Transcript Ankle Injuries

Lower Leg and Ankle
Walking Gait

Stance Phase

Swing Phase
• Heel-strike
• Midstance
• Toe-off
Walking Gait
HEE- STRIKE
TOE-OFF
Walking Gait



Heel strike the foot lands in an
inverted (supinated) position.
Mid-stance it moves to
eversion (pronation) so the
medial longitudinal arch can
absorb the impact.
Moves back to inversion
(supination) during toe-off.
Walking Gait
Walking Gait

Problem occur
when the foot is too
rigid and does not
invert (pronate)
adequately or when
the foot remains
inverted (pronated)
past midstance.

Excessive pronation or supination can
be prevented with proper shoes.
Running Gait


Running differs from walking in that
during walking, one foot is always in
contact with the ground.
During running there is a point when
neither foot is in contact with the ground.
Shin Splints
Medial
 Anterior

Medial Tibial Stress
Syndrome




Tenderness is usually found between 3 and
12 centimeters above the tip of the medial
malleolus at the posterio-medial aspect of the
tibia.
Inflammation of the periostium (periostitis)
Most frequently involved is the Tibalis
Posterior tendon and muscle, but the Flexor
Digitorum Longus and Flexor Hallucis
Longus may also be involved.
Stress fractures can also occur in this area.
Anterior Compartment
Syndrome




Soft tissue injuries at the muscular origin and
bony or periosteal interface of the bone and
muscle origin.
Due to micro tears of the Tibialis Anterior
either at the origin or in the fibers
themselves.
Or microtrauma to the bone structure itself.
Stress fractures can also occur in this area.
Exertional Compartment
Syndrome




Caused by the muscles swelling within a closed
compartment with a resultant increase in pressure in the
compartment.
The blood supply can be compromised and muscle injury
and pain may occur.
Abnormal compartment pressure:
•
•
•
A resting pressure greater than 20 mm Hg; or
An exertional pressure greater than 30 mm Hg; or
A pressure of 25 mm Hg or higher 5 minutes after stopping
exercise.
This may require surgical decompression of the
compartment.
Causes - FYI





Tight posterior muscles
Imbalance between the
posterior and anterior muscles
Running on concrete or other
hard surfaces
Improper Shoes - inadequate
shock protection
Overtraining
Treatment (FYI)






Rest. The sooner you rest the sooner it will heal.
Apply ice 10-15 minutes for 2-3x per day in the
early stages when it is very painful.
Anti inflammatory drugs
Wear shock absorbing insoles in shoes.
Maintain fitness with other non weight bearing
exercises.
Apply heat and use a heat retainer after the initial
acute stage, particularly before training.
Stress Fractures





Bone remodeling
Repetitive stress weakens the bone
10-20% of injuries to athletes
Most common locations: tibia, fibula and
metatarsals.
Tibial and fibular stress fractures can
develop from “shin splints”
Causes of Stress Fractures - FYI







Training errors
Abnormal limb length
Low body weight (< 75% of ideal)
Eating disorders
Previous inactivity
White race
Female
Diagnosis (FYI)



X-ray
MRI
CT scans
Ankle Sprains - FYI



Most common athletic injury. 25% of all injuries.
The risk of ankle sprains varies with the sport
•
21-53% basketball, 17-29% soccer, 25% volleyball.
Ankle sprains account for 10% to 15% of all lost
playing time
Ankle Sprains




The medial malleolus is shorter than the lateral
mallelous so there is naturally more inversion than
eversion.
Greater inversion increases the potential for overstretching of the lateral ligaments.
Most sprains involve the lateral ligaments from
excessive inversion.
Deltoid ligament is sprained less often (25% of ankle
sprains)
Lateral Collateral Ligament
Ankle Sprains
Classification of Sprains


1st Degree:
•
•
•
•
Stretching of the ATFL
little or no edema
tenderness
maintain function.
2nd Degree
•
•
•
Partial tear of the ATFL
and/or CFL
moderate edema
some function loss

3rd Degree
•
•
•
Complete tear ATFL,
CFL, and/or PTFL
total loss of function
significant edema
Ankle Sprains by Grade
Sign/symptom
Grade I
Grade II
Grade III
Tendon
No tear
Partial tear
Complete tear
Loss of functional ability
Minimal
Some
Great
Pain
Minimal
Moderate
Severe
Swelling
Minimal
Moderate
Severe
Ecchymosis
Usually not
Frequently
Yes
Difficulty bearing weight
No
Usually
Almost always
Treatment (FYI)





AAFP (see table 3)
R.I.C.E.
Ice for 20 minutes on and 20 minutes off for the first
two hours.
After that, 20 min intervals over the next 48-72
hours,
Compression wrap with donut or horse shoes to fill
in gaps around malleolus from 24-36 hours; after
48-72 hours contrasts baths with ROM exercises for
4 minutes in warm and 1 min in ice water.
Plantar Fasciitis



The plantar fascia runs from the calcaneus to the
metatarsals.
This tight band acts like a bow string to maintain the arch of
the foot.
Plantar fasciitis refers to an inflammation of the plantar
fascia.
Plantar Fasciitis



Inflammation is usually
due to repeated trauma
to where the tissue
attaches to the
calcaneus.
The trauma results in
microscpic tears at the
calcaneus attachment
site.
This may produce heal
spurs
Plantar Fasciitis


Pain is worse in the morning
or after a period of inactivity
Causes
• High arch
• Excessive pronation
• Footwear (worn out, stiff)
• Increase in intensity
Turf Toe




Turf toe is really a bruise or sprain that occurs at the base
of the big toe at the joint called the metatarsal phalangeal
joint.
It usually occurs when the toe is jammed forcibly into the
ground or, more commonly, when the toe is bent
backward too far (hyperextended)
It causes significant pain and swelling at the base of the
big toe.
It can be a significant problem because players use the
toe when they run and plant and push off.
Achilles Tendonitis - FYI


Causes
•
•
Rapidly increasing training effort
Adding hills or stair climbing to
training
• Starting too quickly after a layoff
• Poor footwear
• Excessive pronation
• Tight posterior leg muscles
If left untreated, it may progress to
a complete rupture.
Achilles Tendon Rupture - FYI





Most frequently ruptured tendon
Complete ruptures are due to eccentric
loading during abrupt stopping, landing
from a jump.
Usually a popping sound is heard with
a complete tear.
There may or may not be an obvious
gap 2 to 6 cm from the calcaneus
attachment.
Treatment may or may not include
surgery but both require immobilized
for 3 months.
Ankle Exercises
 Calf stretch
 Soleus stretch
 Resisted dorsal
and plantar flexion
 Heel raises
 Step-up
 Jump rope
Ankle Exercises
Wobble Boards