1. Lower Leg and Ankle Sport related Injuries Dr Ali.Yassaie Orthopaedic surgeun

5. LATERAL LIGAMENTS

7. Calcaneus Sustentaculum Tali Navicular Talus Tibia Deltoid Ligament MEDIAL ANKLE

8. Shin Splints Medial Anterior

9. Medial Tibial Stress Syndrome Tenderness is usually found between 3 and 12 centimeters above the tip of the medial malleolus at the posterio-medial aspect of the tibia. Inflammation of the periostium (periostitis) Most frequently involved is the Tibalis Posterior tendon and muscle, but the Flexor Digitorum Longus and Flexor Hallucis Longus may also be involved. Stress fractures can also occur in this area.

11. causes Running Aerobics Military Pes planus(over pronation)

12. Diagnosis Ph/ex X-ray MRI Bone scan

13. Treatment R.I.C.E Strengthening exercises Gradual return to activity Orthoses for pronation Med arch support ESWT Surgury

14. Anterior Compartment Syndrome Soft tissue injuries at the muscular origin and bony or periosteal interface of the bone and muscle origin. Due to micro tears of the Tibialis Anterior either at the origin or in the fibers themselves. Or microtrauma to the bone structure itself. Stress fractures can also occur in this area.

15. Exertional Compartment Syndrome Caused by the muscles swelling within a closed compartment with a resultant increase in pressure in the compartment. The blood supply can be compromised and muscle injury and pain may occur. Abnormal compartment pressure: A resting pressure greater than 20 mm Hg; or An exertional pressure greater than 30 mm Hg; or A pressure of 25 mm Hg or higher 5 minutes after stopping exercise. This may require surgical decompression of the compartment.

16. Key Causes Tight posterior muscles Imbalance between the posterior and anterior muscles Running on concrete or other hard surfaces Improper Shoes - inadequate shock protection Overtraining

17. Treatment Rest. The sooner you rest the sooner it will heal. Apply ice 10-15 minutes for 2-3x per day in the early stages when it is very painful.ice Anti inflammatory drugs Wear shock absorbing insoles in shoes.shock absorbing insoles Maintain fitness with other non weight bearing exercises. Apply heat and use a heat retainer after the initial acute stage, particularly before training.heat retainer

18. Stress Fractures Bone remodeling Repetitive stress weakens the bone 10-20% of injuries to athletes Most common locations: tibia, fibula and metatarsals. Tibial and fibular stress fractures can develop from “shin splints”

19. Causes of Stress Fractures Training errors Abnormal limb length Low body weight (< 75% of ideal) Eating disorders Previous inactivity White race Female

20. Diagnosis X-ray MRI CT scans

22. Tibia stress fx Most common Dist or prox 1/3 Gradual pain during training Local bone tenderness Usually transverse

23. Treatment Stop running Use crutches Up to 3 months Surgery if chronic>4-6 month

24. Medial Malleolus stress fx repetitive running and jumping bony tenderness and ankle effusion

25. Treatment For grade 1 and 2 injuries cast for 6 to 8 weeks For grade 3 and 4 stress fractures, similar conservative measures are appropriate, but healing may take 4 to 5 months surgery

26. Ankle Sprains Most common athletic injury. 25% of all injuries. The risk of ankle sprains varies with the sport 21-53% basketball, 17-29% soccer, 25% volleyball. Ankle sprains account for 10% to 15% of all lost playing time The medial malleolus is shorter than the lateral mallelous so there is naturally more inversion than eversion.

28. Ankle Sprains Greater inversion increases the potential for over- stretching of the lateral ligaments. Most sprains involve the lateral ligaments from excessive inversion. Deltoid ligament is sprained less often (25% of ankle sprains) Of the lateral ligments, the ATFL is sprained the most often followed by the CFL Sprains ocur most often with the foot in plantar flexion and inversion.

29. Lateral Collateral Ligament

30. Ankle Sprains

31. Classification of Sprains 1st Degree: Stretching of the ATFL little or no edema tenderness maintain function. 2nd Degree Partial tear of the ATFL and/or CFL moderate edema some function loss 3rd Degree Complete tear ATFL, CFL, and/or PTFL total loss of function significant edema

32. Ankle Sprains by Grade Sign/symptomGrade IGrade IIGrade III Tendon Loss of functional ability Pain Swelling Ecchymosis Difficulty bearing weight No tear Minimal Minimal Minimal Usually not No Partial tear Some Moderate Moderate Frequently Usually Complete tear Great Severe Severe Yes Almost always

33. Inversion and Eversion Stress Tests

34. Anterior drawer test

35. Treatment R.I.C.E. Ice for 20 minutes on and 20 minutes off for the first two hours. After that, 20 min intervals over the next 48-72 hours, Compression wrap with donut or horse shoes to fill in gaps around malleolus from 24-36 hours; after 48-72 hours contrasts baths with ROM exercises for 4 minutes in warm and 1 min in ice water.

36. Treatment

37. Achilles Tendonitists Pain at the back of the heel Gradual enlargement and pain at the insertion of the Achilles tendon Progressive difficulty with wearing of closed-back shoes pain after a period of rest, such as on first arising in the morning

38. Achilles Tendonitists Causes Rapidly increasing training effort Adding hills or stair climbing to training Starting too quickly after a layoff Poor footwear Excessive pronation Tight posterior leg muscles If left untreated, it may progress to a complete rupture.

39. Treatment heel lift placed in the shoe Oral NSAIDS stretching exercises for the calf ice applied to the region daily protective silicone pad acute unset 6 weeks of short leg cast Injection Surgery

40. Achilles Tendon Rupture Most frequently ruptured tendon Complete ruptures are due to eccentric loading during abrupt stopping, landing from a jump. Usually a popping sound is heard with a complete tear. There may or may not be an obvious gap 2 to 6 cm from the calcaneus attachment. Treatment may or may not include surgery but both require immobilized for 3 months.

41. Thomson(squeeze)test

42. Plantar Fasciitis The plantar fascia runs from the calcaneus to the metatarsals. This tight band acts like a bow string to maintain the arch of the foot. Plantar fasciitis refers to an inflammation of the plantar fascia.

43. Plantar Fasciitis Inflammation is usually due to repeated trauma to where the tissue attaches to the calcaneus. The trauma results in microscpic tears at the calcaneus attachment site. This may produce heal spurs

44. Plantar Fasciitis 40 to 70 years Male Unilateral>bilateral Overweight

45. Plantar Fasciitis Pain is worse in the morning or after a period of inactivity Causes High arch Excessive pronation Footwear (worn out, stiff) Increase in intensity

46. X-ray

47. treatment Shoe inserts (cups and pads) oral NSAIDS local steroid injections Extracorporeal Shock Wave Therapy Rarely surgery

48. Thank you