Ankle Injuries

Ankle Injuries

Ankle Sprains are the most common Orthopedic and Emergency room visit reason. 45% basketball, 31% soccer and 24% volleyball most common injury.

80% are inversion injures caused by excessive inversion and plantarflexion.

ATF is most common injured ligament

Ankle Sprain

Signs and Sx 1st Degree- minor discomfort, point tender,

little or no swelling or instability. 2nd Degree- portion of one or more

ligaments is torn. Pain, swelling, point tender, loss of normal ROM. Slight laxity and athlete unable to walk normal.

3rd Degree- complete tear of at least one ligament resulting in joint instability. Loss of function, rapid swelling, possible fx.

Ankle Sprain

Treatment RICE-Rest, Ice, Compress, Elevate Rest for at least 24 hours with a

compressive wrap and ice every few hours

Ankle Sprain

Rehabilitation First start ROM exercises.

AROM-PROM-RROM Stretching is important during this time in a

pain free range. Strengthening should start as soon as it is

tolerated, within 1-2 days Isometric-isotonic

Special Tests

Anterior Drawer Test (for the Ankle)- Test the laxity of the ATF ligament

Special Tests

Talar Tilt Test- Test the laxity in the CF ligament

Arch Sprains

Once an arch is weakened, it cannot absorb shock normally.

Once a ligament is stretched it will fail to hold the bones in the correct position.

Causes include overuse, fatigue, nonsupportive shoes, weight, training surface.

Arch Sprains

Treatment RICE Tape or arch supports Usually Longitudinal Arch is injured

Blisters

As the layers of the skin rub together the friction causes separation and blisters.

The body responds with fluid in the separation which may break and cause an open wound.

In not cared for infection may result

Blister

Treatment If closed and small do not open, stop

friction from continuing. If open and not flapping leave the skin in

place. Protect against infection by cleaning daily Prevent with proper shoes and socks and

by preventing friction.

Syndesmosis Sprain

AKA High Ankle Sprain Syndesmosis Joint is the one

between the tibia and fibula. MOI dorsiflexion and inversion Often mistaken for a fx

Great Toe Strain-Turf Toe

Strain of the great toe flexor tendon MOI-foot slipping backward on a slippery

surface which forcefully hyperextends the toe.

Treatment RICE Taping

Plantar Fasciitis

An inflammation of the Plantar

Fascia Plantar Fascia is a nonelastic

ligamentous tissue that extends from the anterior calcaneous to the head of the metatarsals.

Plantar Faciitis

It is a chronic injury due to overuse, unsupportive footwear or tight Achilles.

Pain is usually at calcaneous, or the origin of the facia.

Untreated it can cause heel spurs, muscle strains or shin splints.

Plantar Faciitis

Treatment Correct training problems Ice Massage Ultrasound Arch support or taping Heel cups

Heel Spur

Often a result of Plantar Faciitis or tight heel cords.

A bony growth results from the pull of the facia.

Taping can help but surgery can be required.

Achilles Tendonitis

An inflammation of the Achilles tendon. Caused by overuse or a single incident

of over stressing it. Can be a result of constant over pronation.

Usually the injury is at the attachment to the calcaneus.

Achilles Tendonitis

Signs and Sx Pain with plantarflexion Crepitus in the tendon region Pain and swelling

Achilles Tendonitis

Prevention is the best treatment Ice, Anti-inflammitory and stretching Ultrasound as necessary. What kind?

Achilles Tendon Rupture

Causes include poor conditioning and overexertion, previous history of tendonitis. Can be direct trauma as well.

Typically 1 year before return to play Typically rupture

2 inches above

insertion.

Special Test

Thompson Test- Achilles Tendon Rupture

Muscle Cramps

Cramps-sudden involuntary contraction of a muscle. Unknown specific cause, but there are many factors that contribute: Fatigue Post Fracture Dehydration Poor nutrients Poor flexibility Improper fitting equipment

Treatment

Passive stretching Massage Fluid replacement ice

Medial Tibial Stress Syndrome

AKA Shin Splints A result of tight calves, excessive

pronation and an overworked tibialis anterior.

Usually occurs at beginning of season or with change in workout.

More painful in AM when soft tissue has tightened overnight.

Medical Tibial Stress Syndrome

Treatment Ice after practice Stretching of the posterior leg. Orthotics to correct biomechanical problem Anti-inflammatory Strengthening muscle imbalances

Stress Fracture

Incomplete fracture of the bone. When repeated stress put on the bone is

greater than the body’s ability to heal it. Characterized by a specific hot spot of

pain, less painful in morning because bone has been resting.

Bone scan is only definitive diagnosis.

Compartment Syndrome

Swelling within one or more of the compartments of the lower leg

Most common is anterior compartment syndrome.

Can be acute or chronic Surgery is usually

necessary

Fractures

Often times the best sign of a fx is weight bearing ability and swelling.

Point tenderness is more intense than a fx and not near a ligament.

Sometimes a grade 3 sprain is mistaken for a fx.

Fractures

Tibia fractures often are very painful and the athlete is unable to weight bear. Swelling is often (but not always) immediate.

Fractures

Fibula fractures are often mistaken for a contusion because there is less pain with weight bearing.

Fractures

There are 26 bones in the foot that can be fractured as well, only an e-xray is definitive, but sometimes swelling indicates a definite problem

Special Tests

Bump Test- Test the possible fracture of the lower leg

Squeeze Test- Test the possible fracture of the lower leg.