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The Ankle and Lower Leg Injuries

The Ankle and Lower Leg Injuries. Prevention : Heel cord stretching Before and after activity Strength training Achieving static & dynamic joint stability Neuromuscular control Enhanced by locomotion on uneven surfaces or balance board Footwear Shoes for which they are intended

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The Ankle and Lower Leg Injuries

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  1. The Ankle and Lower Leg Injuries

  2. Prevention: • Heel cord stretching • Before and after activity • Strength training • Achieving static & dynamic joint stability • Neuromuscular control • Enhanced by locomotion on uneven surfaces or balance board • Footwear • Shoes for which they are intended • Taping vs. bracing • Prophylactic protection

  3. Functional Exam • If the following movements aggravate a recent injury, they should be avoided • Walks on toes (tests PF) • Walks on heels (tests DF) • Walks on lateral border of feet (inversion) • Walks on medial border of feet (eversion) • Hops on injured ankle • Start/stop run motion • Changing directions quickly • Figure 8’s

  4. Ankle Sprains

  5. Ankle Sprains Inversion or lateral ankle sprain

  6. Cause: inversion with plantar flexion S&S: swelling; pt. tenderness; discoloration; joint Instability; sprain grades 1, 2, 3 Care: RICE; ice first 72 hrs (20 min on, 1 hr off); ace wrap (begin distal to proximal) NSAIDs; horseshoe; splint; crutches; rehab focusing on balancing

  7. Eversion ankle sprains • Represent only about 5-10% of all ankle sprains • Less common due to bony and ligamentous anatomy • Takes longer to heal due to the strength of the deltoid ligaments

  8. S&S: medial pain; unable to weight bear; grades 1,2,3 Care: xray to rule out fracture; RICE; NSAIDs; rehab; same as lateral ankle

  9. Ankle fractures Cause: same mechanism as sprain S&S: immediate swelling; pt. tenderness over bone; apprehension to wt. bear Care: splint; referral for xray; immobilization 6-8 wks

  10. Tibial and Fibular fx Cause: tibia = most common; indirect or direct trauma; S&S: immediate pain; swelling; deformity Care: referral; immobilization for wks - mo.

  11. Tibial and fibular stress fracture Cause: tibia>fibula; repetitive loading; biomechanical foot problems; training errors; nutritional deficiencies S&S: pain with activity; worse when stopped; focal pt. tenderness; swelling Care: REST; walking boot

  12. Medial Tibial Stress Syndrome (MTSS) Cause: repetitive microtrauma; muscle weakness; shoes; changing surfaces; malalignment; heel cord tightness S&S: diffuse pain; initial pain = after activity; as condition progresses = constant Care: r/o stress fracture; G/S stretching; ice; strengthening; correct foot mechanics; taping

  13. Compartment Syndrome Cause: acute or chronic; increase in pressure causes compression of muscle and neurovascular structures S&S: deep aching pain; tightness/swelling of compartment; neurological involvement is rare; weakness in foot and toe extension Care: rest; ice; NSAIDs; surgery (return usually in 10 days)

  14. Achilles Tendon Rupture Cause: sudden, forceful plantar flexion; usually occurs in 30+ y.o. S&S: feels snap/pop; reports feeling “kicked in calf”; plantar flexion = painful and limited; palpable defect Care: surgery; 6-8 wks immobilization

  15. Achilles tendinitis Cause: repetitive stress/strains; in duration/intensity is too soon; hill workouts  pain S&S: pain; stiffness; gradual onset; warm and painful to palpation; thickening; crepitus Care:  activity; gastroc/soleus stretch; shoes; transverse friction massage; taping

  16. Shin Contusions Cause: forceful blow to anterior leg S&S: intense pain; hematoma forms; possible compartment syndrome or fracture Care: RICE; NSAIDs; padding; massage once swelling has subsided

  17. Leg cramps and spasms • Once an athlete receives a cramp they are likely to keep recurring during activity • In some cases it is best to stop activity to prevent further injury Cause: fatigue; dehydration; electrolyte imbalance S&S: pain with contraction of the calf muscle Care: mild, gradual stretching; ice massage; water/electrolyte replacement

  18. Gastrocnemius strain Cause: stop and go; jumping; medial head most susceptible S&S: pain; swelling; muscle disability; Care: RICE; NSAIDs; gentle stretching; heel wedge; elastic wrap

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