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Sport Injuries - Ankle and Lower Leg Injuries


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View of Bones and Ligaments
Anatomy: Muscles
fractured a bone

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Sport Injuries - Ankle and Lower Leg Injuries

  1. 1. Presenter: Nazri Azeli Mohd Sharul Azrin Jeff Fakhruddin Shamsudin Azham Afzanizam Hamzah Mohd Razmi Rozan
  2. 2. Muscles of the Lower Leg and Foot
  3. 3. Action Muscles Ankle dorsiflexion Extensor Digitorium longus, extensor hallucis longus, tibialis anterior Ankle plantarflexion Soleus, gastrocnemius Ankle inversion Tibialis posterior, flexor digitorium longus, flexor hallucis longus Ankle Eversion Peroneus longus, peroneus brevis
  4. 4.  Functional Tests  While weight bearing the following should be performed  Walk on toes (plantar flexion)  Walk on heels (dorsiflexion)  Walk on lateral borders of feet (inversion)  Walk on medial borders of feet (eversion)  Hop on injured ankle  Start and stop running  Change direction rapidly  Run figure eights
  5. 5.  Ankle Injuries: Sprains  Single most common injury in athletics caused by sudden inversion or eversion moments  Inversion Sprains  Most common and result in injury to the lateral ligaments  Anterior talofibular ligament is injured with inversion, plantar flexion and internal rotation
  6. 6. -The foot is twisted outwards. -The inner ligament, called the deltoid ligament, is stretched too far. -Patients will have pain on the inner side of the ankle
  7. 7.  injury to the ligaments around the ankle  ligaments above the joint, syndesmosis ligaments injured
  8. 8.  Graded Ankle Sprains  Signs of Injury  Grade 1  Grade I ankle sprains cause stretching of the ligament. The symptoms tend to be limited to pain and swelling. Most patients can walk without crutches, but may not be able to jog or jump.  Grade 2  A grade II ankle sprain is more severe partial tearing of the ligament. There is usually more significant swelling and bruising caused by bleeding under the skin. Patients usually have pain with walking, but can take a few steps.  Grade 3  Grade III ankle sprains are complete tears of the ligaments. The ankle is usually quite painful, and walking can be difficult. Patients may complain of instability, or a giving-way sensation in the ankle joint.
  9. 9. Sign/symptom Grade I Grade II Grade III Tendon No tear Partial tear Complete tear Loss of functional ability Minimal Some Great Pain Minimal Moderate Severe Swelling Minimal Moderate Severe Ecchymosis Usually not Frequently Yes Difficulty bearing weight No Usually Almost always
  10. 10. Care  Must manage pain and swelling  Apply horseshoe-shaped foam pad for focal compression  Apply wet compression wrap to facilitate passage of cold from ice packs surrounding ankle  Apply ice for 20 minutes and repeat every hour for 24 hours  Continue to apply ice over the course of the next 3 days  Keep foot elevated as much as possible  Avoid weight bearing for at least 24 hours  Begin weight bearing as soon as tolerated  Return to participation should be gradual and dictated by healing process
  11. 11.  There are 2 common type of bone fracture in your feet: i. Hairline stress fractures ii. Traumatic fractures
  12. 12.  Ankle Fractures/Dislocations  Cause of Injury  Number of mechanisms – often similar to those seen in ankle sprains  Signs of Injury  Swelling and pain may be extreme with possible deformity  Care  Splint and refer to physician for X-ray and examination  RICE to control hemorrhaging and swelling  Once swelling is reduced, a walking cast or brace may be applied, immobilization lasting 6-8 weeks  Rehabilitation is similar to that of ankle sprains once range of motion is normal
  13. 13.  Tiny litle hairline cracks in bones.  Some fractures are Straight and spiral in nature.  This tiny cracks from excessive pounding, twisting and repetitive actions during activities.(own explainations)
  14. 14.  Cause from blow, impact or accident are much more obvious.  TF are very painful and related with pain and swelling.  If skin broken, the injury susceptible to infection.(need medical)
  15. 15. Tibial and Fibular Fracture
  16. 16.  Acute Leg Fractures  Cause of Injury  Result of direct blow or indirect trauma  Fibular fractures seen with tibial fractures or as the result of direct trauma  Signs of Injury  Pain, swelling, soft tissue insult  Leg will appear hard and swollen (Volkman’s contracture)  Deformity – may be open or closed  Care  X-ray, reduction, casting up to 6 weeks depending on the extent of injury
  17. 17.  Stress Fracture of Tibia or Fibula  Cause of Injury  Common overuse condition, particularly in those with structural and biomechanical insufficiencies  Result of repetitive loading during training and conditioning  Signs of Injury  Pain with activity  Pain more intense after exercise than before  Point tenderness; difficult to discern bone and soft tissue pain  Bone scan results (stress fracture vs. periostitis)
  18. 18.  Care  Eliminate offending activity  Discontinue stress inducing activity 14 days  Use crutch for walking  Weight bearing may return when pain subsides  After pain free for 2 weeks athlete can gradually return to activity  Biomechanics must be addressed
  19. 19. Medial Tibial Stress Syndrome (Shin Splints)  Cause of Injury  Pain in anterior portion of shin  Stress fractures, muscle strains, chronic anterior compartment syndrome, periosteum irritation  Caused by repetitive microtrauma  Weak muscles, improper footwear, training errors, varus foot, tight heel cord, hypermobile or pronated feet and even forefoot supination can contribute to MTSS  May also involve stress fractures or exertional compartment syndrome
  20. 20.  Shin Splints (continued)  Signs of Injury  Diffuse pain about disto-medial aspect of lower leg  As condition worsens ambulation may be painful, morning pain and stiffness may also increase  Can progress to stress fracture if not treated  Care  Physician referral for X-rays and bone scan  Activity modification  Correction of abnormal biomechanics  Ice massage to reduce pain and inflammation  Flexibility program for gastroc-soleus complex  Arch taping and orthotics
  21. 21.  Compartment Syndrome  Cause of Injury  Rare acute traumatic syndrome due to direct blow or excessive exercise  May be classified as acute, acute exertional, or chronic  Signs of Injury  Excessive swelling compresses muscles, blood supply and nerves  Deep aching pain and tightness is experienced  Weakness with foot and toe extension and occasionally numbness in dorsal region of foot
  22. 22.  Care  If severe acute or chronic case, may present as medical emergency that requires surgery to reduce pressure or release fascia  RICE, NSAID’s and analgesics as needed  Avoid use of compression wrap = increased pressure  Surgical release is generally used in recurrent conditions  May require 2-4 month recovery (post surgery)  Conservative management requires activity modification, icing and stretching  Surgery is required if conservative management fails
  23. 23.  Achilles Tendonitis  Cause of Injury  Inflammatory condition involving tendon, sheath or paratenon  Tendon is overloaded due to extensive stress  Presents with gradual onset and worsens with continued use  Decreased flexibility exacerbates condition  Signs of Injury  Generalized pain and stiffness, localized proximal to calcaneal insertion, warmth and painful with palpation, as well as thickened  May progress to morning stiffness
  24. 24.  Care  Resistant to quick resolution due to slow healing nature of tendon  Must reduce stress on tendon, address structural faults (orthotics, mechanics, flexibility)  Aggressive stretching and use of heel lift may be beneficial  Use of anti-inflammatory medications is suggested
  25. 25.  Achilles Tendon Rupture  Cause  Occurs when sudden stop and go; forceful plantar flexion when  Commonly seen in athletes > 30 years old  Generally has history of chronic inflammation  Signs of Injury  Sudden snap (kick in the leg) with immediate pain which rapidly subsides  Point tenderness, swelling, discoloration; decreased ROM  Obvious indentation and positive Thompson test
  26. 26.  Care  Usual management involves surgical repair for serious injuries  Non-operative treatment consists of RICE, NSAID’s, analgesics, and a non-weight bearing cast for 6 weeks to allow for proper tendon healing  Must work to regain normal range of motion followed by gradual and progressive strengthening program
  27. 27. Before surgery During surgery
  28. 28.  Shin Contusion  Cause of Injury  Direct blow to lower leg (impacting periosteum anteriorly)  Signs of Injury  Intense pain, rapidly forming hematoma  Increased warmth  Care  RICE, NSAID’s and analgesics as needed  Maintaining compression for hematoma (which may need to aspirated)  Fit with doughnut pad and orthoplast shell for protection
  29. 29.  Attach elastic to secure object.  Place elastic around forefoot.  Pull foot toward shin • Place elastic around ball of foot. • Push down against elastic.
  30. 30.  Attach elastic to secure object.  Pull forefoot outward.  Loop elastic around forefoot. • Attach elastic to secure object. • Pull forefoot inward against. • Loop elastic around forefoot.
  31. 31. • Place bandage on floor • Slide the bandage backward from the forward using one foot only.
  32. 32. Plantar fasciitis injury • The “plantar fascia” is a piece of connective tissue that runs from the heel bone (calcaneus) to the base of the toes, on the sloe of your foot.
  33. 33. Sign and symptoms • Sharp pain at the bottom of your heel, almost like walking on glass. • Mild swelling within your foot and around your heel. • The pain, tends to be worse with the first few steps in the morning, going up stairs or standing on tiptoes. • Pain after long periods of standing or getting up from sitting. • Post exercise pain, usually wont occur during exercise.
  34. 34. Treatment..? • Wearing a splint fitted to your calf and foot while you sleep, to stretch the fasica, tendons and surrounding tissue. • Doctors may prescribe off-the-shelf or make custom-fitted orthotics to help distribute pressure to your feet more effectively. • Physiotherapy can provide you with a series of exercises and stretches designed to decrease pain, improve range of motion and strengthen lower leg muscles, all of which will help your ankle and heel.
  35. 35. Penilaian kecederaan pergelangan kaki dan bahagian bawah kaki
  36. 36. Komponen penilaian • Mekanisme kecederaan • Tanda-tanda • Simptom-simptom • Ujian ketahanan • Ujian yang khas atau spesifik
  37. 37. Terkoyak bahagian sisi pergelangan kaki • Mekanisme kecederaan - plantarflexion - inversion • Tanda: - bengkak (swell) - perubahan warna (discoloration) • Simptom-simptom: - merasa sakit sepanjang sisi pergelangan kaki(ankle)
  38. 38. julat pergerakan yang normal untuk pergelangan kaki(ankle) • Dorsifleksi - 20 darjah • Plantarfleksi - 50 darjah • Inversi - 20 darjah • Eversi - 5 darjah
  39. 39. Pemegangan bahagian utama pada pergelangan kaki: • Anterior talofibular ligamen (ATF) • Calcaneal fibular (CF) • Poterior talofibular (PTF) • Bahagian sisi (lateral) molleolus • Kuboid (cuboid) • Sinus tarsi • Metatarsal • Peroneal tendon
  40. 40. Menilai pergelangan sisi kaki • Anterior drawer - penilaian ligamen anterior talofibular (ATF)
  41. 41. • Inversi talar tilt - penilaian ke atas ligamen Calcaneal fibular.
  42. 42. • Eversi talar tilt  Untuk menilai deltoid ligamen  Tekanan akan diberikan sedikit demi sedikit untuk melihat tahap kecederaan melalui dorsifleksi dan plantarfleksi.
  43. 43. Terseliuh (sprain) bahagian tengah(medial) • Mekanisme kecederaan: - Dorsifleksi - eversi - Putaran ekternal(external rotation) • Tanda : - Bengkak - Perubahan warna (discoloration/subacute) • Simptom-simptom : -kesakitan sepanjang bahagian tengah (medial) pergelangan kaki
  44. 44. Pemegangan bahagian utama pada pergelangan kaki: • Anterior tibiotalar • Tibionavicular • Tibiocalcaneal • Posterior tibiotalar • Medial malleolus • Lateral malleolus • Sustentaculum tali • Navicular • Sendi talocrural
  45. 45. Penilaian keretatkan bahagian bawah kaki dan Pergelangan kaki • Bump test - Tekan pada bahagian atas tumit - Beri tekanan sehingga merasa sakit pada bahagian yang retak. - Tekanan di tambah dan berhenti apabila kesakitan di rasai oleh pesakit
  46. 46. That’s ALL….. Thank you…….