Leg Problems : Outline

1
(No Transcript)
2
Leg Problems Outline

• Gross Anatomy
• Achilles Problems
• Compartment Syndromes
• Shin Splints (MTSS)

3
LEG PROBLEMS CONT

• Stress Fractures
• Signs, Symptoms and Treatments
• Prevention programs

4
GAIT CYCLE
? 25 stance
5
Pronation
Supination
6
Pronation is the impact absorption phase of
gait. We either pronate too much, not enough or
just right.
7
As weight is transferred from the outside of the
foot to the inside of the foot, the leg
internally rotates. As weight shifts from
inside to out, external rotation of the leg
occurs.
8
Reminder Muscles
of the leg.
9
(No Transcript)
10
(No Transcript)
11
Flex. Hallucis Longus
Achilles Tendon
Flex. Digitorum Longus
P. Longus
Tib. Posterior
P. Brevis
P. Tertius
Tib. Anterior
Ext. Digitorum Longus
Ext. Hallucis Longus
12
COMPARTMENT SYNDROMES Traumatic and Exertional
13
Volume demands in Compartment.
Pressure in comp.
Muscle swells and dumps fluid.
Compromise of capillary profusion.
14
Muscles are attempting in work in a hypoxic
environment. Not only is this difficult, it is
painful and muscles continue to swell in a
hypoxic environment.
15
Nerves are the first structures to show signs of
hypoxia
16
SENSATION
17
Compartment Evaluation

• Test strength x 10
• Stretch muscle
• Palpate for firmness
• Examine skin.

18
Anterior
Left Leg
19
Anterior Compartment Area of Sensory Deprivation
20
LATERAL
Left Leg
21
Deep Posterior
Pain on palpation middle to lower third of
postero-medial tibia.
Sensory deprivation to plantar foot.
22
Measuring Compartment Pressures
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
It is not how high the pressure is during
running it is how long it takes to return to
normal.
Bad
Ideal
20
Insertion
28
GENERAL TREATMENT GUIDELINES
Stretching, gradual motion before activity. Icing
after activity. Stretching, stretching Modificatio
n of activity
29
SHIN SPLINTS
30
(No Transcript)
31
PERIOSTITIS an inflammation of the outer
covering of the bone.
FASCIITIS and inflammation of the fascial
covering of the muscle.
32
Shin Splints and M.T.S.S..History of excessive
weight bearing (jumping,running, or standing for
prolonged periods of time, in combination with
improper shoes.
33
Shin Splints and M.T.S.S.
Associated with varus alignment (bowlegs) of the
lower extremity and excessive pronation.
Improper footwear may be a factor.
34
GENERAL TREATMENT

• Icing
• Stretching
• Strengthening
• Motion Control of foot.

35

SHIN SPLINTS
Tibialis Posterior is eccentrically working to
slow down the internal rotation of the leg on the
foot during pronation of the foot. Muscle
thought to pull away from bone.
36
MEDIAL TIBIAL STRESS SYNDROME
Soleus muscle slows down the internal rotation of
the tibia on the foot during pronation. Pain in
lower medial third.
37
(No Transcript)
38
Postero-medial Tibia
39
ACHILLES TENDON
Gastrocnemius, Soleus, Plantaris
Tendon and Paratenon
40
ACHILLES TENDONITIS
41
Grade I No discomfort prior to activity. No
limitations. Stiffness after activity.
42
Grade II
Discomfort before activity. Pain during
activity. Pain and tightness after.
Nodules
43
Grade III
Pain and stiffness before activity. Pain limits
quality and quantity of activity. Very painful
after.
44
ACHILLES THICKENING
45
Achilles Tendon Rehab
46
(No Transcript)
47

48

DEEP
POSTERIOR
COMPARTMENT
49
ICING BEFORE AND AFTER ACTIVITY
50
Stretching of Achilles. Squeezing lump out of
tendon. Curtail injurious activity and
substitute other fitness activities. Heel lifts
in shoes.
51
Achilles Paratenonitis
52
Achilles Paratenonitis
Irritation of the paratenon. Caused by
overuse. Rubbing of paratenon on the achilles
tendon. Pain, crepitation. STOP! Icing,
stretching.
53
ACHILLES RUPTURE
Previous multiple minor trauma.
Passive stretch plus active contraction
TEAR!
54
EXAMINATION
History Palpation Thompson Test Strength Testing
55
Thompsons Test
56
Ruptured Achilles Tendon
Tear 1 above heel or at musculotendinous
junction. Palpate for gaps. Manually test for
strength. Have athlete do single leg toe raise.
57
ACHILLES RUPTURE
58
Impact absorbed by shoe,
muscles, bones (joints). Too strong of a
muscle pull on one side of the bone
59
ACTIVITY PAIN
Pain at onset, reduced on warm-up, after pain
s.p.
Pain escalates as activity continues.
c.s.
s.f.
Pain before activity, same during and the same
after.
60
NIGHT PAIN
s.p.
No night pain.
c.s.
No night pain.
s.f.
Deep aching pain that wakes athlete.
61
REPEATED MUSCLE CONTRACTIONS
s.p.
No effect.
c.s.
Cause a slowing and a weakening of contraction
(x10)
s.f.
No effect.
62
SENSORY CHANGES
s.p.
No Changes.
c.s
Potential changes corresponding to compartment.
s.f.
No Change.
63
MUSCLE STRETCH
s.p.
No change.
c.s.
Stretching a muscle within the affected compart.
will increase pain.
s.f.
No change.
64
QUESTIONS?