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Introduction
Many factors contribute to the development of injuries in the lower leg and ankle. Research has indicated that the likely reason for the occurrence of leg injuries is due to its overuse (Hreljac, Marshall, & Hume, 2000). The mechanics of the lower limb also play a part. However, research has suggested that the abnormality of the structure of the leg also increase the chances and risks for injury. Some studies have been carried out to assess the types of injuries sustained by different sportsmen but the relationship between the injury patterns and the structural deviations in different sportsmen has not been established.
Leg injuries may be seen as any injuries that involve the bone, the muscle, the joints or ligaments in the leg. There are various types of leg injuries and one of them is a fracture. This involves the breaking of bones in the leg. Another form of injury is a dislocation. This is whereby a bone gets out of the joint for whatever reasons. A sprain is another form of leg injury. This injury involves the ligaments and it is whereby the ligament stretches and tears. A sprained ankle, for example, is one of the commonest ligament injuries of the leg. This is normally accompanied by swelling and paining of the outside side of the ankle.
A strain is another type of leg injury. This is said to have occurred when the muscle stretches and tears. An example is the pulled muscle. Another type of injury is the muscle overuse injury, which is mainly characteristic to sports or exercise. A muscle bruise is an injury that occurs when the leg gets a direct blow. The thigh muscles, for example, may suffer from a muscle bruise. Bone bruises may also result from a direct blow. The hip may suffer from such a bruise.
Accidents and injuries normally occur in the field or in any other situation. However, there are several ways one can prevent such injuries from occurring. When injury occurs, the first thing to do is to diagnose it then treat it. For a leg to heal completely from an injury, the individual must spend a specific amount of time in treatment and rehabilitation. This paper will look at some of the common injuries of the ankle and the lower leg, show how to diagnose them, treat them and prevent them from recurring.
Anatomy and function of the lower leg and ankle
The lower leg, also known as the lower limb, of a human leg includes the area that extends from the knee to the ankle. This area is also referred to crus. The back portion of the lower leg is called the calf while the front part is the shin. The bones that are in the lower leg include the tibia and fibula, also known as the shinbone and the smaller, rear calf bone respectively. The kneecap is the bone located in front of the knee.
Normally, the huge joints of the lower leg are aligned on a straight line that demonstrates the mechanical longitudinal nature of the limb. This straight line stretches from the head of the thighbone, through the knee joint to the center of the ankle. This straight line is known as the Mikulicz.
The ankle is the junction between the leg and the foot. This joint is formed when the two portions of the leg meet and it is called the talocrural joint. It forms a synovial hinge joint that joins the rare end of the shinbone to the smaller, rare calf bone in the lower leg at the opposite tip of the talus. The ankle bares three bones. These are the talus, tibia and fibula. It is also bound by four strong ligaments, which include the calcaneofibular ligament, posterior talofibular ligament, deltoid ligament and the anterior talofibular ligament.
The muscles of the legs may be classified into two depending on its functions. Some are responsible for dorsiflexion of the foot that cause the toes to be brought closer to the shin. These muscles work by reducing the angle between the dorsum and the leg. Examples of muscles that work in this way include the extensor hallucus longus, the extensor digitorum longus, the tibilais anterior and the peroneus tertius muscles. These muscles form the first of the four compartments of muscles in the lower leg.
The other category of muscles causes plantarflexion, which is the movement that increases the angle between the shin and the front part of the leg. These muscles fall in the second compartment of muscles in the lower leg. This is the lateral compartment. The muscles that are contained in this category include the peroneus brevis and the peroneus longus muscles. This can be demonstrated as one presses the pedal of an automobile using the foot.
The third compartment of muscles is the posterior compartment. This compartment holds the large muscles. These muscles are called the calf muscles and include the soleus and gastrocnemius muscles. These muscles attach to the Achilles tendon and function through plantarflexion. The fourth category of muscles of the lower limb is the deep posterior compartment. As the name suggests, these muscles are located deep within the back of the lower limb.
The muscles found in this compartment include the flexor hallucus longus, which moves the big toe, the tibialis posterior muscle, which pulls in the foot and the flexor digitorum longus, which moves the toes. The most powerful muscles in the legs are those that make up the calf. These are the gastrocnemius and soleus. The muscle on the front lower leg is the anterior tibialis. They are related to the shin splints.
The lower leg and the ankle of the human leg are critical for the movement of the individual. The complex muscles in the leg are coordinated by the brain to facilitate the functions such as standing, kicking, running or walking, among other activities that can be achieved by the legs. This enables people to run in marathons, participate in swimming competitions and play football.
Common injuries of the ankle and the lower leg
There are various injuries that can be sustained in the lower leg and ankle. The ankle, for example, could sustain a fracture or a sprain. The injuries that occur at the ankle get their definition from the type of tissue that is affected. The injury could occur at the bone, the tendons or ligaments. The major injuries that could be sustained on the lower leg are the shin splits, Achilles, lower leg contusion and calf strains. These injuries to the lower leg and ankle are mostly sustained during sports.
Ankle fracture
How it occurs
An ankle fracture could be said to have occurred when there is a break of the anklebones. Three bones meet at the ankle and a break of either one or more of them would result in an ankle fracture. A certain research suggested that 59% of all injuries involved that ankle (Ekstrand & Gillquist, 1983).
How it is diagnosed
An ankle fracture could be diagnosed through the observation of the symptoms and signs. The symptoms are similar to those of the sprains but the difference is that the pain endured from a fracture is more intense compared to that of a sprain. A clinical examination is necessary to determine the exact location of the pain and condition of the vessels and nerves around that area. Diagnosis could be through the use of X-rays to show the exact location of the breakage.
How to treat it
The type of treatment offered for fractures depend on the stability of the ankle joint. Treatment with skeletal traction has been performed successfully and this did not require surgery to be done (Allen, Nash, Ioannidies, & Bell, 1984). However, if the fracture pattern were considered not to be stable, it would require surgery to be performed. This surgery is known as an open reduction and internal fixation surgery. This involves the implanting of metal structures to hold the bones into place. The metals are permanently implanted. After the surgery, there is likelihood to develop distal tibiofibular synostosis and this would cause some symptoms to be observed. However, this is not an issue since it does not require further treatment (Albers, Kort, Middendorf, & Dijk, 1996).
Rehabilitation
After surgery, the ankle would need to remain immobilized for a particular period in order for it to heal completely. A cast or splint is placed in order for the ankle to remain immobilized and it would require being in place for at least six to eight weeks for it to completely heal. If the patient takes good care of the fracture and avoids further injury, the cast would be removed after that period elapses.
Prevention
Preventing ankle fractures from occurring may be difficult because most of them occur accidentally. However, the best prevention may be to be very careful while performing activities that involve the use of the lower leg. This includes during sports and any other similar activity. One should be careful while jumping from high elevations since landing awkwardly might cause an ankle fracture.
Ankle sprain
How it occurs
An ankle sprain is an injury that occurs in the ligaments. A sprain results when a greater that usual stretching force is applied to the ligaments at the ankle. This occurs mainly when the foot is inverted or turned inwards. Several situations or incidences can cause this to happen. One of them is the awkward planting of the foot when running or stepping on the floor. Research has also indicated that runners who go a whole year without a break from training risk incurring lower extremity injury (Gent et al., 2007).
How it is diagnosed
A physician needs to examine the leg to ensure that no serious injuries other than a sprain has occurred. This may be the examination to ascertain that a fracture has not occurred and that the arteries and the nerves are not injured. He will need to handle the foot and move the ankle joint to determine which bones were involved. X-rays or CT scans may be required to ascertain the absence of a fracture to the ankle. Sprains, in most cases, may be endured and the athlete or any other victim may be seen going on with the activity despite of the pain. The pain is a usually dull or sharp one that is felt at the ankle.
How it is treated
The treatment for ankle sprains may differ depending on its severity. Those who sustain minor sprain injuries could be treated and released within three days but the severe ones might last up to six months on treatment. The treatment for the minor ankle injury only involves the immobilization of the foot. Unstable ankle injuries might need the intervention of a doctor to perform surgery.
Rehabilitation
A victim of a sprain injury should be careful not to incur further injury to the ankle as this would lengthen the time required for the healing process. The victim should therefore be involved more in resting rather than activity. A serious ankle sprain might require the foot to be placed at a higher elevation to facilitate the healing process. For a serious ankle sprain to heal completely, the cast would need to be in place for up to six months. A minor sprain could take only two or three days to heal completely.
Prevention
After an ankle sprain has occurred, the risks for further injury are increased incredibly and in order to prevent this from happening, one need to perform exercised on the lower leg. This would reduce the risks for sustaining further injury. To prevent sprains from occurring, it would be important to wear shoes that provide good support or those that allow for the insertion of braces inside. One should also avoid playing on uneven or slippery surfaces. During sports, warming up before starting the intense activity is important to reduce the chances of an ankle sprain from occurring.
Calf strain
How it occurs
Calf muscle strain is an injury that occurs at the lower leg. Particularly, it occurs at the calf muscles and it is said to have occurred when it either tears or stretches. The injury could occur within the bulk of the muscle or at the tendons. Calf strain may occur when one lands badly after a long or high jump, after extreme sprinting or when one performs extensive exercise immediately before warming up the muscles. A certain research by Hawkins and Fuller (1999) suggested the importance of performing warm-up exercises. The same research indicated that the lower leg is usually very susceptible to injury because it endures a lot of stress when one is running, jumping, turning or stopping suddenly.
How it is diagnosed
To diagnose the type of injury and prove it a calf muscle strain, one needs to have some swelling and bruising on the damaged area. This would also be accompanied by some sore and pain when touched. Pain may be experienced when one points the foot directly towards the ground.
How to treat it
This type of injury on the calf muscles could be easily treated if it were not too bad. This could be achieved within few days of gentle stretching. However, if the injury is severe, the victim should ice the area immediately. This should be done at regular intervals during the day. One should avoid putting any weight on that leg and elevate it as soon as possible. Elevation of the leg would reduce the swelling.
Rehabilitation
During the treatment period, one should perform a number of exercises to aid in re-strengthening the calf muscles and fully recover from the injury.
Prevention
Research provides the best prevention for this type of injury and this involves the performing of some warm-up exercises before participating in intense sporting activity and improving the fitness training programmes (Hawkins & Fuller, 1999). This injury is mostly sustained during sporting events that require intense sporting activity. Warming up is essential since it enables the blood rich in oxygen to reach the working muscles and enhances its performance. Warming up is a simple exercise but it would save someone the trouble of enduring such pains and injuries as the calf strain.
Shin splint injury
How it occurs
This is an injury associated with the overuse of muscles of the lower leg. This condition mainly affects the sportsmen and especially those in athletics and acrobatics. This is because the injury occurs if there is repeated pounding of the feet onto hard surfaces. This injury affects the muscles, tendons or the bone covering. The affected part may stretch and tear or get irritated.
How it is diagnosed
Shin splint injury usually produces a vague pain in the leg or the pain may be felt along the shin. Pain may also be felt when one tries to run or jump. Some swelling may also be seen along the shin.
How to treat it
Treatment may depend on the intensity of the injury. If the shin splint injury were a minor one, then gentle stretching of the calf muscles would perhaps be enough for the healing process. Research has suggested that a person with minor shin injury may continue when the syndrome is present. However, in case of severe injury that involves stress fractures, this would require different treatment since this injury involves more focal pain (Holder & Michael, 1984).
Rehabilitation
A minor shin split injury could take about two weeks to heal while severe ones take longer. During the treatment process, one should stretch the muscles in front of the leg. This could be done by sitting with the legs straight. One can also press the toes of the injured leg downwards. While doing this, one would feel the pull in the front leg muscle.
Prevention
The best prevention for this type of injury is to perform flexibility training, calf stretches and exercises that would strengthen the ankle. Warm-up exercises are important to prevent the occurrence of this injury since it helps increase the temperature of the blood in the muscles and increase the availability of oxygen in the muscles. This helps lubricate the connective tissues and muscles and help reduce risk of overstretching. Footballers are also advised to wear shin guards (Ekstrand & Gillquist, 1983) to prevent shin split injury.
Conclusion
The lower leg and the ankle are highly susceptible to common injuries that may be either minor or severe. There are various ways of diagnosing these injuries since every injury has its characteristics. This diagnosis would help in determination of the type of injury and therefore, aid in the treatment process. Rehabilitation of the injury is also important to ensure full recovery and to prevent further injury from occurring. However, prevention is better than cure.
References
Albers, G., Kort, A., Middendorf, P., & Dijk, N. (1996). Distal tibiofibular synostosis after ankle fracture. The Journal of Bone and Joint Surgery, 78(2), 250-252. Web.
Allen, M., Nash, J., Ioannidies, T., & Bell, P. (1984). Major vascular injuries associated with orthopaedic injuries to the lower limb. Annals of the Royal College of Surgeons of England, 66(1), 102-104. Web.
Ekstrand, J., & Gillquist, J. (1983). Soccer injuries and their mechanisms: A prospective study. Medicine and Science in Sports and Exercise, 15(3), 267-270. Web.
Gent, et al. (2007). Incidence and determinants of lower extremity running injuries in long distance runners: A systematic review. British Journal of Sports Medicine, 41(1), 469-480. Web.
Hawkins, R., & Fuller, C. (1999). A prospective epidemiological study of injuries in four English professional football clubs. British Journal of Sports Medicine, 33(1), 196-203. Web.
Holder, L., & Michael, R. (1984). The specific scintigraphic pattern of shin splints in the lower leg: Concise communication. Journal of Nuclear Medicine, 25(8), 865-869. Web.
Hreljac, A., Marshall, R., & Hume, P. (1999). Evaluation of lower extremity overuse injury potential in runners. Medicine and Science in Sports and Exercise, 32(9), 1635-1641. Web.
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