Lower Leg

Anatomy Bone Tibia 2 nd longest bone in body Weight bearing bone wide at top and bottom Fibula non weight bearing no protection at mallious and behind knee

Anatomy  Interosseous Membrane  Defuses stress  Space between fibula and tibia  Fibers run diagonal  Extension of fibula and tibia ligament  Has holes for anterior tibia artery and vein

4 Compartments of lower leg Anterior compartment  Extensor hallicus longus  Tibia anterior  Extensor digitium longus  Tendon of pernoal tertius  Deep pernoal nerve and srtery  Tibial artery and vein  Deep posterior  flexor hallius longus  Flexor digitium longus  Posterior tibialis  Posterior tibia artery and vein  Pernoal artery and vein  Tibial nerve

 Lateral compartment  Peroneus longus  Peroneus brevis  Superifical pernoal nerve  Superifical posterior  Gasrocnimus  Soleus  Tendon of planteris

Shin Splints  Define- imbalance or incorrect muscle pull causing inflammation or small tears  Causes- mechanics  Fallen or falling long arch  Poor shoes  Surface  Running same directions on bank track  Hard early season practice  Mid to end season fatigue  Tight gasroc and soleus  Weak anterior muscles

Shin Splints continued  S/Sx- can occur overnight, burring type pain, point tenderness along tibia, pain during plantar and dorsal flexion  Stages- pain only after practice, pain before and after, pain always, pain is great, cant stand  R/O- stress fracture, compartment syndrome, bone cancer, shin spit will not show on x ray

Shin splints cont.  Tx- limit practice, ice and tape, find cause, if pain continues stop activity  Rehab- strengthen and stretch anterior muscle of leg  Stretch Achilles and gasroc, soleus, strength long arch, modality, ice before and after  Tape support

Stress Fractures  Common overuse stress condition, especially among distance runners  Causes  More likely to occur in people with structural deformities of the foot  Hypermobile pronated foot- fibular stress fractures, those with rigid pes cavus- tibial stress fracture  The wider the tibia the lower the incidence of stress fractures S/Sx Pain more intense after the activity than during the activity Night pain Point tenderness TX Discontinue running and other stressful locomotor activities for about 14 days If pain is severe were a cast or use a crutch to walk After 2 weeks of no pain they can begin running again

Acute Compartment syndrome  Compartment syndrome happens when pressure builds up as your muscle in compartment swells beyond size that is comfortable for the compartment to contain. S/Sx : -pain in your leg which is worse than expected for the type of injury sustained -severe pain when you move your leg -sudden swelling of your leg -pale skin on leg -pain when toes are moved Causes: Can develop after breaking a bone or an injury that involves your leg being crushed. The pressure on your muscle can be made worse if you have a tight splint, dressing, or a cast on leg. T/x: Remove anything confining your leg. Will need surgery to relieve the tension and pressure in leg and give room got muscle to swell.

Peroneal Tendon Sublaxiation/Dislocation  The Peroneus longus and brevis tendons pass through a common groove located behind the lateral malleolus.  Causes: Often occurs in activities that apply dynamic forces (turning, sharply cutting) to foot and ankle.  S/sx: complaining that the tendon snaps in jumping out of the groove and then back when stress is released. And also experiences recurrent pain, snapping, and ankle instability.  Tx: compression with a felt pat cut in a horseshoe- shaped pattern sorrounding the lateral malleolus. RICE. Time for conservatory care is 5 to 6 weeks.

Achilles bursitis  Definition-Inflammation of the bursa located at the bottom of the calcaneus  Causes- friction on the Achilles, poorly fitted shoes, pants, over use, and rapid calf contractions, commonly seen in Achilles tendinitis  Symptoms-Pain in the calcaneus, when calf contracts, redness, tenderness, inflammation  Treatment- RICE, stretching out the calf and heel raises, heel wedges may be needed, possible cortisone shot if needed

Contusions  Caused by a forceful blow to the area  s/sx: Intense pain, Hematoma, Bruise  Tx: Rice, NSAIDS, Compression, ROM exercises, Stretch muscle.

Achilles Strains  Cause- Achilles strains are common in sports and occur most often after ankle sprains or sudden excessive dorsiflexion of the ankle.  S/sx- While sustaining this injury the patient feels acute pain and extreme weakness on plantar flexion.  Tx- First, as with other acute conditions, pressure is first applied with an elastic wrap together with the application of cold. Unless the injury is minor, hemorrhage may be extensive, requiring RICE over an extended period of time. After hemorrhaging has subsided an elastic wrap should be applied for continued pressure

Achilles Tendon Rupture  Define- complete tear of the Achilles tendon  Causes- middle age weekend warrior  S/SX- heard Pop, extreme pain, no plantar flexion in ankle, positive thompson test  Tx- Surgery, out one year.