Common Injuries of the Foot and Ankle

Sprain Definition: A sprain is a stretch or tearing of one or more ligaments of the ankle. Sprains are generally graded on a scale of I to III depending on their severity. Definition: A sprain is a stretch or tearing of one or more ligaments of the ankle. Sprains are generally graded on a scale of I to III depending on their severity.

Grade I: slight stretching of ligaments, may have some pain, no significant swelling or discoloration. Grade I: slight stretching of ligaments, may have some pain, no significant swelling or discoloration. Grade II: moderate stretching of ligaments, some swelling and discoloration, orthopedic tests will reveal a “soft” endpoint. Grade II: moderate stretching of ligaments, some swelling and discoloration, orthopedic tests will reveal a “soft” endpoint. Grade III: fibers of the ligament are completely torn, usually severe and immediate swelling, orthopedic tests will reveal no endpoint Grade III: fibers of the ligament are completely torn, usually severe and immediate swelling, orthopedic tests will reveal no endpoint

Inversion Sprain Most common mechanism for ankle sprains. Most common mechanism for ankle sprains. Involves one or more of the lateral ligaments of the ankle Involves one or more of the lateral ligaments of the ankle

Eversion Sprain Not that common due to strength of the deltoid (medial) ligament and bony structure. Not that common due to strength of the deltoid (medial) ligament and bony structure. Severe sprains often are accompanied by fractures of the fibula. Severe sprains often are accompanied by fractures of the fibula.

Sprain Treatment: The immediate treatment for any degree of sprain is rest, ice, compression and elevation. The immediate treatment for any degree of sprain is rest, ice, compression and elevation. NSAID’s may be taken for pain and swelling. NSAID’s may be taken for pain and swelling. Doctor referral if fracture is suspected. Doctor referral if fracture is suspected.

Achilles Bursitis Definition: A bursa is a fluid-filled membrane that lubricates between areas of friction(bone-to-tendon or bone-to-ligament). Bursitis is occurs when the bursa becomes inflamed. Definition: A bursa is a fluid-filled membrane that lubricates between areas of friction(bone-to-tendon or bone-to-ligament). Bursitis is occurs when the bursa becomes inflamed.

Achilles Bursitis S/Sx: Point tenderness over attachment of Achilles to the heel. Point tenderness over attachment of Achilles to the heel. Swelling may be present. Swelling may be present. Usually has a gradual onset Usually has a gradual onset

Achilles Bursitis

Treatment: Heat before activity Heat before activity Ice after activity Ice after activity NSAID’s NSAID’s Gentle stretching of Achilles tendon Gentle stretching of Achilles tendon Lingering cases should be referred to a doctor. Lingering cases should be referred to a doctor.

Achilles Tendonitis Def: Inflammation of the achilles tendon Def: Inflammation of the achilles tendon MOI: may be from a single incident but more often from an accumulation of smaller stresses MOI: may be from a single incident but more often from an accumulation of smaller stresses

Achilles Tendonitis S/Sx: Usually gradual onset of S/Sx Usually gradual onset of S/Sx Early on, pain occurs only during activity and slowly progresses to pain all of the time Early on, pain occurs only during activity and slowly progresses to pain all of the time Point tenderness over tendon Point tenderness over tendon Swelling may be present Swelling may be present

Achilles Tendonitis

Treatment: Rest, ice and NSAID’s Rest, ice and NSAID’s Gentle stretching of tendon Gentle stretching of tendon Heat before activity/Ice after activity Heat before activity/Ice after activity Taping and/or heel lift Taping and/or heel lift Ultrasound Ultrasound Possible doctor referral Possible doctor referral

Heel Contusion Bruise to the heel Bruise to the heel MOI: stop and go activities or jumping movements MOI: stop and go activities or jumping movements S/Sx: Severe pain on bottom of heel, pain with weight-bearing S/Sx: Severe pain on bottom of heel, pain with weight-bearing Tx: RICE, taping, donut pad, ultrasound, whirlpool Tx: RICE, taping, donut pad, ultrasound, whirlpool

Turf Toe Def: Sprain of the 1 st MP joint Def: Sprain of the 1 st MP joint MOI: kicking object, stubbing toe, dropping heavy object on it, fields with turf. Occurs as foot is planted and the foot and ankle is dorsiflexed. As the shoe grasps the playing surface, body weight and forward momentum force the 1 st MP joint into hyperextension. MOI: kicking object, stubbing toe, dropping heavy object on it, fields with turf. Occurs as foot is planted and the foot and ankle is dorsiflexed. As the shoe grasps the playing surface, body weight and forward momentum force the 1 st MP joint into hyperextension.

Turf Toe

S/Sx: pain during push-off phase of gait, active joint motion or manual resistance. Pain when attempting quick stops. Point tenderness over MP joint, limited ROM S/Sx: pain during push-off phase of gait, active joint motion or manual resistance. Pain when attempting quick stops. Point tenderness over MP joint, limited ROM Tx: RICE, NSAIDs, Tx: RICE, NSAIDs, ultrasound, tape ultrasound, tape

Medial Tibial Syndrome Def: Shin splints: a general term applied to a variety of conditions that seasonally plague many athletes Def: Shin splints: a general term applied to a variety of conditions that seasonally plague many athletes MOI: factors that may lead to an increase incidence of shin splints are: MOI: factors that may lead to an increase incidence of shin splints are: Biomechanical factors Biomechanical factors Change in intensity, duration, or frequency of workouts Change in intensity, duration, or frequency of workouts Improper or worn footwear Improper or worn footwear Change in surface Change in surface Improper warm-up and cool-down Improper warm-up and cool-down Change in type of workout Change in type of workout

Shin Splints S/Sx: S/Sx: Grade I: pain after activity Grade I: pain after activity GradeII: pain before and after activity not affecting performance GradeII: pain before and after activity not affecting performance Grade III: pain before, during and after activityand affecting performance Grade III: pain before, during and after activityand affecting performance Grade IV: pain so sever that performance is impossible Grade IV: pain so sever that performance is impossible

Shin Splints Tx: varies by individual Tx: varies by individual Constant heat (whirlpools and US) with taping Constant heat (whirlpools and US) with taping NSAIDs NSAIDs Ice massage before or after Ice massage before or after Stretching of anterior and posterior structures Stretching of anterior and posterior structures

Fractures Definitions: Fractures of the foot and ankle can occur in any number of places. Fractures of the foot and ankle can occur in any number of places. The fibula is a non-weightbearing and can be fractured by a direct blow. The fibula is a non-weightbearing and can be fractured by a direct blow. Fractures of the tibia are often accompanied by a fracture of the fibula. Fractures of the tibia are often accompanied by a fracture of the fibula.

Fractures S/Sx: Fractures of the fibula may not display any gross deformities. There will be point tenderness and a positive percussion test. The person may be able walk. Fractures of the fibula may not display any gross deformities. There will be point tenderness and a positive percussion test. The person may be able walk. Tib/Fib fractures will have a gross deformity. The athlete will not be able to bear weight. Tib/Fib fractures will have a gross deformity. The athlete will not be able to bear weight.

Fractures Treatment: For a suspected fibular fracture, the athlete should be immobilized and referred to a doctor. For a suspected fibular fracture, the athlete should be immobilized and referred to a doctor. For a Tib/Fib fracture, try to calm the athlete down and monitor for signs of shock. Check for pulse and sensation distal to the injury site. Splint and send immediately to a hospital (or call 9-1-1) For a Tib/Fib fracture, try to calm the athlete down and monitor for signs of shock. Check for pulse and sensation distal to the injury site. Splint and send immediately to a hospital (or call 9-1-1)

Tib/Fib fracture at moment of impact