The Ankle and Lower Leg Injuries

Prevention: –Heel cord stretching Before and after activity –Strength training Achieving static & dynamic joint stability –Neuromuscular control Enhanced by locomotion on uneven surfaces or balance board –Footwear Shoes for which they are intended –Taping vs. bracing Prophylactic protection

Functional Exam –If the following movements aggravate a recent injury, they should be avoided Walks on toes (tests PF) Walks on heels (tests DF) Walks on lateral border of feet (inversion) Walks on medial border of feet (eversion) Hops on injured ankle Start/stop run motion Changing directions quickly Figure 8’s

Ankle Sprains

Inversion or lateral ankle sprain

Cause: inversion with plantar flexion S&S: swelling; pt. tenderness; discoloration; joint Instability; sprain grades 1, 2, 3 Care: RICE; ice first 72 hrs (20 min on, 1 hr off); ace wrap (begin distal to proximal) NSAIDs; horseshoe; splint; crutches; rehab focusing on balancing

Eversion ankle sprains –Represent only about 5- 10% of all ankle sprains –Less common due to bony and ligamentous anatomy –Takes longer to heal due to the strength of the deltoid ligaments

S&S: medial pain; unable to weight bear; grades 1,2,3 Care: xray to rule out fracture; RICE; NSAIDs; rehab; same as lateral ankle

Ankle fractures Cause: same mechanism as sprain S&S: immediate swelling; pt. tenderness over bone; apprehension to wt. bear Care: splint; referral for xray; immobilization 6-8 wks

Tibial and Fibular fx Cause: tibia = most common; indirect or direct trauma; S&S: immediate pain; swelling; deformity Care: referral; immobilization for wks - mo.

Tibial and fibular stress fracture Cause: tibia>fibula; repetitive loading; biomechanical foot problems; training errors; nutritional deficiencies S&S: pain with activity; worse when stopped; focal pt. tenderness; swelling Care: REST; walking boot

Medial Tibial Stress Syndrome (MTSS) Cause: repetitive microtrauma; muscle weakness; shoes; changing surfaces; malalignment; heel cord tightness S&S: diffuse pain; initial pain = after activity; as condition progresses = constant Care: r/o stress fracture; G/S stretching; ice; strengthening; correct foot mechanics; taping

Compartment Syndrome Cause: acute or chronic; increase in pressure causes compression of muscle and neurovascular structures S&S: deep aching pain; tightness/swelling of compartment; neurological involvement is rare; weakness in foot and toe extension Care: rest; ice; NSAIDs; surgery (return usually in 10 days)

Achilles Tendon Rupture Cause: sudden, forceful plantar flexion; usually occurs in 30+ y.o. S&S: feels snap/pop; reports feeling “kicked in calf”; plantar flexion = painful and limited; palpable defect Care: surgery; 6-8 wks immobilization

Achilles tendinitis Cause: repetitive stress/strains;  in duration/intensity is too soon; hill workouts  pain S&S: pain; stiffness; gradual onset; warm and painful to palpation; thickening; crepitus Care:  activity; gastroc/soleus stretch; shoes; transverse friction massage; taping

Shin Contusions Cause: forceful blow to anterior leg S&S: intense pain; hematoma forms; possible compartment syndrome or fracture Care: RICE; NSAIDs; padding; massage once swelling has subsided

Leg cramps and spasms –Once an athlete receives a cramp they are likely to keep recurring during activity –In some cases it is best to stop activity to prevent further injury Cause: fatigue; dehydration; electrolyte imbalance S&S: pain with contraction of the calf muscle Care: mild, gradual stretching; ice massage; water/electrolyte replacement

Gastrocnemius strain Cause: stop and go; jumping; medial head most susceptible S&S: pain; swelling; muscle disability; Care: RICE; NSAIDs; gentle stretching; heel wedge; elastic wrap