Transcript Ankle Injuries

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
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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
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RICE-Rest, Ice, Compress, Elevate
Rest for at least 24 hours with a
compressive wrap and ice every few hours
Ankle Sprain
 Rehabilitation
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First start ROM exercises.
 AROM-PROM-RROM
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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
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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
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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
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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
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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.
Heel Spur
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
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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:
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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
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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.