The Lower Leg

ANATOMY  Bones  Tibia  Fibula

MUSCLES  The muscles are in four compartments with 2-4 muscles in each compartment  Compartments are held together by fascia

MUSCLE COMPARTMENTS 1. LATERAL – everts the ankle 2. ANTERIOR – dorsiflexes the ankle 3. DEEP POSTERIOR – plantarflexes the ankle (the calf muscle) 4. POSTERIOR MEDIAL – inverts and plantarflexes the ankle  Page 317 and 318

Major Muscles and Actions  Anterior Tibialis - dorsiflexor  Peroneals - evertors  Gastrocnemius – plantarflexor  Soleus – plantarflexor  Posterior Tibialis – invertor

INJURIES  Muscle Cramps  Sudden, violent contraction of the calf muscles  Causes:  Fatigue, overtraining, dehydration, poor nutrition, injury, poor flexibility  S/S: – sharp pain in the calf, toe is pointed  Tx: gentle stretch, ice, hydrate, can return to play if subsides and does not continue

INJURIES  STRESS FRACTURE  Cause: Repetitive pounding with training  S/S: Hurts more with and after activity, pain on one spot on bone  Tx: Requires x-ray, possibly a bone scan  If positive, no weight bearing for at least 2 weeks, no running for 4-6 weeks

INJURIES  MEDIAL TIBIAL STRESS SYNDROME  ‘SHIN SPLINTS’  Occurs in distal 2/3 of posterior/medial tibia  Causes: pronation, lack of flexibility in the lower legs, hard surfaces, hills, muscle weakness, poor shoes

INJURIES  MEDIAL TIBIAL STRESS SYNDROME  S/S: resisted plantar flexion and inversion should hurt, pain is just off the tibia  Treatment : prevention (shoes, arch support), strengthening, stretching, ice massage, contrast bath, tape arches Refer to MD if no improvement to rule out stress fracture

INJURIES  COMPARTMENT SYNDROME  Occurs when pressure increases in compartment and shuts off blood and nerve supply to the foot  Most often occurs in the anterior and deep posterior compartment  THREE TYPES  Acute  Acute Exertional  Chronic

INJURIES  ACUTE COMPARTMENT SYNDROME  Medical emergency  Causes: direct blow to the lower leg  Usually in the anterior lower leg  Symptoms come about several hours later  S/S: compartment is tense, warm, red and shiny; complains of (c/o) deep aching pain; circulation and sensory problems in foot  Tx: ice, elevation – refer to ER immediately

INJURIES  ACUTE EXERTIONAL/CHRONIC COMPARTMENT SYNDROME  Cause: running and jumping activities  S/S: With activity, foot goes to sleep, crampy pain, and tingling. When activity stops, it goes away. Consistent as to when it comes on with activity  Tx: ice, activity modification, stretching, massage, and referral to the doctor (possible surgery)

INJURIES  ACHILLES TENDINITIS  Chronic, overuse condition that comes about gradually  Causes: running and jumping, repetitive stress, running up hills, poor flexibility  S/S: achy type pain, Achilles is tender on palpation, pain with standing plantarflexion, may have crepitus, hurts to warm up and to cool down

INJURIES  ACHILLES TENDINITIS  TREATMENT  If there is crepitus, no running for 1-2 weeks  Stretch!  Heel lift in both shoes  Orthodics  Heat and/or ice

INJURIES  ACHILLES TENDON RUPTURE  Achilles in largest tendon in body  For Gastronemius and Soleus muscles  Most common tearing spot is 1” above its insertion on the calcaneus  Causes: Sudden, forceful plantar flexion and extension of the knee, age, previous tendinitis  S/S: Feel and hear a snap, “kicked in the leg”, very weak plantarflexion, no Achilles observed  Tx: Immobilization to ER, surgery?

TEST FRIDAY, FEB 20th  FOOT  ANKLE  LOWER LEG  ANATOMY  INJURIES  Causes  Signs and Symptoms  Treatments