ANKLE
    
The ankle is a very important in our everyday life, if it is fractured (broken), sprained or strained, life could be difficult.  Since the ankle supports the entire weight of the body, it is more susceptible to injury.  On an average yearly basis an estimated two million people treat for ankle injuries.

Ankle injuries usually occur by an unexpected twist of the ankle.  The most common ankle injuries are a STRAIN, which is when a muscle or tendon overstretches. A Sprain is more serious and occurs when a ligament, which connects one bone to another, overstretches or tears.  If a ligament tears, it may pull a piece of the bone with it, known as an Avulsion Fracture.  To rule out a fracture or dislocation, x-rays are performed. Most ankle sprains and strains heal within 2 to 6 weeks. Treatment usually consists of rest, ice, compression, and elevation.  Severe sprains and strains may take up to 12 weeks to heal and may require physical therapy.  Ankle sprains and strains rarely require surgery.

A Fractured ankle is serious and intensely painful, heals slowly, and may present complications later in life, such as traumatic arthritis and chronic pain. An orthopaedist requests numerous x-rays to determine the nature and position of the fracture and what corrective actions to take. Fractures of the ankle can occur in various ways and consist of:

Stress Fracture is a crack in the outer shell of the bone, bearing limited weight and the possibility of a cast.

Simple Fracture is more serious, involves a complete break of the bone into two pieces, and may require surgery to reset the bone.

Comminuted Fracture of the bone is shattered into several fragments and surgery can be extensive and may require screws, metal plates, pins, or staples to stabilize the pieces of the bone in position.

            If complications arise later in life such as traumatic arthritis or chronic pain from an ankle injury or fracture, than an arthroscopic surgical procedure may be necessary to remove bone fragments, scar tissue, and damaged cartilage.

KNEE

The knee is the largest joint in the body and also the most complex.  It is made up of four bones (tibia, fibula, patella, and femur) that are connected by ligaments, tendons, and muscles.  There are four main ligaments:  anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). 

ANTERIOR CRUCIATE LIGAMENT INJURY can occur in various ways, but the most common are a twisting injury or a sideways blow to the knee.  The ACL is one of the main stabilizing ligaments of the knee.  In most cases the knee will be painful and swollen.  Depending on the severity of the injury the knee may be unstable and “give out” or “collapse”.  The ACL does not have the ability to completely heal once injured.  A general knee rehabilitation program is the most important factor in improving knee function and stability.   

POSTERIOR CRUCIATE LIGAMENT INJURY most commonly occurs with a direct blow to the front of the upper tibia (shin bone).  The PCL helps stabilize the knee by preventing excessive backward movement of the shin bone on the femur (thigh bone).  These injuries are less likely to cause instability, so it is less likely to be detected.  The PCL does not have the ability to completely heal once injured.  A general knee rehabilitation program is the most important factor in improving knee function and stability. 

MEDIAL AND LATERAL COLLATERAL LIGAMENT INJURIES can vary in severity.  The MCL is usually injured by a blow to the outer side of the leg.  The LCL is usually injured by a blow to the inner side of the leg.  A pop or snap may be heard or felt after the injury.  A general knee rehabilitation is the most important factor in returning the individual back to their previous level of activity. 

MENISCUS (CARTILAGE) INJURIES occur with a combined loading and twisting of the knee.   The meniscus is a shock absorber that lies between the femur (thigh bone) and the tibia (shin bone).  There is a medial (inner) and lateral (outer) meniscus and injury to either one is often referred to as torn cartilage.  Most patients complain of pain and swelling, with the pain intensifying upon bending or twisting the knee.  A MRI is required if this type of injury is suspected along with arthroscopic surgery which aids in the diagnosis and treatment of meniscal injuries. 

PATELLAR DISLOCATION (DISLOCATED KNEECAP) can occur after a plant and twist type of injury or a contact injury.  The patella or kneecap is the bone in front of the knee.  It glides up and down the groove in the thigh bone (femoral groove) as the knee bends and straightens.  When the patella comes completely out of the femoral groove it is called patellar dislocation, or partially which is termed patellar subluxation.  The knee may not be as “normal” as the uninjured knee.  A general knee rehabilitation is the most important factor in improving knee function and stability. 

OSTEOARTHRITIS in the knee may present as pain, swelling, stiffness, and “locking”.  This is a chronic disorder that progresses over time.  It can affect one’s ability to run or walk up and down stairs.  There is no cure, but there are many different types of therapy. 

THIGH

The thigh is the area between the hip and the knee.  It contains a thick and strong bone known as the femur.  The hamstring and the quadriceps are the main muscles in the thigh. Many common injuries may occur to this area of the leg such as:

Contusions- When a muscle is crushed against the bone.  This type of injury causes internal bleeding in the muscle.  Bruising may or may not occur, but loss of function and pain are usually present after this type of injury.  Contusions may occur in either the hamstring or the quadriceps.  An impact to the front of the leg will cause a quadriceps contusion (dead leg or charley horse), while impact to the back of the leg will cause a hamstring contusion.  Immediately following this type of injury, you should see a doctor so that the bleeding can be monitored.  In addition, rehabilitation with a physical therapist is likely to be required in order for full function to return to the muscles.

Strains- A strain is a tear in a muscle, which is usually caused by an overload on the muscle or by moving the muscles too fast.  A muscle can completely rupture or it may just have slight tears.  Strains of the thigh may occur in the hamstring muscle or the quadriceps muscle.  A hamstring strain usually results in a sudden sharp pain in the back of the leg, muscles may go into spasm and sometimes swelling and bruising will occur.  Tightness in the thigh is also a characteristic of this type of injury.  A quadriceps strain is very similar to a hamstring strain but the pain is in the front or side of the leg not in the back.  Also, some pain may be felt whenever one tries to straighten the knee against resistance (if trying to lift something up with the foot or ankle).  This injury may cause an inability to walk properly and pain may be felt when walking.  Some swelling and bruising may occur.   A rehabilitation program with a physical therapist may be required.

Thighbone Fracture: To break the thighbone (femur) across its length requires a lot of force, such as in a car accident.  A break of the thighbone may result in life-threatening injuries to other body systems.  A broken thighbone is usually obvious. Severe pain, deformity and swelling, and inability to move the leg are some characteristics.  The injured thighbone may be shorter than the uninjured bone because of the strong thigh muscles pulling the bones out of alignment.  This will most likely cause extensive bruising.  A physician must examine the injury to evaluate the amount of blood loss and permanent damage to the nerves. Many x-rays may be required to determine the extent of the injury.  The thighbone will need to be realigned and immobilized until it heals.  An orthopaedic surgeon is more than likely to be the one who decides the treatment type.
Casting. This method is usually required for young children who have this type of injury (under 8 years, depending on size and weight).

LOWER LEG

The three main muscles of the lower leg are the gastrocnemius, soleus, and anterior tibialis.  The gastrocnemius and the soleus are the calf muscles.  The anterior tibialis is the muscles blamed for shin splints.  The Achilles tendon is a culprit of lower leg pain and susceptible to injury.  The lower leg has two bones, the tibia (shin bone) and the fibula. 

SHIN SPLINTS is pain along the tibia either on the front outside or on the back inside portion of the lower leg.  The first risk factor of injury is overtraining, especially in beginner runners.  Running on hard, jarring surfaces can cause shin splints too. 

ACHILLES TENDONITIS is a chronic injury that occurs primarily from overuse.  The Achilles tendon is the largest and most exposed in the body.  The pain tends to come on gradually over time.  If your Achilles tendon is sore, you need to pay attention to it and rest. 

STRESS FRACTURES are an overuse injury or a repeated impact on hard surfaces.  High impact sports such as track, gymnastics, and basketball can increase the risk of stress fractures.  In all of these sports, the repetitive stress on the foot striking the ground can cause trauma.  The most important treatment for a stress fracture is rest. 

ABRASIONS (ROAD RASH) are very common injuries that are usually caused by an accident on a hard surface.  The ground friction causes layers of skin to rub off.  They cause a great deal of pain because some nerve endings are exposed. 

 CALF STRAIN (TENNIS LEG) is caused by ripping away of part of the gastrocnemius or soleus muscle from the Achilles tendon.  It occurs high in the back of the leg.  This is common in running sports that require a quick acceleration in changes of direction, such as tennis.