1. Injuries to the Lower Leg, Ankle and Foot

2. Bony Anatomy
Bony Anatomy includes: Tibia, Fibula, Tarsals, Metatarsals, Phalanges

3. Bony Anatomy
Medial view: tarsals and metatarsals

4. Medial Ligaments of Ankle
Deltoid Ligament
rarely injured in sports
mechanism of injury typically eversion with dorsiflexion
longer time to heal than lateral ankle ligaments

5. Lateral Ligaments of Ankle
3 primary ligaments:
anterior talofibular
posterior talofibular
Calcaneofibular
NOT as large & strong as the deltoid.
Mechanism of injury is inversion associated with plantar flexion.

6. Lower Leg Anatomy
3 Compartments
Anterior, Lateral, & Posterior

7. Fractures Mechanism Signs/symptoms:
most often caused by direct trauma to the tibia, fibular or bone(s) of the foot
repeated “microtrauma” can result in a stress fracture
growth plate injures can occur in the adolescent -- known as “Salter-Harris” fractures
Signs/symptoms:
swelling/deformity, discoloration
broken bone end protruding
athlete reports a snap/pop
inability to bear weight
stress fractures often become more painful at night

8. Fractures First Aid: treat for shock
apply sterile dressing to any open wounds
carefully immobilize using appropriate splinting technique
contact EMS and arrange for transport

9. Ankle Fracture

10. Ankle Fracture

11. Ankle Dislocation

12. Ankle Sprains Details one of the most common injuries to this region
Due to skeletal and ligamentous variables, lateral sprains are more common.
80-85% of all ankle sprains are to the lateral ligaments --inversion sprains
Eversion sprains, while less frequent, are often severe.
Syndesmosis Sprain: Sprain of the ligaments connecting the tibia and fibula.

13. Signs/symptoms:
1st deg. -- pain, mild disability, pt. tenderness, little or no swelling
2nd deg. -- pain, mild to moderate disability, pt. tenderness, loss of function, some laxity, swelling
3rd deg. -- pain & severe disability, pt. tenderness, loss of function, laxity, severe swelling

14. Ankle Sprains First Aid: ice, compression and elevation
apply a horseshoe - or doughnut-shaped pad
use crutches, partial or full weight bearing
any questions regarding severity, refer to a physician for further evaluation and diagnosis

15. Ankle Sprain Prevention
Research indicates that taping is only good for a short period of time. Braces may be as effective as tape and at a much lower cost
Best prevention is to strengthen the muscles of the lower leg as well as develop proprioception.

16. Two examples of rigid ankle braces

17. Tib/Fib Syndemosis Sprain
Signs and Symptoms
Often treated as lateral ankle sprain, which is inappropriate, hindering recovery.
The difference is the mechanism of injury. Tib-fib sprains involve dorsiflexion followed by axial loading with external rotation of the foot.
Symptoms – positive sprain test, but athlete is in great pain.
Slower healing
Sometimes physicians will cast.

18. Achilles Tendon
Achilles tendon commonly injured -- more often in older (30+) male athlete
can be either an acute or chronic, overuse injury
acute injuries often associated with blunt trauma
chronic injuries often associated with sudden increase in training intensity

19. Common Injuries Signs/symptoms First Aid: swelling and deformity
pop or snap
pain in lower leg
loss of function, especially in plantar flexion
First Aid:
immediate application of ice and compression
immobilize with appropriate splint
arrange for transport to a medical facility

20. Torn Tendon

21. Achilles Surgery

22. Compartment Syndrome
usually involves the anterior compartment of the lower leg
Chronic form is related to overuse of the muscles of the compartment
Trauma, such as being kicked in the leg, can result in swelling within the compartment as well.
In either case, swelling puts pressure on vessels and nerves.

24. Compartment Syndrome Signs/symptoms/First Aid:
pain/swelling and loss of sensation and/or motor control in the lower
loss of pulse in the foot
inability to extend the big toe or dorsiflex the foot apply ice & elevate -- do NOT apply compression
loss of pulse or sensation -- medical emergency - transport to medical facility

25. Shin Splints Signs/symptoms: First Aid:
lower leg pain -- typically a chronic injury that progressively worsens
pain is often bilateral
“Shin splints” is generic pain in the lower legs, typically caused by change in surface or workout.
First Aid:
apply ice and have the athlete rest
use of NSAIDs may be helpful
seek a professional to identify the cause

26. Foot Disorders Plantar Fasciitis
plantar fascia spans from the metatarsal heads to the calcaneal tuberosity
Ball of foot to heel.
this tissue can become inflamed and painful
painful in the morning when first rising from bed
point tenderness in the region of the calcaneal tuberosity

27. Common Injuries Treatment of Plantar Fasciitis and Heel Spurs
often related to chronic plantar fasciitis
involves ossification at the site of attachment to the calcaneus
Treatment of Plantar Fasciitis and Heel Spurs
rest and NSAIDs
stretching of the Achilles
doughnut pad beneath the heel spur

28. Common Injuries Morton’s Neuroma
growth (enlargement) of the interdigital nerve usually between the 3rd and 4th metatarsal heads
pain will radiate into the 3rd and 4th toes
tight fitting shoes have been identified as a major causative factor
going barefoot often relieves the symptoms
the neuroma may have to be treated surgically

29. Common Injuries Care for Neuroma
Teardrop pad can be placed between met heads to increase space, decreasing pressure on neuroma
Shoes with wider toe box would be appropriate
the neuroma may have to be treated surgically

30. Common Injuries Foot disorders Arch problems
two groups of arch problems: pes planus and pes cavus
Pes Planus = flat arch
Pes Cavus = high arch

31. Common Injuries
corrective taping may provide temporary support for the arch
In some cases, the athlete may benefit from a properly constructed orthosis.
Orthotics should be constructed by a trained professional.

32. Common Injuries Blisters & calluses
very common formations, result from friction between layers of skin
when a blister forms, fluid collects between skin layers, occasionally the fluid will contain blood
if the blister is large, it should be drained
When draining a blister, use sterile instruments, latex gloves and eye protection