Lower Leg

Anatomy Bone

Tibia2nd longest bone in bodyWeight bearing bonewide at top and bottomFibula non weight bearingno protection at mallious and behind knee

Anatomy Interosseous Membrane

Defuses stress Space between fibula and tibia Fibers run diagonal Extension of fibula and tibia ligament Has holes for anterior tibia artery and vein

4 Compartments of lower legAnterior compartment

Extensor hallicus longus

Tibia anterior Extensor digitium

longus Tendon of pernoal

tertius Deep pernoal nerve

and srtery Tibial artery and vein

Deep posterior flexor hallius longus Flexor digitium

longus Posterior tibialis Posterior tibia

artery and vein Pernoal artery and

vein Tibial nerve

Lateral compartmentPeroneus

longusPeroneus

brevisSuperifical

pernoal nerve

Superifical posteriorGasrocnimusSoleusTendon of

planteris

Shin Splints Define- imbalance or incorrect muscle pull causing

inflammation or small tears Causes- mechanics Fallen or falling long arch Poor shoes Surface Running same directions on bank track Hard early season practice Mid to end season fatigue Tight gasroc and soleus Weak anterior muscles

Shin Splints continued S/Sx- can occur overnight, burring type

pain, point tenderness along tibia, pain during plantar and dorsal flexion

Stages- pain only after practice, pain before and after, pain always, pain is great, cant stand

R/O- stress fracture, compartment syndrome, bone cancer, shin spit will not show on x ray

Shin splints cont. Tx- limit practice, ice and tape, find

cause, if pain continues stop activity Rehab- strengthen and stretch anterior

muscle of leg Stretch Achilles and gasroc, soleus,

strength long arch, modality, ice before and after

Tape support

Stress Fractures Common overuse stress condition, especially among

distance runners Causes

More likely to occur in people with structural deformities of the foot Hypermobile pronated foot- fibular stress fractures, those with

rigid pes cavus- tibial stress fracture The wider the tibia the lower the incidence of stress fractures• S/Sx• Pain more intense after the activity than during the activity• Night pain• Point tenderness• TX• Discontinue running and other stressful locomotor activities for

about 14 days• If pain is severe were a cast or use a crutch to walk• After 2 weeks of no pain they can begin running again

Acute Compartment syndrome Compartment syndrome happens when pressure builds up as your

muscle in compartment swells beyond size that is comfortable for the compartment to contain.

S/Sx :-pain in your leg which is worse than expected for the type of injury sustained-severe pain when you move your leg-sudden swelling of your leg-pale skin on leg-pain when toes are moved

Causes:Can develop after breaking a bone or an injury that involves your leg being crushed. The pressure on your muscle can be made worse if you have a tight splint, dressing, or a cast on leg.

T/x:Remove anything confining your leg. Will need surgery to relieve the tension and pressure in leg and give room got muscle to swell.

Peroneal Tendon Sublaxiation/Dislocation The Peroneus longus and brevis tendons pass through

a common groove located behind the lateral malleolus. Causes: Often occurs in activities that apply dynamic

forces (turning, sharply cutting) to foot and ankle. S/sx: complaining that the tendon snaps in jumping

out of the groove and then back when stress is released. And also experiences recurrent pain, snapping, and ankle instability.

Tx: compression with a felt pat cut in a horseshoe-shaped pattern sorrounding the lateral malleolus. RICE. Time for conservatory care is 5 to 6 weeks.

Achilles bursitis Definition-Inflammation of the bursa located at

the bottom of the calcaneus Causes- friction on the Achilles, poorly fitted

shoes, pants, over use, and rapid calf contractions, commonly seen in Achilles tendinitis

Symptoms-Pain in the calcaneus, when calf contracts, redness, tenderness, inflammation

Treatment- RICE, stretching out the calf and heel raises, heel wedges may be needed, possible cortisone shot if needed

Contusions Caused by a forceful blow to the area

s/sx: Intense pain, Hematoma, Bruise

Tx: Rice, NSAIDS, Compression, ROM exercises, Stretch muscle.

Achilles Strains Cause- Achilles strains are common in sports and

occur most often after ankle sprains or sudden excessive dorsiflexion of the ankle.

S/sx- While sustaining this injury the patient feels acute pain and extreme weakness on plantar flexion.

Tx- First, as with other acute conditions, pressure is first applied with an elastic wrap together with the application of cold. Unless the injury is minor, hemorrhage may be extensive, requiring RICE over an extended period of time. After hemorrhaging has subsided an elastic wrap should be applied for continued pressure

Achilles Tendon Rupture Define- complete tear of the Achilles

tendon Causes- middle age weekend warrior S/SX- heard Pop, extreme pain, no

plantar flexion in ankle, positive thompson test

Tx- Surgery, out one year.