Lower Leg and Ankle Injuries

Shin Splints
Medial

Anterior

Medial Tibial Stress
Syndrome
Tenderness is usually found between 3 and
12 centimeters above the tip of the medial
malleolus at the posterio-medial aspect of
the tibia.
Inflammation of the periostium (periostitis)
Most frequently involved is the Tibalis
Posterior tendon and muscle, but the Flexor
Digitorum Longus and Flexor Hallucis
Longus may also be involved.
Stress fractures can also occur in this area.


Anterior Compartment
Syndrome
Soft tissue injuries at the muscular origin and
bony or periosteal interface of the bone and
muscle origin.
Due to micro tears of the Tibialis Anterior
either at the origin or in the fibers
themselves.
Or microtrauma to the bone structure itself.

Stress fractures can also occur in this area.

Exertional Compartment
Syndrome
Caused by the muscles swelling within a closed
compartment with a resultant increase in pressure in the
compartment.
The blood supply can be compromised and muscle injury
and pain may occur.
Abnormal compartment pressure:
A resting pressure greater than 20 mm Hg; or
An exertional pressure greater than 30 mm Hg; or
A pressure of 25 mm Hg or higher 5 minutes after stopping
exercise.
This may require surgical decompression of the
compartment.

Key Causes
Tight posterior muscles
Imbalance between the
posterior and anterior muscles
Running on concrete or other
hard surfaces
Improper Shoes - inadequate
shock protection
Overtraining

Treatment (FYI)

Rest. The sooner you rest the sooner it will heal.

Apply ice 10-15 minutes for 2-3x per day in the
early stages when it is very painful.
Anti inflammatory drugs
Wear shock absorbing insoles in shoes.
Maintain fitness with other non weight bearing
exercises.
Apply heat and use a heat retainer after the initial
acute stage, particularly before training.

Stress Fractures
Bone remodeling
Repetitive stress weakens the bone

10-20% of injuries to athletes

Most common locations: tibia, fibula and

metatarsals.
Tibial and fibular stress fractures can
develop from shin splints

Causes of Stress Fractures
Training errors
Abnormal limb length

Low body weight (< 75% of ideal)

Eating disorders

Previous inactivity

White race

Female

Diagnosis (FYI)
X-ray

MRI

CT scans

 Metatarsal Stress Fracture
CAUSES:
Decreased density of the
bones (eg. osteoporosis)
Unusual stress on a metatarsal
due to mal position or another
forefoot deformity (eg. bunion)
Abnormal foot structure or
mechanics (eg. flatfoot, over
inversion)

 Ankle Sprains
Most common athletic injury. 25% of all
injuries.
The risk of ankle sprains varies with the sport

21-53% basketball, 17-29% soccer, 25% volleyball.

Ankle sprains account for 10% to 15% of all
lost playing time
The medial malleolus is shorter than the

lateral mallelous so there is naturally more

inversion than eversion.


Ankle Sprains
Greater inversion increases the potential for
over-stretching of the lateral ligaments.
Most sprains involve the lateral ligaments from
excessive inversion.
Deltoid ligament is sprained less often (25% of
ankle sprains)
Of the lateral ligments, the ATFL is sprained
the most often followed by the CFL
Sprains ocur most often with the foot in
plantar flexion and inversion.

Lateral Collateral Ligament

Ankle Sprains

Classification of Sprains
1st Degree: 3rd Degree
Stretching of the ATFL Complete tear ATFL,
little or no edema CFL, and/or PTFL
tenderness total loss of function
maintain function. significant edema
2nd Degree
Partial tear of the ATFL
and/or CFL
moderate edema
some function loss

Ankle Sprains by Grade

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

Treatment (FYI)

AAFP(seetable3)
R.I.C.E.
Icefor20minutesonand20minutesoffforthefirst
twohours.
Afterthat,20minintervalsoverthenext4872
hours,
Compressionwrapwithdonutorhorseshoestofill
ingapsaroundmalleolusfrom2436hours;after48
72hourscontrastsbathswithROMexercisesfor4
minutesinwarmand1mininicewater.

Achilles Tendonitists
Causes
Rapidly increasing training effort
Adding hills or stair climbing to
training
Starting too quickly after a layoff
Poor footwear
Excessive pronation
Tight posterior leg muscles
If left untreated, it may progress to
a complete rupture.

Achilles Tendon Rupture
Most frequently ruptured
tendon
Complete ruptures are due to
eccentric loading during abrupt
stopping, landing from a jump.
Usually a popping sound is
heard with a complete tear.
There may or may not be an
obvious gap 2 to 6 cm from the
calcaneus attachment.
Treatment may or may not
include surgery but both require
immobilized for 3 months.


Plantar Fasciitis

The plantar fascia runs from the calcaneus to the

metatarsals.
This tight band acts like a bow string to maintain the
arch of the foot.
Plantar fasciitis refers to an inflammation of the
plantar fascia.

Plantar Fasciitis
Inflammation is usually
due to repeated
trauma to where the
tissue attaches to the
calcaneus.
The trauma results in
microscpic tears at the
calcaneus attachment
site.
This may produce heal
spurs

Plantar Fasciitis
Pain is worse in the morning
or after a period of inactivity
Causes

High arch
Excessive pronation
Footwear (worn out, stiff)
Increase in intensity

 Turf Toe
Turf toe is really a bruise or sprain that occurs at the base
of the big toe at the joint called the metatarsal phalangeal
joint.
It usually occurs when the toe is jammed forcibly into the
ground or, more commonly, when the toe is bent
backward too far (hyperextended)
It causes significant pain and swelling at the base of the
big toe.
It can be a significant problem because players use the
toe when they run and plant and push off.


Ankle Exercises
Calf stretch
Soleus stretch
Resisted dorsal
and plantar flexion
Heel raises
Step-up
Jump rope
Ankle Exercises
Wobble Boards