lift may be
beneficial Use of anti-inflammatory medications is suggested
Achilles Tendon RuptureCause
Occurs when sudden stop and go; forceful plantar flexion when
Commonly seen in athletes > 30 years old Generally has history of chronic inflammation
Signs of Injury Sudden snap (kick in the leg) with immediate pain
which rapidly subsides Point tenderness, swelling, discoloration; decreased
ROM Obvious indentation and positive Thompson test
Care Usual management involves surgical repair for
serious injuries Non-operative treatment consists of RICE, NSAID’s,
analgesics, and a non-weight bearing cast for 6 weeks to allow for proper tendon healing
Must work to regain normal range of motion followed by gradual and progressive strengthening program
INABILITY TO PLANTARFLEX
Before surgery During
surgery
Shin Contusion Cause of Injury
Direct blow to lower leg (impacting periosteum anteriorly) Signs of Injury
Intense pain, rapidly forming hematoma Increased warmth
Care RICE, NSAID’s and analgesics as needed Maintaining compression for hematoma (which may need
to aspirated) Fit with doughnut pad and orthoplast shell for protection
ANKLE REHABILITATION PROGRAM
Attach elastic to secure object.
Place elastic around forefoot.
Pull foot toward shin
• Place elastic around ball of foot.
• Push down against elastic.
ANKLE REHABILITATION PROGRAM
Attach elastic to secure object.
Pull forefoot outward.
Loop elastic around forefoot.
• Attach elastic to secure object.
• Pull forefoot inward against.
• Loop elastic around forefoot.
• Place bandage on floor
• Slide the bandage backward from the forward using one foot only.
Plantar fasciitis injury
• The “plantar fascia” is a piece of connective tissue that runs from the heel bone (calcaneus) to the base of the toes, on the sloe of your foot.
Sign and symptoms• Sharp pain at the bottom of your heel, almost like
walking on glass.• Mild swelling within your foot and around your heel.• The pain, tends to be worse with the first few steps in
the morning, going up stairs or standing on tiptoes.• Pain after long periods of standing or getting up from
sitting.• Post exercise pain, usually wont occur during exercise.
Treatment..?• Wearing a splint fitted to your calf and foot while you sleep,
to stretch the fasica, tendons and surrounding tissue.• Doctors may prescribe off-the-shelf or make custom-fitted
orthotics to help distribute pressure to your feet more effectively.
• Physiotherapy can provide you with a series
of exercises and stretches designed to decrease
pain, improve range of motion and strengthen
lower leg muscles, all of which will help your
ankle and heel.
Penilaian kecederaan pergelangan kaki dan bahagian bawah kaki
Komponen penilaian
• Mekanisme kecederaan• Tanda-tanda• Simptom-simptom• Ujian ketahanan• Ujian yang khas atau spesifik
Terkoyak bahagian sisi pergelangan kaki
• Mekanisme kecederaan
- plantarflexion
- inversion• Tanda:
- bengkak (swell)
- perubahan warna (discoloration)• Simptom-simptom:
- merasa sakit sepanjang sisi pergelangan kaki(ankle)
julat pergerakan yang normal untuk pergelangan kaki(ankle)
• Dorsifleksi - 20 darjah• Plantarfleksi - 50 darjah• Inversi - 20 darjah• Eversi - 5 darjah
Pemegangan bahagian utama pada pergelangan kaki:
• Anterior talofibular ligamen (ATF)• Calcaneal fibular (CF)• Poterior talofibular (PTF)• Bahagian sisi (lateral) molleolus• Kuboid (cuboid)• Sinus tarsi• Metatarsal• Peroneal tendon
Menilai pergelangan sisi kaki
• Anterior drawer
- penilaian ligamen anterior talofibular (ATF)
• Inversi talar tilt
- penilaian ke atas ligamen Calcaneal fibular.
• Eversi talar tilt Untuk menilai deltoid ligamen Tekanan akan diberikan sedikit demi sedikit
untuk melihat tahap kecederaan melalui dorsifleksi dan plantarfleksi.
Terseliuh (sprain) bahagian tengah(medial)
• Mekanisme kecederaan:
- Dorsifleksi
- eversi
- Putaran ekternal(external rotation)• Tanda :
- Bengkak
- Perubahan warna (discoloration/subacute)• Simptom-simptom :
-kesakitan sepanjang bahagian tengah (medial) pergelangan kaki
Pemegangan bahagian utama pada pergelangan kaki:
• Anterior tibiotalar• Tibionavicular• Tibiocalcaneal• Posterior tibiotalar• Medial malleolus• Lateral malleolus• Sustentaculum tali• Navicular• Sendi talocrural
Penilaian keretatkan bahagian bawah kaki dan
Pergelangan kaki
• Bump test
- Tekan pada bahagian atas tumit
- Beri tekanan sehingga
merasa sakit pada bahagian
yang retak.
- Tekanan di tambah dan berhenti
apabila kesakitan di rasai oleh
pesakit
That’s ALL…..
Thank you…….