3Fractured FibulaAnkle Fracture – commonly caused by eversion. The fibula is often broken.
4Stress Fracture What is a stress fracture? -An overuse injury. -A small crack or fracture in the boneWhat causes it?-When muscles become fatigued or overloaded and can not absorb the stress and shock and repeated impact.-Fatigued muscles transfer that stress to the nearby bone and the result is a small crack or fracture, in the bone.
5Ballerina Fracture Where does it occur? -5th metatarsal. What is it? -An avulsion of the proximal tip of the 5th metatarsal where the peroneus brevis muscle tendon attaches.Cause-A severe inversion ankle sprain causes peroneus brevis tendon to pull away the base of the 5th metatarsal (Ballerina fracture)
6Jones FractureThese X-Rays show a fracture of the proximal end of the 5th Metatarsal. This fracture is commonly called a "Jones Fracture".Where does it occur?-5th metatarsal.What is it?-A fracture to the 5th metatarsal caused by direct trauma to the styloid process.Cause-Repetitive inversion ankle sprains-Poor shoe and tape support
9Inversion Ankle Sprain 85% of sprains are caused by ankle inversion.Inversion sprains cause damage to the lateral ligamentsCalcaneofibular and anterior and posterior talofibular ligaments
10Eversion Ankle Sprain15% of sprains result from eversion mechanisms which are often the result of an outside force such as being fallen on from the outside.Damage to the deltoid ligament
11Syndesmosis Sprain What is it? -The tibia and fibula spread on the talus, the ankle mortise is disrupted and the ankle can become very unstable.-Syndesmosis damage-Anterior and Posterior tibiofibular ligamentCause-injured with an eversion force.
12Ruptured Achilles Tendon Third degree strain of the tendonAchilles Tendon Tear and Repair
13Achilles Tendonitis What is the Achilles tendon? -It is the largest and most vulnerable tendon in the body.-It joins the gastrocnemius and the soleus muscles of the lower leg to heel of the foot.-Tendons are strong, but not very flexible so they can only so far before they get inflamed and tear or rupture.What is it?-Chronic injury caused from overuse.-Inflammation of the Achilles tendon.What causes it?-Ignoring early warning signs and pushing through pain.-tight or weak calf muscles.-Tightness increases the stress on the Achilles tendon, and a tendonitis can develop.
14Plantar Fasciitis What does the plantar fascia do? -Provides support for the medial longitudinal arch of the foot. The plantar fascia is stretched and the arch flattens slightly to absorb the impact each time the heel impacts the ground. The fascia is not very flexible and such repetitive stretching from impact can result in small tears in the fascia.What is plantar fasciitis?-Chronic injury-Common in runners-Common cause of pain on the bottom of the heel and usually defined by pain during the first steps of the morning.-Pain also occurs at the start of activity and go away with use.-It returns after a long rest and then restarting activity.What causes it?-Repetitive flexion and extension of the toes-Sudden weight gain
15Turf Toe What is turf toe? -A sprain or jammed toe -Typically the halluxPossible Responsible Factors-artificial turf - no give, can be like playing on hard asphalt-shoes - too much forefoot flexion (no turf toe plate)-combination of turf & shoesMechanism of injury-hyperextension (most common)-hyperflexion-valgus injury - usually from sudden accelerationWhat causes it?-When the toe is bent upwards this causes damage to the ligaments which can become stretched.
17Assessing the Lower Leg and Ankle HistoryPast historyMechanism of injuryWhen does it hurt?Type of, quality of, duration of pain?Sounds or feelings?How long were you disabled?Swelling?Previous treatments?
18Observations Posture? Is there difficulty with walking? Deformities, asymmetries or swelling?Color and texture of skin, heat, redness?Patient in obvious pain?Is range of motion normal?
19Palpation Special Tests Does anything feel out of place? Is it hot? Depends on the injury
20Percussion and compression tests Used when fracture is suspectedPercussion test is a blow to the tibia, fibula or heel to create vibratory force that resonates w/in fracture causing painCompression test involves compression of tibia and fibula either above or below site of concernThompson testSqueeze calf muscle, while foot is extended off table to test the integrity of the Achilles tendonPositive tests results in no movement in the foot
22Ankle Stability Tests Anterior drawer test Talar tilt test Used to determine damage to anterior talofibular ligament primarily and other lateral ligament secondarilyA positive test occurs when foot slides forward and/or makes a clunking sound as it reaches the end pointTalar tilt testPerformed to determine extent of inversion or eversion injuriesWith foot at 90 degrees calcaneus is inverted and excessive motion indicates injury to calcaneofibular ligament and possibly the anterior and posterior talofibular ligamentsIf the calcaneus is everted, the deltoid ligament is tested
24Medial Subtalar Glide Test Kleiger’s testUsed primarily to determine extent of damage to the deltoid ligament and may be used to evaluate distal ankle syndesmosis, anterior/posterior tibiofibular ligaments and the interosseus membraneWith lower leg stabilized, foot is rotated laterally to stress the deltoidMedial Subtalar Glide TestPerformed to determine presence of excessive medial translation of the calcaneus on the talusTalus is stabilized in subtalar neutral, while other hand glides the calcaneus, mediallyA positive test presents with excessive movement, indicating injury to the lateral ligaments
26Functional TestsWhile weight bearing the following should be performedWalk on toes (plantar flexion)Walk on heels (dorsiflexion)Walk on lateral borders of feet (inversion)Walk on medial borders of feet (eversion)Hops on injured anklePassive, active and resistive movements should be manually applied to determine joint integrity and muscle functionIf any of these are painful they should be avoided
27Prevention of Injury to the Ankle Stretching of the Achilles tendonStrengthening of the surrounding musclesProprioceptive training: balance exercises and agilityWearing proper footwear and or tape when appropriate
28Injury PreventionStrength training allows the supporting musculature to stabilize where ligaments may no longer be capable of holding the original tension between bones of the joint. This will also help prevent reinjury.
29Chronic Ankle Injury “the vicious cycle” Why are some people prone to ankle re-injury over and over?Most commonly due to lack of rehabilitation, but more importantly lack of neuromuscular training.This means the person has not retrained the body to recognize where the ankle and foot are during motion.This sets up the body part to be re-injured due to improper feedback to the brain about body position.
30Injury PreventionNeuromuscular Control is the ability to compensate for uneven surfaces or sudden change in surfaces. It is retrained by using balance and agility exercises such as a BAPS board or standing on one leg with eyes closed as well as using a single leg on a mini trampoline.
31Neuromuscular Control Training Can be enhanced by training in controlled activitiesUneven surfaces, BAPS boards, rocker boards, or Dynadiscs can also be utilized to challenge athlete
32Injury preventionTight Achilles tendons can predispose someone to injuring the ankle. Tendonitis, plantar fasciitis, and other disorders may occur due to a tight Achilles tendon.
33Injury PreventionFootwear is something often overlooked but improper footwear can predispose someone with a foot condition such as pes planus (flat feet) to be more prone to having problems with their feet and ankles.
34Preventative Taping and Orthosis Taping is often post injury treatment. Some will argue that taping will weaken the ankle. This has not been proven without a doubt but exercise and strengthening of the ankle is always advised.Othotics will help rectify conditions that are permanent and will not be fixed by any other means.
35Tape vs. Brace Why choose one over another Taping may be more time consuming over braceBraces may or may not allow more support over tapeTape allows more functional movement and often feels more stableTape will loosen with timeBraces will often loosen with timeIt really is based on the quality of the brace vs. the ability of the person to tape. Both have advantages and disadvantages.