Lower Limb Trauma

Lower limb trauma refers to the injuries of the foot and ankle that most commonly occur as a result of accidents or sports injuries. They can include sprains, strains, fractures and dislocations.

Anatomy of the Foot and Ankle

The complex anatomy of the foot and ankle consists of 26 bones, 33 joints, and many muscles, tendons, ligaments, blood vessels and nerves. The ankle joint connects the leg with the foot and is composed of three bones: tibia, fibula and talus. The tibia or shinbone, and fibula or calf bone are bones of the lower leg, which articulate with the talus or ankle bone, enabling up and down movement of the foot.
 
The foot can be divided into three parts: the hindfoot, midfoot and forefoot. The hindfoot forms the ankle and heel and is made up of the talus bone and calcaneus or heel bone. The midfoot connects the hindfoot to the forefoot, and consists of one navicular bone, one cuboid bone and three cuneiform bones. These bones are connected to five metatarsal bones of the forefoot, which form the arch of the foot for shock absorption while walking or running. The forefoot is also made up of the toes or digits, formed by phalanges, three in each toe, except the big toe, which has only two.

Causes of Lower Limb Trauma

Trauma may result from an accident, poor training practices or use of improper gear. Injuries may also be caused when an individual is not medically fit or because of insufficient warm-up and stretching exercises.
 
Ankle injuries are the most common sports-related injuries, but you don't necessarily have to be an athlete, as walking on an uneven surface can result in twisting of the ankle. The most common ankle injuries include sprains, strains and fractures.

The foot and ankle in the human body work together to provide balance, stability, movement and propulsion. Any injury to the foot and ankle can cause pain and inability to walk or bear weight.

Symptoms of Lower limb Trauma

The common symptoms of foot and ankle trauma are pain, swelling, numbness or tingling sensation, or the inability to move or apply weight on the foot.

Diagnosis of Lower Limb Trauma

To diagnose the problem, your doctor will review your medical history and means of trauma caused on the foot, and perform a thorough physical examination, check for tenderness, inflammation, pain, range of motion and inability to bear weight on the foot. Further, imaging tests such as X-rays, CT and MRI scans are ordered to confirm the diagnosis.

Left untreated, an injury to the foot and ankle can cause chronic pain, deformity, non-union or failure to heal, and lead to arthritis, which affects your ability to walk.

Treatment for Lower Limb Trauma

Treatment depends on the type of injury. Your doctor will initially prescribe medication to relieve pain and inflammation, and suggest R.I.C.E. (rest, ice, compression and elevation of the injured leg above heart level), which may relieve symptoms in mild strains and sprains. Some major injuries may require bracing or wearing a cast or boot to avoid weight-bearing and promote healing. 

Severe injuries may require surgery to reduce fractured bones, or repair or reconstruct torn ligaments and tendons.

There are many surgical techniques to treat foot and ankle trauma. Some of them include:

Open reduction and internal fixation

The surgical procedure for foot fractures involves an incision made over the fractured bone to expose the fracture. The fragments of bone are realigned and stabilised with metal wires, screws, pins and plates. The incision is closed and dressed. Your foot will be placed in a splint, shoe, boot or cast.

Percutaneous screw fixation

For some types of fractures, reduction can be achieved with a closed manipulation of the foot using X-ray. The bone can either be pushed or pulled to set into place without making a large incision. This method, called percutaneous fracture fixation, can be performed with one or more small incisions instead of the traditional large incision, through which the implants are fixed.

Arthroscopy

This is a minimally invasive surgery where a small camera, called an arthroscope, is used to view the ankle joint and guide miniature instruments to remove fragments of torn ligament, bone or cartilage from within the joint.

Reconstruction

Torn ligaments can be surgically repaired with sutures or replaced with a graft, which can be another ligament and/or tendon retrieved from the foot or around the ankle.

Fusion

In cases of severe injury, damaged bones are fused together so that they heal into one single bone. This limits movement in the joint.

Post-op

Following surgery, your foot or ankle will be immobilised using a splint or cast. You will be advised physiotherapy to regain range of motion, stretch and strengthen your foot.

Fractures are monitored for healing with X-rays. You will be informed when it is safe to return to sports and regular activities.

Downtime

While fractures may take 4 to 8 weeks, or longer to heal, most foot sprains take from 2 to 4 weeks to 6 to 8 months, depending on the severity.

Prognosis

Minor injuries usually heal on their own with simple home treatments. It is important to allow complete healing, as resuming activities before complete healing can lead to re-injury. Injury to certain parts of the foot and ankle can cause long-term problems such as loss of full range of movement, despite the best medical treatment.


Foot & Ankle Specialists