Achilles & Ankle Injuries Achilles Tear and Ankle Sprain

Objectives To identify the causes, symptoms, treatment, and prevention of various lower leg and ankle injuries.

Achilles Tear

The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear or completely rupture.

Symptoms of Achilles Tear An Achilles tendon can partially tear or completely rupture. A partial tear may cause mild or no symptoms. A complete rupture causes pain and sudden loss of strength and movement. A popping or snapping sound when the injury occurs Pain, possibly severe, and swelling near your heel An inability to bend your foot downward or "push off" the injured leg when you walk An inability to stand up on your toes on the injured leg

Causes for Achilles Rupture Ruptures often are caused by a sudden increase in the amount of stress on your Achilles tendon. Increasing the intensity of sports participation Falling from a height Stepping into a hole Risk Factors Age. The peak age for Achilles tendon rupture is 30 to 40. Your sex. Achilles tendon rupture is up to five times more likely to occur in men than in women. Sports. Achilles tendon injuries occur more often in sports that involve running, jumping and sudden starts and stops — such as soccer, basketball and tennis. Steroid injections. Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures.

Treatment for Achilles Rupture Nonsurgical This approach typically involves wearing a cast or walking boot with wedges to elevate your heel; this allows the ends of your torn tendon to heal. The likelihood of re-rupture may be higher with a nonsurgical approach, and recovery can take longer. Surgery Making an incision in the back of your lower leg and stitching the torn tendon together. Rehab Physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within six to nine months.

Prevention of Achilles Tear Stretch and strengthen calf muscles. Calf-strengthening exercises can also help the muscle and tendon absorb more force and prevent injury. Vary your exercises. Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming. Avoid activities that place excessive stress on your Achilles tendons, such as hill-running and jumping activities. Choose running surfaces carefully. Avoid or limit running on hard or slippery surfaces. Increase training intensity slowly. Achilles tendon injuries commonly occur after a person abruptly increases his or her training intensity.

Ankle Sprain A sprained ankle occurs when you roll, twist or turn your ankle in an awkward way, and the ligaments are forced beyond their normal range of motion. This can stretch or tear the ligaments that help stabilize joints, preventing excessive movement.

Ankle Sprain

Grades of Ankle Sprain Grade 1 sprain: Slight stretching and some damage to the fibers of the ligament. Grade 2 sprain: Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs. Grade 3 sprain: Complete tear of the ligament. If the examiner pulls or pushes on the ankle joint in certain movements, gross instability occurs.

Different Grades of Ankle Sprain

Sprained Ankle

Inversion vs. Eversion

Inversion or Eversion?

Symptoms of Ankle Sprain Pain, especially when you bear weight on the affected foot Swelling and, sometimes, bruising Restricted range of motion Some people hear or feel a "pop" at the time of injury. If your signs and symptoms are severe, it's possible you may have broken a bone in your ankle or lower leg.

Risk Factors for Ankle Sprain Sports participation. Ankle sprains are a common sports injury. Sports that require rolling or twisting your foot, such as basketball, tennis, football, soccer and trail running. Playing sports on an uneven surface also can increase your risk. Prior ankle injury. Once you've sprained your ankle, or had another type of ankle injury, you're more likely to sprain it again.

Treatment of Ankle Sprain R.I.C.E. Medication In most cases, over-the-counter pain relievers — such as ibuprofen (Advil, Motrin, others), naproxen (Aleve, others) or acetaminophen (Tylenol, others) — are enough to handle the pain caused by a sprained ankle. Therapy A few days after your injury, after the swelling has gone down, you may want to see a physical therapist and start performing exercises to restore your ankle's range of motion, strength, flexibility and balance.

Prevention Warm up before you exercise or play sports. Be careful when walking, running or working on an uneven surface. Wear shoes that fit well and are made for your activity. Don't wear high-heeled shoes. Don't play sports or participate in activities for which you are not conditioned. Maintain good muscle strength and flexibility. Practice stability training, including balance exercises.