GarageBand.pdfAnkle and Lower Leg Pathologies
Ankle Pathologies
- Sprains (most common)
- Etiology
- Ankle sprains are one of the most common ankle injuries seen. A sprain is defined as the stretching or tearing of a ligaments or capsular tissue. More frequently than not, lateral ankle spains occur and are caused by a sudden forceful inversion of the ankle. These sprains are more common with plantarflexion and inversion because this is the joint postion at which the ankle bones are maximally incongruent. The type of ligament that is injured during a sprain is dependent upon the exact position the ankle is in when the sprain occurs. One common cause of an inversion ankle sprain is by slipping off a step or curb, or stumbling in a pothole or on uneven ground.
- Sprain Classifications (Citation)
- First-Degree Sprain - A stretching of the ligament. This includes very little if any tearing of the ligaments fibers. This degree of sprain is commonly associated with mild pain and tenderness, at the site of injury as well as a slight swelling of the joint.
- Second-Degree Sprain - Partial tear of the ligament. The ligament is still partially connected however many fibers have torn apart. This degree of sprain is commonly associated with moderate pain and swelling at the joint, along with some loss of the joints function.
- Third-Degree Sprain - Complete tear of the ligament. The ligament is no longer connecting the joint. This degree of sprain is commonly associated with swelling, complete loss of function of the joint, severe tenderness as well as gross laxity and instability.
- Anterior Talofibular Ligament
- This ligament is the most commonly affected ligament with an inversion sprain.
- Calcaneofibular Ligament
- Posterior Talofibular Ligament
- Deltoid Ligament
- Anterior Tibiotalar Ligament
- Tibiocalcaneal Ligament
- Posterior Tibiotalar Ligament
- Tibionavicular Ligament
- Signs & Symptoms
- Pain
- Tenderness
- Swelling
- Bruising
- Loss of functional ability
- Special Tests
- Anterior Drawer Test (To test for Anterior Talofibular Ligament Sprain)
- Talar Tilt (To test for Calcaneofibular or Deltoid Sprain)
- Kleiger's Test (To test for Deltoid Spraint)
- Squeeze Test (TSyndesmosis Sprain)
- Treatment
- A sprained ankle should be taped, splinted or braced in order to prevent further injury. Crutches or a cane should also be used until the individual can walk normally without pain or limping.
- The ankle needs to be rested and prevented from being used during activites that cause pain.
- The ankle should also be iced 3-5 times a day for 15-20 minutes for the first 1-3 days following injury.
- To decrease swelling, a bandage should be wrapped from mid-calf down to the toes with an even pressure throughout as well as the ankle being elevated above the heart level
- Etiology
(www.comfortshoe.com/
- Strains (similar to sprains...but different!)
- Etiology
- A strain is defined as the stretching or tearing of muscles and/or tendons beyond their normal range of motion. Strains are caused by excessive forces placed on muscles or tendons, causing excessive tension in the muscle. Muscle strains occur most often at the point in the muscle where the muscle belly becomes the muscle tendon. Muscle strains can be acute or chronic. Acute strains are the result of a an immediate trauma to the muscle, such as lifting heavy objects. This results in the muscle producing more force than the muscle fibers can accomidate. Chronic muscle strains are the result of repeated overuse of the muscles.
- Strain Classifications
- First-Degree Strain - Stretching of the muscle fibers. This degree of strain is associated with tenderness at the site of injury, with pain increasing as the muscle contracts. Decreased strength is seen during range of motion testing.
- Second-Degree Strain - Tearing of some of the muscle fibers. The muscle is still somewhat intact, however many fibers have been torn apart. Often this is also accompinied by ecchymosis, or skin discoloration due to blood leaking into tissues from ruptued blood vessles. This degree of strain is associated with a more severe pain at the site of injury, a more severe pain caused during muscle contraction, swelling as well as decreased strength during range of motion testing.
- Third-Degree Strain - Complete tearing of the muscle. This in turn produces a complete loss of function of the muscle. This degree of strain is associated with severe pain, swelling and ecchymosis. The muscle is also unable to produce any type of force.
- Signs & Symptoms
- Pain
- Muscle Spasm
- Muscle Weakness
- Swelling
- Cramping
- Inflammation
- Loss of muscle function
- Treatment
- Reducing swelling using rest, ice, compression and elevation for approximately 24-48hours post injury.
- Cruches and or casting of the injured ankle may be used to immobilize the leg and assist with locomotion.
- Severe second or third-degree strains may require surgery to repair the damage to the muscle.
- Etiology
- Fractures
- Etiology
- An ankle fracture is a common injury that most often occurs from an inward or outward rolling of the ankle. A fracture is defined as a partial or complete break in a bone. Ankle fractures can range from severe to not as serious. A severe fracture would be a shattering type break of the bones where as a less serious fracture would be an avulsion injury in which a small piece of a bone has been pulled off.
- Talus
- Calcaneus
- Signs & Symptoms
- Pain
- Tenderness
- Discoloration/Bruising
- Swelling
- Loss of function/Limited ROM
- Treatment
- The way in which an ankle fracture is treated depends solely on the type and severity. The most common form of treatment is immobilization, where the ankle and foot are restricted from movement in a cast or splint, allowing the bones to heal together properly. For more severe fractures surgery is the necessary treatment in order to repair the fracture.
- Etiology
- Dislocations
- Etiology
- An ankle dislocation is the loss of opposition of the articular surfaces, which is the result of a significant force being applied to the joint. Due to the stability of the ankle joint, and the large amount of force that would be required, it is rare for a dislocation to occur without there also being a fracture.The four different types of dislocations are posterior, anterior, lateral, and superior. A posterior disloaction is the most common and results from the talus moving in a posterior direction in relation to the distal tibia. This tends to occur most often when the ankle is in plantar flexion. An anterior dislocation results from the foot being forced anteriorly at the ankle joint and occurs with forced dorsiflexion or a posterior force applied to the tibia with the foot in a fixed position. A lateral dislocation is the result of forced inversion or eversion of the ankle. A superior dislocation occurs when a force drives the talus upwards and usually occurs from a fall from a height.
- Talus
- Subtalar Joint
- Signs & Symptoms
- Visibly deformed/Out of place
- Swollen
- Discolored/Bruising
- Pain
- Immovable/Difficulty moving the joint
- Tingling/Numbness
- Treatment
- If an obvious dislocation has occurred, the first step should be to imediately immobilize the joint. In most cases, it is a good idea to leave the shoe on the injured foot until the injured person reaches a hospital. The dorsal pedis and tibial pulses should be checked and monitored to determine if blood supply is reaching the distal areas of the foot. Dislocations and fractures should be treated by professionals in a hospital environment due to the fact that these injuries will require relocation of the joint and possibly even surgical interventions to keep the bones and joints in proper alignment.
- Etiology
- Tendon Ruptures
- Etiology
- Tendon ruptures are generally a traumatic injury caused by an excessive, strong, overstretch of the tendon. This causes the tendon to either partially or ocmpletely rupture which can often cause an obvious deformity. Avulsion fractures are also common if the tendon itself does not rupture.
- Achilles Tendon
- Plantaris Tendon
- Tibialis Anterior Tendon
- Tibialis Posterior Tendon
- Flexor Digitorum Longus Tendon
- Flexor Hallucis Longus Tendon
- Peroneus Brevis Tendon
- Peroneus Longus Tendon
- Signs & Symptoms
- Snap or pop heard or felt
- Severe pain
- Immediate bruising
- Weakness
- Not able to use affected area
- Immovable
- Cannot bear weight
- Deformity of area
- Achilles tendon rupture: Inability to support yourself on your tiptoes on the affected leg
- Special Tests
- Thompson Test (To test for Achilles Tendon Rupture)
- Treatment
- Tendon rupture treatment can either be operative or non-operative. If an opertion is not necessary, then the tendon and joint are placed in a plaster cast for eight weeks. If surgery is required, the tendon is then repaired surgically, which generally offers a lesser chance of re-rupture.
- Etiology
- Tendinitis
- Etiology
- Tendinitis is most commonly caused by repetitive microtrauma (insufficient rest periods between activity, loading, and compression) to the tendon, activating the inflammatory response, thus leading to chronic inflammation and thickened tendons. It can also arise from a direct traumatic force.
- Classifications
- First degree tendinitis- pain and slight dysfunction during activity
- Second degree tendinits- decreased function and pain after activity
- Third degree tendinitis- constant pain that prohibits activity
- Signs and Symptoms
- Muscle tightness
- Swelling
- Walking with a limp
- Compensatory gait patterns to prevent pain
- Tendon is tender to the touch
- Thickening of the tendon
- Treatment
- Rest
- Ice after activity
- Compression
- Elevate to prevent excessive swelling
- Begin exercise program to build range of motion and muscle strength to prevent further injury
- Injection of corticosteroids
- Surgery
- Etiology
Lower Leg Pathologies
-
Fractures
- Etiology
- Fractures of the lower leg generally show obvious signs of deformity following an acute injury. An audible snap or crack can often be heard by bystanders. These fractures are generally caused by an excessive blow to the lower leg.
- Tibia
- Fibula
- Signs & Symptoms
- Pain
- Tenderness
- Discoloration/Bruising
- Swelling
- Loss of function/Limited ROM
- Grating (broken bone ends rubbing together)
- Deformity/Shortening of leg
- Special Tests
- Bump Test (To test for Tibial, Fibular, Calcaneal, or Talar stress fractures)
- Squeeze Test (To test for Fibular stress fractures)
- Treatment
- Lower leg fractures should be immediately immobilized and the shoe should be left on the foot. It's important to check for the dorsal pedis and tibial pulses in order to ensure that blood flow is maintained to the distal portion of the limb. If the fracture is compund, bleeding should be managed. After being transported to a medical facility, the limb can then be casted, or if surgery is required, the broken bones can be realigned and then casted.
- Etiology
- Dislocations
- Etiology
- A lower leg dislocation occurs when the tibia or fibula become displaced or misaligned and are most often caused by a sudden impact or blow to the joint. Dislocations of the lower leg are most often the result of car or industrial accidents but can also occur in sports.
- Tibiofemoral Joint
- Tibiofibular Joint
- Signs & Symptoms
- Visibly deformed/Out of place
- Swollen
- Discolored/Bruising
- Pain
- Immovable/Difficulty moving the joint
- Tingling/Numbness
- Treatment
- Lower leg dislocations should be treated similarily to fractures with immediate immobilization of the joint and determination of the dorsal pedis and tibial pulses. If the dislocation has torn exterior tissue, bleeding should be managed until the patient is transported to a medical facility where the joint can be realigned and casted.
- Etiology
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