The Lower Leg

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The Lower Leg
ANATOMY
 Bones
 Tibia
 Fibula
MUSCLES
 The
muscles are in four compartments
with 2-4 muscles in each compartment
 Compartments are held together by
fascia
MUSCLE COMPARTMENTS
1.
2.
3.
4.
LATERAL – everts the ankle
ANTERIOR – dorsiflexes the ankle
DEEP POSTERIOR – plantarflexes the
ankle (the calf muscle)
POSTERIOR MEDIAL – inverts and
plantarflexes the ankle
 Page
317 and 318
Major Muscles and Actions
 Anterior
Tibialis - dorsiflexor
 Peroneals - evertors
 Gastrocnemius – plantarflexor
 Soleus – plantarflexor
 Posterior Tibialis – invertor
INJURIES
 Muscle
Cramps
 Sudden,
violent contraction of the calf
muscles
 Causes:

Fatigue, overtraining, dehydration, poor
nutrition, injury, poor flexibility
– sharp pain in the calf, toe is pointed
 Tx: gentle stretch, ice, hydrate, can return
to play if subsides and does not continue
 S/S:
INJURIES

STRESS FRACTURE
 Cause: Repetitive pounding with training
 S/S: Hurts more with and after activity,
pain on one spot on bone
 Tx: Requires x-ray, possibly a bone scan
 If positive, no weight bearing for at least
2 weeks, no running for 4-6 weeks
INJURIES
 MEDIAL
 ‘SHIN
TIBIAL STRESS SYNDROME
SPLINTS’
 Occurs in distal 2/3 of posterior/medial tibia
 Causes: pronation, lack of flexibility in the
lower legs, hard surfaces, hills, muscle
weakness, poor shoes
INJURIES
 MEDIAL
 S/S:
TIBIAL STRESS SYNDROME
resisted plantar flexion and inversion
should hurt, pain is just off the tibia
 Treatment : prevention (shoes, arch
support), strengthening, stretching, ice
massage, contrast bath, tape arches
Refer to MD if no improvement to rule out
stress fracture
INJURIES
 COMPARTMENT
 Occurs
SYNDROME
when pressure increases in
compartment and shuts off blood and
nerve supply to the foot
 Most often occurs in the anterior and deep
posterior compartment
 THREE TYPES
Acute
 Acute Exertional
 Chronic

INJURIES
 ACUTE
COMPARTMENT SYNDROME
 Medical
emergency
 Causes: direct blow to the lower leg
Usually in the anterior lower leg
 Symptoms come about several hours later

 S/S:
compartment is tense, warm, red and
shiny; complains of (c/o) deep aching pain;
circulation and sensory problems in foot
 Tx: ice, elevation – refer to ER immediately
INJURIES
 ACUTE
EXERTIONAL/CHRONIC
COMPARTMENT SYNDROME
 Cause:
running and jumping activities
 S/S: With activity, foot goes to sleep,
crampy pain, and tingling. When activity
stops, it goes away. Consistent as to when
it comes on with activity
 Tx: ice, activity modification, stretching,
massage, and referral to the doctor
(possible surgery)
INJURIES
 ACHILLES
 Chronic,
TENDINITIS
overuse condition that comes
about gradually
 Causes: running and jumping, repetitive
stress, running up hills, poor flexibility
 S/S: achy type pain, Achilles is tender on
palpation, pain with standing plantarflexion,
may have crepitus, hurts to warm up and to
cool down
INJURIES
 ACHILLES
TENDINITIS
 TREATMENT
If there is crepitus, no running for 1-2 weeks
 Stretch!
 Heel lift in both shoes
 Orthodics
 Heat and/or ice

INJURIES
 ACHILLES
 Achilles

TENDON RUPTURE
in largest tendon in body
For Gastronemius and Soleus muscles
 Most
common tearing spot is 1” above its
insertion on the calcaneus
 Causes: Sudden, forceful plantar flexion and
extension of the knee, age, previous tendinitis
 S/S: Feel and hear a snap, “kicked in the leg”,
very weak plantarflexion, no Achilles observed
 Tx: Immobilization to ER, surgery?
TEST FRIDAY, FEB 20th
 FOOT
 ANKLE
 LOWER
LEG
 ANATOMY
 INJURIES
 Causes
 Signs
and Symptoms
 Treatments
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