3 Bony Anatomy Medial view: tarsals and metatarsals
4 Medial Ligaments of Ankle Deltoid Ligament rarely injured in sports mechanism of injury typically eversion with dorsiflexion longer time to heal than lateral ankle ligaments
5 Lateral Ligaments of Ankle 3 primary ligaments: anterior talofibular posterior talofibular Calcaneofibular –NOT as large & strong as the deltoid. –Mechanism of injury is inversion associated with plantar flexion.
7Fractures –Mechanism most often caused by direct trauma to the tibia, fibular or bone(s) of the foot repeated “microtrauma” can result in a stress fracture growth plate injures can occur in the adolescent -- known as “Salter-Harris” fractures –Signs/symptoms: swelling/deformity, discoloration broken bone end protruding athlete reports a snap/pop inability to bear weight stress fractures often become more painful at night
8Fractures –First Aid: treat for shock apply sterile dressing to any open wounds carefully immobilize using appropriate splinting technique contact EMS and arrange for transport
9 Ankle Fracture
10 Ankle Fracture
11 Ankle Dislocation
12 Ankle Sprains Details one of the most common injuries to this region Due to skeletal and ligamentous variables, lateral sprains are more common. 80-85% of all ankle sprains are to the lateral ligaments -- inversion sprains Eversion sprains, while less frequent, are often severe. Syndesmosis Sprain: Sprain of the ligaments connecting the tibia and fibula.
13 Signs/symptoms: –1st deg. -- pain, mild disability, pt. tenderness, little or no swelling –2nd deg. -- pain, mild to moderate disability, pt. tenderness, loss of function, some laxity, swelling –3rd deg. -- pain & severe disability, pt. tenderness, loss of function, laxity, severe swelling
14 Ankle Sprains First Aid: ice, compression and elevation apply a horseshoe - or doughnut-shaped pad use crutches, partial or full weight bearing any questions regarding severity, refer to a physician for further evaluation and diagnosis
15 Ankle Sprain Prevention –Research indicates that taping is only good for a short period of time. Braces may be as effective as tape and at a much lower cost –Best prevention is to strengthen the muscles of the lower leg as well as develop proprioception.
16 Two examples of rigid ankle braces
17 Tib/Fib Syndemosis Sprain –Signs and Symptoms Often treated as lateral ankle sprain, which is inappropriate, hindering recovery. The difference is the mechanism of injury. Tib-fib sprains involve dorsiflexion followed by axial loading with external rotation of the foot. Symptoms – positive sprain test, but athlete is in great pain. Slower healing Sometimes physicians will cast.
18 Achilles Tendon –Achilles tendon commonly injured -- more often in older (30+) male athlete –can be either an acute or chronic, overuse injury –acute injuries often associated with blunt trauma –chronic injuries often associated with sudden increase in training intensity
19 Common Injuries Signs/symptoms –swelling and deformity –pop or snap –pain in lower leg –loss of function, especially in plantar flexion First Aid: –immediate application of ice and compression –immobilize with appropriate splint –arrange for transport to a medical facility
20 Torn Tendon
21 Achilles Surgery
22 Compartment Syndrome –usually involves the anterior compartment of the lower leg –Chronic form is related to overuse of the muscles of the compartment –Trauma, such as being kicked in the leg, can result in swelling within the compartment as well. –In either case, swelling puts pressure on vessels and nerves.
24 Compartment Syndrome Signs/symptoms/First Aid: –pain/swelling and loss of sensation and/or motor control in the lower –loss of pulse in the foot –inability to extend the big toe or dorsiflex the foot apply ice & elevate - - do NOT apply compression –loss of pulse or sensation -- medical emergency - transport to medical facility
25 Shin Splints Signs/symptoms: –lower leg pain -- typically a chronic injury that progressively worsens –pain is often bilateral –“Shin splints” is generic pain in the lower legs, typically caused by change in surface or workout. First Aid: –apply ice and have the athlete rest –use of NSAIDs may be helpful –seek a professional to identify the cause
26 Foot Disorders Plantar Fasciitis –plantar fascia spans from the metatarsal heads to the calcaneal tuberosity Ball of foot to heel. –this tissue can become inflamed and painful –painful in the morning when first rising from bed –point tenderness in the region of the calcaneal tuberosity
27 Common Injuries Heel Spurs –often related to chronic plantar fasciitis –involves ossification at the site of attachment to the calcaneus Treatment of Plantar Fasciitis and Heel Spurs –rest and NSAIDs –stretching of the Achilles –doughnut pad beneath the heel spur
28 Common Injuries Morton’s Neuroma –growth (enlargement) of the interdigital nerve usually between the 3rd and 4th metatarsal heads –pain will radiate into the 3rd and 4th toes –tight fitting shoes have been identified as a major causative factor –going barefoot often relieves the symptoms –the neuroma may have to be treated surgically
29 Common Injuries Care for Neuroma –Teardrop pad can be placed between met heads to increase space, decreasing pressure on neuroma –Shoes with wider toe box would be appropriate –the neuroma may have to be treated surgically
30 Common Injuries Foot disorders Arch problems –two groups of arch problems: pes planus and pes cavus –Pes Planus = flat arch –Pes Cavus = high arch
31 Common Injuries –corrective taping may provide temporary support for the arch –In some cases, the athlete may benefit from a properly constructed orthosis. –Orthotics should be constructed by a trained professional.
32 Common Injuries Blisters & calluses –very common formations, result from friction between layers of skin –when a blister forms, fluid collects between skin layers, occasionally the fluid will contain blood –if the blister is large, it should be drained –When draining a blister, use sterile instruments, latex gloves and eye protection