Lecture 5 - Lower Leg Injuries Flashcards

Question

What is the deep posterior compartment of the leg?

Answer 1

- contains the muscles that invert the foot, plantar flex the ankle & flex the toes

Answer 2

- tibialis posterior, flexor hallicus longus, flexor Digitorum longus (known as TOM, DICK & HARRY) - also contains the posterior tibial nerve

Answer 3

- inversion sprain - eversion sprain

Answer 4

- the medial malleolus is shorter, allows greater inversion - ligaments on the outside of the ankle are fewer & weaker - Shape of the Talus predisposes laxity of the joint

Answer 5

- plantar flexion inversion sprain - mid stance (90°) inversion sprain - dorsiflexion inversion sprain - anterior shear sprain

Answer 6

- occurs when the foot is forcefully plantar flexed while simultaneously turning inwards (inversion) - causes damage to the anterior talofibular ligament (ATFL)

Answer 7

- causes damage to the calcaneofibular ligament (CFL) by pivoting or twisting

Answer 8

- occurs when the foot is dorsiflexed & inverted - causes damage to the posterior talofibular ligament (PTFL)

Answer 9

- the ankle joint is stressed in an anterior direction, causing the anterior & distal anterior talofibular ligament (ATFL) to be damaged

Answer 10

- 1st degree (mild sprain) - 2nd degree (moderate sprain) - 3rd degree (severe sprain)

Answer 11

- Some stretching of ligament, no tearing, no major disability, able to bear weight - Full range of motion (R.O.M.) very little swelling - Recovery 2-3 days: can return to participation at this time with support - *prevention of re-injury conditioning protocol is essential*

Answer 12

- Moderate to severe stretching, some tearing, moderate swelling, increased pain - Decreased ROM (due to pain & swelling) - Some instability in the ankle joint (test within first 10 or 15 min. or too much swelling occurs & may masks findings) - Recovery 2-4 weeks (usually 4) return to activity good support required (I.e.. tape or brace)

Answer 13

- Involves rupture of ATFL & CFL ligaments, Severe swelling & pain (initially) - Severe sprain can be accompanied by dislocation & subluxation - The only way to tell the difference between 3rd degree & 2nd degree is through stress X-Ray - In 2nd & 3rd degree sprains always have x-ray done to check for fracture

Answer 14

- Recovery is 6-8 weeks - may be even longer if surgery in required - surgery may be required should occur within ten days (ie ligaments will shrink to resting length) otherwise reconstructive surgery is required

Answer 15

- occurs when the foot is in dorsi-flexion & forced into eversion - The deltoid ligament complex is damaged due to the strength of the ligament complex - it is not uncommon to see avulsion

Answer 16

- Review MOI & Past History of Injury - Rule out fracture - Observe for Obvious Signs Of Injury - Complete; Active, Passive, & Isometric Resisted Tests - Perform Ligament Stress Tests; Drawer, Inversion, & Eversion - Palpate all Specific structures of the joint

Answer 17

- Always rule out fractures first - Use PIER (pressure, ice, elevation rest) 1-20 mins every 1 1/2 hours 4x/day; Do this for the first 24-48 hours after injury - can use contrast baths & Heat related modalities

Answer 18

- early stage - mid to late stage

Answer 19

- writing the alphabet while in the hot whirlpool - Towel stretches (for calf and Achilles) - Pulling up a flat towel with toe scrunches (strengthens intrinsic foot muscles)

Answer 20

- Surgical tubing all foot extrinsic muscles - Toe raises - strengthens the calf muscles

Answer 21

- challenge & improve your sense of body position & movement - They can help stabilize joints and reduce the risk of injury - these exercise can be instituted after acute period - in most cases the athlete can be doing something within 2 days

Answer 22

- typically low-impact exercises like swimming or stationary biking - they allow you to maintain cardiovascular fitness without putting additional stress on your injured ankle - for the athlete this must be considered as early as possible

Answer 23

- able to bear weight without pain, full ROM, no swelling, demonstrate normal strength, & perform sport-specific movements without discomfort - essentially, your ankle should be fully functional & pain-free - using Functional patterns; cutting, stop start , figure 8 etc

Answer 24

- Towel stretch, standing calf stretch, standing soleus stretch, ankle ROM, resisted dorsiflexion/plantarflexion, reisisted inversion/eversion, heel raises, step-up, static & dynamic balance exercises

Answer 25

- Proper conditioning & Ankle proprioception: - Wearing proper shoes: preferably high cut shoes - Ankle wraps/ or appropriate brace - *Taping along with high cut shoes show great reduction in ankle injury* - A drawback exists with tape in that after 15 min you lose 30-40% of the support of the tape

Answer 26

- potts-fracture - bimalleolar fracture - tri malleolar fracture - avulsion fracture - Epiphyseal fracture

Answer 27

- Fibular fracture above the malleolus along with a fracture of the tibial malleolus

Answer 28

- Both malleolus are fractured accompanying a forced eversion & torsion of the foot/ankle

Answer 29

- Both malleoli & the posterior margin of the tibia are fractured - the difference between this & a bi-malleolar is that torsion has forced the talus posteriorly, & breaks off the posterior lateral margin of the tibia

Answer 30

- Ligament pulls a piece of bone away from one of the bony attachment at the ankle or foot

Answer 31

- Fractures involving the growth plate in children & adolescents - Caution must be taken with severe ankle sprains as the epiphyseal area may be involved & could affect growth

Answer 32

- Includes all fractures not involving the malleolus - Mal-alignment or Mal-union if only tibia is fractured - Fibula only supports 1/6th of the weight going through that side - The individual may be able to weight bear if this is the only bone to break\\

Answer 33

- Involves tendon swelling, resulting in irritation of the in-folded membrane (i.e., Inflammatory fluid moves into area) - When injured the individual has difficulty in plantar-flexion actions against resistance

Answer 34

- I.C.E. - repeated 15 - 20 minutes 3-4 x day - When inflammation is chronic all activity must be stopped - Most important in chronic overuse symptoms is to rest (2 weeks to 6 months) - If severe, restricting activity by casting is sometimes used. (Walking boot with range of motion limiters are a better choice.)

Answer 35

- a degenerative condition, involving the breakdown of the Achilles tendon - often due to chronic overuse without proper healing, leading to pain, stiffness, & potential weakness

Answer 36

- a painful condition affecting the Achilles tendon - In most cases, Achilles tendinopathy is a type of overuse injury & is more common in younger people

Answer 37

- A rupture of the Achilles tendon is a tearing & separation of the tendon fibers so that the tendon can no longer perform its normal function

Answer 38

- a direct blow causes bleeding & fluid buildup under the periosteum (the membrane covering the bone), resulting in pain, swelling, & potential discoloration

Answer 39

- known as shin splints - causes pain between the knee & the ankle - Results when the stresses in the lower extremity are not absorbed adequately & one or more of the structures in the leg are not able to remodel fast enough - This results in stress related breakdown of the structure with resultant inflammatory change

Answer 40

- The concern is not what happens in a single impact, but what happens with the thousands of repetitions that occur over time & affect both soft tissue & bone - Consideration must also be given to the fact that muscle strength usually increases faster than bone is able to remodel & therefore makes the bone more susceptible to stress syndrome

Answer 41

- Tearing of the interosseous membrane - Micro tearing of muscle away from the bone - *Stress Fractures of the tibia &/or fibula*

Answer 42

- Inflammation of the outer lining of bone due to pulling by muscle attached to it

Answer 43

- tiny cracks in a bone caused by repetitive force, often from overuse

Answer 44

- X-rays are initially done after injury or symptoms first assessed, if they are inconclusive x-rays should be repeated after 10- 14 days of rest - Healing of the fracture causes calcium build up & these can then be seen on x-rays - A bone scan is often required to detect the problem

Answer 45

- no absorption lack of heel to toe movement; Increased forces directed up leg - Running or playing sports on hard surfaces increases stress up the leg - Over pronated or supinated foot posture

Answer 46

- camber of road causes increased stress on foot & lower leg (i.e., Top foot will be in increased pronation; While bottom foot forced into supination)

Answer 47

- force on medial aspect of foot & lateral aspect of knee joint

Answer 48

- force on lateral side of the foot & medial aspect of knee joint

Answer 49

- must rest the leg for 3 weeks minimum - If the individual has to play you try & control symptoms so you use ice before & after activity & as much as possible throughout the day - Correct biomechanical dysfunction - Correct any strength & or flexibility dysfunction

Answer 50

- Deep contusion or Fracture the most likely cause - Compartment fascia will not allow for sudden compartment expansion due to the bleeding - Tibial artery, deep peroneal nerve affected

Answer 51

- necrosis of muscle, inability to dorsiflex the foot, parasthesia in the web space between 1st & 2nd toes

Answer 52

- Involves engorgement of muscles in a given compartment (usually anterior or deep posterior) which then compromises blood flow causing ischemia & pain - If compression is intense enough may get weakness in involved muscle groups also - may be Parasthesia in the web space between 1 an 2 toes - Recurrent episodes of the problem may require surgical release of fascia to allow muscle expansion

Answer 53

- Excessive Perspiration of the feet - Cause: Overactive Sympathetic nervous System, Susceptible to blisters, infection, skin diseases - Tx: Foot powders in shoe, Rubbing alcohol to dry feet, Foot antiperspirants, Sympathectomy

Answer 54

- also known as onychocrptosis - Leading edge of toenail grows into the soft tissue of the nail bed - Causes: Trauma to the nail, Improper cutting of toe nails, Tight shoes or Socks, Abnormal shape of nail plate, Abnormal thickness of nail - Tx: soak foot in warm water, wear open shoes

Answer 55

- thickened layers of skin caused by repeated pressure or friction - Inelastic tissue that may shear off exposing underlying skin to infection - Tx: Hot water soaks followed by using a scraper or pumice stone to rub & thin out the callus, Pedicure, Proper fitting shoes & socks, Orthotics with MET pads

Answer 56

- Result of high friction over the toe joints - Cause: tight shoes with shallow toe box, poor fitting shoes - Tx: donut pad to help protect against friction, hot water soaks gently file down (do not cut)

Answer 57

- a small, inflamed patch of skin with a smooth center - usually appear between the toes. - Causes: Moisture & high friction between toes due to tight shoes - Tx: wear proper fitting shoes & socks, proper foot hygiene; keep toe clean & dry

Answer 58

- small, rough growths on the feet, on the balls & heels of the feet - caused by a virus that invades the skin through tiny cuts or abrasions. - contagious, commonly spread in public swimming pools or communal showers - more common in children than in adults - Tx: doctors may burn them off with liquid nitrogen

Answer 59

- known as heel spur - is a protuberance (outgrowth) of the heel bone where the plantar fascia attaches - Causes: secondary to plantar fasciitis, improper footwear

Answer 60

- also known as bunions - Seen as the big toe moving in to the middle of the foot - Causes: Hereditary predisposition to the angulation, Improper shoes with a tight toe box - Tx: toe wedge or support, orthotics, surgery (if too painful to walk or do daily activities)

Answer 61

- Results from shearing forces between skin layers, May be clear, bloody or purulent. - Tx: decrease friction, wear proper fitting shoes, keep feet dry, wear absorbent socks, & use foot powders

Answer 62

- Compression injury to the interdigital nerve between the Metatarsal Heads. - Cause: Tight shoes, Over-pronation creating a shearing force during toe off in gait

Answer 63

- inflammation of the fibrous tissue along the bottom of your foot that connects your heel bone to your toes - Causes: Tension & stress on the fascia can cause small tears, Repeated stretching & tearing of the facia can irritate or inflame it

Answer 64

- Metatarsalgia (or forefoot pain) is a catch-all term that includes several painful foot conditions - Inclusive of pain at the metatarsal heads, bursitis, arthritis, sesamoiditis, & periostiti

Answer 65

- a fungal infection that usually begins between the toes but can involve the whole foot - occurs most commonly in people whose feet have become very sweaty while confined within tight-fitting shoes

Answer 66

- scaly rash, itching, stinging & burning

Answer 67

- Athlete's foot is contagious & can be spread via contaminated floors, towels or clothing - Requires use of antifungal medication Either topical (oral used in severe cases)