MRS. REED'S HEALTH SCIENCES - Home



Chapter 19

Discussion Questions

1. Identify and describe the anatomy of the ankle and lower leg.

2. How can ankle injuries be prevented?

3. Demonstrate the steps that should be taken when assessing ankle and lower leg injuries.

4. Describe the three types of ankle sprains.

5. Contrast the management of grade 1, 2, and 3 ligament sprains.

6. What is the usual mechanism for fractures of the ankle?

7. Describe the various injuries that can occur to the Achilles tendon. Indicate their etiology and symptoms and signs.

8. What tendons are most likely to develop tendinitis around the ankle?

9. Discuss the etiology, symptoms and signs, and management of the various acute or traumatic injuries that can occur in the lower leg.

10. What are the possible causes of medial tibial stress syndrome?

11. Contrast the acute anterior compartment syndrome with the chronic type.

12. Describe the various overuse problems that can occur in the lower leg.

13. Describe the appropriate progression of treatment that should be used in the rehabilitation of ankle and lower leg injuries.

Class Activities

1. Students should pair up and identify and palpate the bony landmarks, ligamentous structures, and muscle tendons associated with the ankle and lower leg as they are discussed in class.

2. After proper instruction, each student should demonstrate that he or she can perform a thorough evaluation of an ankle or lower leg injury.

3. Present the signs and symptoms of an injury or condition. Have the students identify it and explain how to manage it.

4. In groups of four or five, have students interview one athlete who has experienced an injury to the ankle or lower leg. From their interaction, the group can submit a 3 to 5 page typewritten report that covers as many of the following evaluation procedures as possible:

a. History

b. Initial evaluation of injured structures

c. Observational data gathered immediately after the injury

d. Bony and soft tissue that were palpated

e. Extent of the athlete's range of motion, or lack of it

f. Stress tests or special tests that were performed to determine the extent of the injury

g. Any circulatory and neurological tests that were performed

h. Immediate management (e.g., compression, splinting, etc.)

i. Follow-up care (doctor's referral, surgery, etc.)

j. Planned rehabilitation program and various exercises used to prepare the athlete for full participation

WORKSHEET ANSWERS

Matching

1. J 5. F 8. A

2. B 6. I 9. G

3. E 7. H 10. C

4. D

Short Answers

11. RICE over an extended period of time. After hemorrhaging has subsided, an elastic wrap can be lightly applied for continued pressure, and the athlete can be sent home. The patient should begin stretching and strengthening the heel cord complex as soon as possible. A lift should be placed in the heel of each shoe to decrease stretching of the tendon

12. A firm grasp of the contracted muscle, together with mild, gradual stretching, relieves most acute spasms. An ice pack or gentle ice massage may also be helpful in reducing spasm.

13. Volkmann's contracture

14. Posterior tibialis and the peroneals

15. Ultrasound, limited activity, heel lifts, and massage

16. A moderate to severe inversion sprain or forceful dorsiflexion of the ankle can tear the peroneal retinaculum, allowing the peroneal tendon to dislocate out of its groove.

17. Two of the following:

Faulty postural alignement

Muscle fatigue

Body chemical imbalance

Lack of proper reciprocal muscle coordination between anterior and posterior aspects of the leg

Fallen arches

Overuse stress

Listing

18. Weakness of foot dorsiflexion or extension of the great toe

19. Decreased ability of the peroneal tendon to evert the foot

20. Paresthesia of the web space between the first and second toe or over the foot's entire dorsal region

21. Fallen arches

22. Prolonged stage of pronation

23. Foot inadequately stable on toe-off or a cavus foot

Essay

24-26. (See pages 558 and 560 in text)

Constant heat in the form of whirlpools and ultrasound therapy gives positive results and, together with supportive taping and gradual stretching, affords a good general approach to the problem. Phonophoresis and iontophoresis also have been effective. Ice massage to the skin region and taking two aspirin have been beneficial before a workout. Exercise must also accompany any therapy program, with special consideration to the calf muscles and the plantar and dorsiflexion movements of the foot.

Injury Assessment

27-29. Refer to pages 553-554 in your textbook.

30-32. Refer to pages 544 and 551 in your textbook.

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