LEG CONTUSION, LOWER LEG
DEFINITION--Bruising of the skin and underlying tissues of the lower leg due to a direct blow. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate muscles, tendons or other soft tissue. The lower leg is particularly susceptible to contusions because it is frequently exposed to direct blows. If the blow is over the tibia (shin bone), it is much more likely to be severe.
BODY PARTS INVOLVED
Lower-leg tissues, including blood vessels, muscles, tendons, nerves, covering to bone (periosteum) and connective tissue.
The peroneal nerve where it wraps around the upper portion of the fibula. Injury to the nerve can lead to painful neuritis or temporary paralysis and a dropped foot.
SIGNS & SYMPTOMS
Swelling--either superficial or deep.
Pain at the contusion site.
Feeling of firmness when pressure is exerted on the injury.
Discoloration under the skin, beginning with redness and progressing to the characteristic "black and blue" bruise.
Restricted leg function proportional to the extent of injury.
Feeling an "electric shock" followed by temporary muscle paralysis, causing the foot to drop.
CAUSESDirect blow to the leg, usually from a blunt object.
RISK INCREASES WITH
Violent contact sports--especially when lower legs are not adequately protected.
Medical history of any bleeding disorder such as hemophilia.
Poor nutrition, including vitamin deficiency.
Use of anticoagulants or aspirin.
HOW TO PREVENTWear appropriate protective devices, such as an elastic bandage over felt or sponge rubber, if there is risk of a lower-leg contusion during athletic activity.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care unless the contusion is quite small.
Self-care for minor contusions, and for serious contusions during rehabilitation.
Physical therapy for serious contusions.
Your own observation of symptoms.
Medical history and physical exam by a doctor for all except minor injuries.
X-rays of the lower leg, ankle and knee to assess total injury to soft tissue and to rule out the possibility of underlying fractures. The total extent of injury may not be apparent for 48 to 72 hours.
Excessive bleeding leading to disability. Infiltrative-type bleeding can sometimes lead to calcification and impaired function of the injured muscle.
Prolonged healing time if usual activities are resumed too soon.
Infection if skin over the contusion is broken.
PROBABLE OUTCOMEHealing time varies with the extent of injury, but average healing time for a lower-leg contusion is 1 to 2 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplementa1.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Wrap an elasticized bandage over a sponge- rubber donut on the injured area. Keep the area compressed for about 72 hours.
Continue ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage gently over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, heat liniments or ointments, or whirlpool treatments.
Massage gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Acetaminophen or ibuprofen. Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain.
ACTIVITYBegin activities slowly and stop exercise as soon as pain begins. Increase activity as healing progresses.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may prescribe vitamin and mineral supplements to promote healing.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have a lower-leg contusion that doesn't improve in 1 or 2 days.
Skin is broken and signs of infection (drainage, increasing pain, fever, headache, muscle aches, dizziness or a general ill feeling) occur.
Signs appear of peroneal-nerve injury (paralysis, dropped foot or loss of sensation in the foot).