Lower Limb Injuries

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What is a Lower Limb Injury?

Patients’ mobility depends principally on the integrity and function of their lower limbs. Lower limbs are particularly prone to injuries due to daily life activities, sports, leisure and job demands. Generally, there are two types of injuries, acute injury which occurs as a consequence of a more rapid or high energy single impact and an overuse injury which results from low energy but high frequency insult. Understanding the mechanism of these injuries is essential for both prevention and their management.

The spectrum of probable lower limb injuries is extensive and therefore medical consultation is necessary in individual circumstances. Prompt medical attention and treatment plan adherence are critical for recovery and full restoration of function after a traumatic event.

Common Types of Lower Limb Injuries:

Soft Tissues Contusion

When the soft tissues are subjected to a blunt impact, the underlying blood vessels within the muscles or skin and underlying tissues are injured, resulting in a haematoma (blood leak) into the surrounding tissues. Swelling, blood collection, bruising, pain, sensitivity and function loss may occur temporarily. Rarely would there be a need of any serious intervention, as simple contusions usually heal spontaneously.

Joint Sprains or Joint dislocation

Sprains occur after an injury that causes stretching or tearing of ligaments and joint capsule and are due to sudden and/or extensive movement in the joint. Swelling, blood collection, bruising, pain, sensitivity and function loss may occur temporarily. Most of the sprains heal spontaneously. Dislocation is a consequence of higher energy trauma with full rupture of ligaments, and displacement of joint components. It is a medical emergency and needs immediate joint reduction.

Muscle and Tendon Strains and Ruptures

Involve the stretching or tearing of muscles or tendons. These injuries often occur due to sudden movements, overexertion, or direct trauma to the muscle or tendon. Severe pain and bruising with loss of function is often associated with strain. An incomplete tendon or muscle tear can heal spontaneously. A more severe injury can lead to complete muscle or tendon rupture, they often need surgical repair.

Bone Fractures

Lower limb fractures can involve the bones of the thigh, shin, or foot. Fractures can result from accidents, falls, or sports-related impacts. Minor fractures will heal spontaneously with minimal immobilization. Displaced or unstable fractures will need surgical reduction and fixation.

Achilles Tendon Injuries

Overuse can cause Achilles tendonitis (inflammation) over a period of time, usually necessitating a period of conservative treatment and rarely leading to surgical intervention. On the other hand, a sudden stretch to the Achilles tendon or a blunt injury to the posterior ankle can cause a complete rupture of the Achilles tendon – that, most often, will necessitate a surgical repair.

Overuse

A submaximal force on a bone or tendon will not cause a fracture or rupture immediately, however, after numerous repetitions it can lead to an overuse fracture or overuse tendon inflammation and/or rupture.

Examples:

Knee Sprains: Can be benign, but can also be associated with a more severe condition, such as anterior cruciate ligament (ACL) tears, meniscus tears, and patellar dislocation. These injuries often stem from sudden changes in direction, impact, or overuse.
Ankle Sprains: The most common lower limb injuries occur due to twisting or rolling of the foot and cause the ankle joint capsule and ligaments to be overstretched or torn. Most of them need a period of conservative treatment. They need not be ignored as, despite being benign, if untraded they can have devastating consequences to the ankle joint.

What does a Lower Limb Injury feel like?

The sensations experienced during lower limb injuries can. Common symptoms include pain, swelling, bruising, tenderness, stiffness, and difficulty in bearing weight or moving the affected joint. Depending on the injury’s severity, individuals might feel sharp or dull pain, instability, or a snapping sensation in the case of a tendon rupture. The sensations accompanying lower limb injuries vary widely. Pain is a common denominator, but is diverse, and depends on the type and severity of injury and involved body part, ranging from sharp and stabbing to throbbing and dull. Swelling, bruising, redness, inflammation, tenderness and loss of function are also common, and can be accompanied by instability, stiffness, or difficulty to weight bear on the limb or move the affected joint.

What causes Lower Limb Injury?

Causes of Lower Limb Injuries include:

High energy injuries: Falls from height or road traffic accidents lead to a combination of fractures, sprains, strains and contusions.
Overuse: Repetitive activities, such as running or jumping, without proper rest and recovery can result in strains and stress fractures.
Poor Conditioning, Inadequate Warm-up or Improper Technique: increase the risk of muscle and joint injury during sports.
High-impact sports: Soccer, basketball, and skiing put immense stress on the lower limbs and predispose to direct impact injury with or without fracture or severe joint sprain with ligament rupture.
Improper Footwear: leads to overuse problems (like plantar fasciitis or stress fractures), or an acute injury resulting from a slip and fall.

What are the non-surgical options for Lower Limb Injury?

Depending on the injury’s severity, non-surgical treatments include:

Rest decreases stress, reduces pain and promotes healing.
Ice and Compression diminishes swelling and pain.
Elevation helps with the management of swelling and improves blood circulation.
Physical Therapy including a gradual increase in intensity exercises and stretching aids in improving strength, flexibility, and recovery.
Prescription Medication or over-the-counter pain relievers help manage pain, increased muscle tension, swelling and inflammation.
Immobilisation in a cam boot, brace or even a cast can be occasionally necessary to protect the injured limb.

What are the surgical options for Lower Limb Injury?

When conservative treatment is insufficient, surgical intervention might be recommended:

Fracture Fixation

A fracture may need either reduction or fixation or both. A closed reduction of a fracture may be necessary to realign bone fragments, further, the limb will be immobilised with a cast. Occasionally, the fracture site needs open surgery to realign the broken bone. Further, metal rods, nails, screws and plates or external fixators can be used to stabilise the broken bone, until the fragments heal together. The bone heals on average between 6 weeks to 6 months.

Dislocation Reduction

Either sedation or formal surgery may be needed to put the dislocated joint back in its proper position. After a successful reduction, there might still be a need for further surgical joint stabilisation.

Ligament or Tendon Repair

Surgical repair or reconstruction is often required for complete ruptures of ligaments or tendons. Achilles tendon tears, for example, may need only suturing of the tendon. Tears of the cruciate ligaments of the knee, on the other hand, may need formal ligament reconstruction.

Arthroscopy

This minimally invasive technique aids in diagnosing and treating injuries and pathologies inside joints. It allows inspection of the joint and necessary reconstructions being performed through minimal incisions.

Joint Replacement

Severe joint damage as a consequence of acute trauma, old injury or chronic overuse might necessitate joint replacement with an artificial joint surface (such as total hip, total knee or total ankle replacement, for example).

Understanding the common types, causes, and treatment options is crucial for both prevention and effective management of lower limbs injuries. It’s recommended to consult an orthopaedic surgeon and his team for professional and accurate diagnosis and personalized treatment plans tailored to the specific injury and individual needs of a patient.

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