Explain common injuries that occur to the lower leg.
Demonstrate the ability to apply tapes, wraps, braces, and pads to the lower leg when preventing, treating, and rehabilitating injuries.
Explain and demonstrate evidence-based practice for the implementation of taping, wrapping, bracing, and padding techniques for the lower leg within a clinical case.
Acute and chronic injuries and conditions of the lower leg can result from direct force, excessive range of motion, rapid acceleration and/or deceleration, and repetitive stress. Sudden acceleration, such as that experienced by a sprinter pushing off from the blocks or a softball outfielder chasing a fly ball, can cause excessive plantar flexion and/or dorsiflexion of the ankle and can result in a strain or rupture of the lower leg musculature. Moreover, repetitive running and jumping can cause inflammation of, and injury to, the soft tissues. Common injuries to the lower leg include:
Contusions to the lower leg are caused by direct forces and typically involve the tibia and/or posterior musculature. The tibia is susceptible to injury because overlying soft tissue does not provide a lot of protection. Direct forces to the tibia often affect the periosteum and cause irritation. Contusions to the posterior musculature frequently involve the gastrocnemius (Fig. 5–1). These injuries are common in many athletic activities as a result of being kicked or struck with equipment.
Superficial muscles of the posterior lower leg.
Strains to the lower leg musculature are caused by a variety of mechanisms during athletic and work activities. Achilles tendon strains are caused by excessive dorsiflexion of the ankle1 (see Fig. 5–1). For example, a strain can occur as a soccer player suddenly decelerates, changes direction, and accelerates in the opposite direction off the right foot, causing excessive dorsiflexion of the right ankle. An inversion force to the ankle, excessive dorsiflexion, or a direct force to the posterior lateral malleolus can cause a peroneal tendon strain (Fig. 5–2). With a violent eversion and dorsiflexion or inversion and plantar flexion force, the peroneal retinaculum can tear, causing a peroneal tendon subluxation and/or dislocation (see Fig. 5–2). A subluxation and/or dislocation can result, for example, when a wrestler’s left foot is caught on the mat while the trunk is forced forward by an opponent during a takedown, causing eversion and dorsiflexion of the left ankle. Injury to the gastrocnemius, commonly the medial head, can result from activities involving rapid acceleration, deceleration, and jumping. Two common causes of gastrocnemius injury include dorsiflexion of the foot with forced knee extension (Fig. 5–3) and extension of the knee with forced foot dorsiflexion.