Lower extremity injuries

III. LOWER LEG TENDINOPATHIES

These are two much too soon or overuse injuries. Next three

I. ACHILLES TENDON RUPTURE

definition of the problem: the common mechanism of injury: a sudden and powerful eccentric contraction of the gastroc/soleus. This mechanism is best demonstrated in jumping and landing activities in which the knee is extending and the ankle being forced into dorsiflexion classic sign or symptom:audible snap and the sensation of being kicked in the leg. Immediate plantarflexion weakness with pain, swelling, and palpable defect are usually present Can take up to 6 months for full recovery

IV. ACHILLES TENDINITIS

definition of the problem: Achilles tendinitis is defined as disruptive lesions within the substance of the tendon itself, It is surrounded by the paratenon which functions as an elastic sleeve enveloping the tendon and allowing free movement against surrounding tissues. the common mechanism of injury:An area of reduced vascularity is reported 2-6 centimeters proximal to the insertion. classic sign or symptom:The athlete will complain of a dull aching pain during or after activity. Most common tendonitis

B. OS TRIGONUM

definition of the problem: Injury to the os trigonum is common in athletes who function on their toes (ballet dancers) or encounter resistance to dorsiflexion while in the extreme of plantarflexion (soccer player having a kick blocked). the common mechanism of injury:Accessory bone fracture or soft tissue pinching produces severe local pain in the posterior portion of the ankle. classic sign or symptom:

II. TENNIS LEG

definition of the problem: lesion of the medial gastrocnemius head the common mechanism of injury: sudden extension of the knee with foot in a dorsiflexed position classic sign or symptom: the athlete will feel a sudden sharp twinge in the upper medial calf and immediately have difficulty in full weight bearing.

VI. POSTERIOR TIBIALIS TENDINITIS

definition of the problem: microtrauma to the tendon of the posterior tibialis. the common mechanism of injury: hyperpronation biomechanics improper training on crowned or banked surfaces, inappropriate shoe wear, and any structural condition which increases the varum attitude (or hyperpronation) of the lower extremity classic sign or symptom:Pain and swelling is present over the posteromedial crest of the tibia along the origin of the posterior tibialis. Tenderness and crepitation may be found anywhere along the course of tendon as it passes behind the medial malleolus and inserts distally of the navicular and first cuneiform Clinical differentiation is accomplished through detection of tenderness in areas devoid of muscle on the tibial shaft or percussion and tuning fork vibration techniques Posterior shin splints - its when the posterior tibialis which inserts on the periosteium pulls is off the bone and becomes inflamed.

RECURRENT COMPARTMENT SYNDROME

definition of the problem:Chronic, exertional compartment syndrome has the same pathophysiology as acute compartment syndrome, but its presentation and care is different. the common mechanism of injury: classic sign or symptom:The athlete will complain of lower leg pain and tightness that occurs at a consistent interval following the initiation of physical activity.

E. PLANTAR FASCIITIS

definition of the problem:Biomechanical abuse of this tissue results in microtrauma and inflammation the common mechanism of injury:This condition is seen often in the running athlete who hyperpronates or has a rigid cavus foot and tight achilles classic sign or symptom:A gradual, insidious onset of pain is present along the plantar aspect of the foot which can radiate along the path of the fascia. Tenderness to palpation can be found at the medial aspect of the calcaneal tuberosity, in the medial arch The most consistent finding is that of exquisite pain with weight bearing forces of the first few steps in the morning

A. HEEL BRUISES

definition of the problem:- Contusion injuries to the heel and calcaneal fat pad are among the most disabling in sports the common mechanism of injury:jumping or changes of direction . Runners with leg length discrepancy will overstride on the short leg side and have resultant increased impact forces at heel strike are also especially prone to this type of trauma classic sign or symptom:The athlete will complain of severe pain in the plantar calcaneus that is greatly aggravated by weight bearing

ACUTE ANTERIOR COMPARTMENT COMPRESSION SYNDROME

definition of the problem:. Contusions, crush injuries, fractures, or severe overextension may cause a rapid increase in compartmental volume from bleeding or muscular swelling the common mechanism of injury: classic sign or symptom: . Palpation reveals a "woody tension" over the muscles of the anterior compartment and passive plantarflexion evokes pain. This condition is considered a medical emergency as early muscle damage occurs in the first 4-6 hours and irreversible tissue damage within 18 hours.

XII. SESAMOIDITIS

definition of the problem:. Sesamoiditis describes an inflammatory condition of the tissues surrounding the sesamoids the common mechanism of injury:. The athlete most prone to medial sesamoid pathology is the one with a rigid cavus foot, tight achilles, and plantarflexed first ray. classic sign or symptom:The athlete usually presents with tenderness and swelling of the first metatarsal head and pain with passive dorsiflexion or passive toe extension. Bottom of toe

XI. TURF TOE

definition of the problem:Acute hyperextension injuries to the first metatarsophalangeal the common mechanism of injury: Repetitive trauma of this nature results in plantar capsule tears, articular cartilage damage, and possible fracture of the medial sesamoid classic sign or symptom:: The athlete presents with a tender, red, and swollen first metatarsophalangeal joint that has increased pain with passive toe movement. Whole toe

VIII. PERONEAL TENDON SUBLUXATION

definition of the problem:They are subject to subluxation out of this groove if the peroneal retinaculum is ruptured by a sudden and violent dorsiflexion and eversion force the common mechanism of injury:This mechanism is commonly seen in the novice skier (wedge formation) who falls forward while loading the inner edge of the skis. classic sign or symptom:This injury is commonly confused with inversion ankle sprains due to the symptom similarity. The athlete will relate a feeling of tenderness, instability, and swelling in an area around the lateral malleolus. Differential diagnosis can be determined with complaint of intense retromalleolar pain upon resistive dorsiflexion and eversion or in chronic cases, marked instability and audible snapping of the tendon in and out of its groove.

V. ANTERIOR TIBIALIS TENDINITIS

definition of the problem:This injury is characterized by pain and swelling over the dorsum of the foot. the common mechanism of injury: classic sign or symptom: An inflammatory response of the anterior tibialis tendon occurs when it is unable to absorb deceleration forces in the heel strike to foot flat phase of gait. Uncontrolled or excessive pronation following heel strike stretches the anterior tibialis as it attempts to control the speed of forefoot loading. Second most common tendinitis

C. CALCANEAL APOPHYSITIS (SEVER'S DISEASE)

definition of the problem:Traction epiphyseal injuries in active adolescents are common when wearing cleated shoes or rapidly altering heel height of their athletic shoe. Calcareous putting too much pressure on the plate causing loss of circulation. the common mechanism of injury: classic sign or symptom:pain on the posterior heel at the insertion of the achilles This condition will discontinue at skeletal maturity when the apophysis closes.

D. RETROCALCANEAL BURSITIS

definition of the problem:a bursal inflammation between the achilles and calcaneus the common mechanism of injury:This condition is aggravated by excessive compensatory pronation which causes a cumulative trauma and pressure to the posterolateral aspect of the heel. classic sign or symptom:Pain, swelling, and discoloration on the posterolateral and superior aspect of the heel.

G. CUBOID SYNDROME

definition of the problem:displacement of the cuboid bone by the pull of the peroneus longus. the common mechanism of injury:induced with trauma or with a powerful contraction with the foot in a plantarflexed and inverted position. classic sign or symptom:tenderness along the cuboid, peroneus longus, and lateral metatarsal heads.

F. TARSAL TUNNEL SYNDROME

definition of the problem:entrapment neuropathy of the posterior tibial nerve as it passes through the osseofibrous tunnel between the flexor retinaculum and medial malleolus. the common mechanism of injury:The typical mechanism of injury in athletic participation is excessive pronation which causes a tightening of flexor retinaculum. classic sign or symptom: The athlete will report intermittent burning, pain, tingling, and numbness in the medial foot which is aggravated by weight bearing. A positive Tinel's sign may be elicited with tapping or compression over the effected nerves to reproduce the symptoms. In advanced stages, weakness in toe flexion and abductor hallicus atrophy may be evident.

X. INTERDIGITAL NEUROMAS

definition of the problem:tumor of fibrous tissue between metatarsal heads called a Morton's neuroma the common mechanism of injury:Compression and shearing forces classic sign or symptom:The chief complaint is that of a burning or electrical shock sensation in the forefoot that radiates into the toes