1. Ankle Injuries

2. 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

3. 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.

4. Ankle Sprain Treatment RICE-Rest, Ice, Compress, Elevate
Rest for at least 24 hours with a compressive wrap and ice every few hours

5. 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

6. Special Tests
Anterior Drawer Test (for the Ankle)- Test the laxity of the ATF ligament

7. Special Tests
Talar Tilt Test- Test the laxity in the CF ligament

8. 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.

9. Arch Sprains Treatment RICE Tape or arch supports
Usually Longitudinal Arch is injured

10. 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

11. 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.

12. 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

13. 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

14. 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.

15. 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.

16. Plantar Faciitis Treatment Correct training problems Ice Massage
Ultrasound
Arch support or taping
Heel cups

17. 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.

18. 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.

19. Achilles Tendonitis Signs and Sx Pain with plantarflexion
Crepitus in the tendon region
Pain and swelling

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

21. 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.

22. Special Test
Thompson Test- Achilles Tendon Rupture

23. 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

24. Treatment
Passive stretching
Massage
Fluid replacement
ice

25. 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.

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

27. 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.

28. 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

29. 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.

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

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

32. 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

33. Special Tests Bump Test- Test the possible fracture of the lower leg
Squeeze Test- Test the possible fracture of the lower leg.