Etiology and Management of Lower Leg Pain - Essay Example

Pain is a response of the body to some unpleasant and at times dangerous stimulus to the body. This is a defense mechanism possessed by the body to alarm the related tissues and organs o the body. Inflammation is a mechanism through which the human body passes through some stages in response to an insult to the body. These stages are not good as far as their taste is concerned but for the defense of the body, this process has been proved to be the basic component in this regard. Pain is an essential component of the inflammatory process. This is a subjective feeling perceived by the people. Pain has got various types. One individual may respond differently to different types of pain and at the same time, different individuals may respond differently to the same type of pain.
The lower leg is a portion of the body that not only supports the whole body but also helps in moving the body from one place to another. The weight-bearing process may cause some damage to the lower leg structures but when someone is running then this damage may be multiplied. The damage could be related to soft tissue injuries, like a muscle, tendons, or bony tissue ranging from just a stroke to a compound fracture. Various types of trauma and the eventual result of this injury vary depending upon the force and angle of the force applied. As all these traumatic episodes pass through an inflammatory process so the affected individual feels pain accordingly.
Predisposing factors
Some factors are part of the personality of the individual affected or some factors belong to the external factor group which is as important as the intrinsic or personality factors.
Intrinsic factors
• Malalignment
• Poor flexibility
• Anthropometry
• Previous injury
• Running experience

External factors
• Errors in training
• Shoes used are old
• Uneven running surface
• Tibial torsion
• Increased ankle dorsiflexion

The most frequent anatomical structures affected by the injuries caused by running and resulting in lower leg pain are :
• iliotibial band
• Achilles tendon
• shin splints
• tibial stress
• hamstring

Iliotibial band (ITB)
Although the iliotibial band extends from the ileum to the condyles of the tibia after the damage caused due to any factor it results in lower leg pain. This is the most common cause of lateral knee pain among athletes. The affected structure is the bursa surrounding the iliotibial band. The injury usually occurs in those individuals who perform tasks that involve repetitive flexion and extension activities, for example, athletes in soccer, aerobics, etc. The presentation of the case is severe pain in the knee and lower leg.
Management:
Local steroid injection
Management
Conservative
Avoidance of training programs that ends up in this injury
Gentle static strengthening
Correction with orthotics
Cryotherapy
Therapeutic ultrasound
Pharmacologic support
Low dose heparin, wydase, etc
Surgical treatment of the tendinopathy
Chronic exertional compartment syndrome (CECS)
This is one of the commonest causes of lower leg pain which manifests itself in the anterior compartment of the leg due to over usage.
Tibial stress fracture
In the lower leg, either of the two bones, the tibia, and fibula can have a stress fracture. Usually, the fracture appears on the lower end of the two bones on the medial side.
Predisposing factors are:
• Continuous muscle contraction during running may overload the bone and result in stress fracture.
• Continuous exercise especially running causes fatigue of the muscle which results in the maldistribution of the stress to the bones.
• Changing the running surface suddenly also brings a sudden change in the distribution of the stress to the bones, for example, shift from grass training to road running.
• Cumulative effect of small but continuous stress or burden on the bone may also result in the fracture of the bone.
Presentation of the case:
• Pain (usually on the lower third of the tibia) that occurs after running long distances.
• Tenderness and swelling over the site of the fracture.
Management:
• Rest for about eight weeks.
• Regular consultation with the orthopedic surgeon
• Recognition of predisposing and causative factors followed by prevention and avoidance of those factors
• Maintenance of fitness through swimming and running in the water
• Special exercise program to strengthen the muscles Read More