Injuries to the Foot, Ankle and Lower Leg

Mr. Brewer

Ankle Injuries

The ankle is one of the most common injured parts of the body.

Why do you think?

Ankle Injuries

• The ankle has 6 major movements that can be produced, based on the anatomy and how the bones are structured.

• All of the 6 movements can result in injury if they are “extreme” movements.

• Extreme movements = Movements that are either too quick/fast for the muscles to respond to in time, OR they produce enough force to extend the ankle beyond it’s normal range of motion.

Terminology

• Elasticity- A product of matter being deformed, but preserving enough of the original structure to return to it’s original form.

• Plasticity- A product of matter being deformed beyond the point of being able to return to it’s original form, yet not breaking it’s basic structure.

• Fracture/Rupture- In our terms, once a bone, ligament, muscle or tendon is stressed beyond its maximum plasticity, the result is a permanent break (Fracture/Rupture).

Visual Representation of the Physics behind the theory.

Muscle Strains

• Any muscle in the body can be strained.• Some are more difficult to strain because of

the anatomy of the body.• A strain can occur when a muscle is stretched

beyond it’s plasticity.• Or when extreme force is created to make a

quick movement or move a heavy load.

Manual Muscle Tests (MMTs)

• When testing for muscle strains, you can start by allowing the athlete to move the ankle in all 4 major directions.

• Be sure to utilize proper hand placement to isolate the muscle you are testing to get accurate results.– You are looking for:• ROM of the joint (in comparison with the other ankle)• Where the pain is located.• What type of pain is there?

Make or Break

• There are two main ways to test a muscle(and it’s tendons)– A “make” test: A test that starts with the athlete in a

position where the muscle you are testing is on a stretch to start.• You will then apply resistance and ask the athlete to

contract the muscle against your applied resistance.

– A “Break” test: A test where the muscle you are testing is in the state of contraction.• You will then ask the athlete to hold the contraction while

you attempt to move the body part (ankle in this case) from it’s current position.

Activity

With a partner:- One of you will be the “athlete”, and one of you will be

performing the test.- Practice performing both a make and break MMT for the

following movements:- Plantar Flexion- Dorsi-Flexion- Eversion- Inversion

- Switch Roles

Broken Bones

• Just as any muscle in the foot/lower leg can be strained, any bone in the foot/lower leg can be broken.

• Bones can break due to a blunt force, compression, torsion or avulsion.

• An avulsion fracture involves the tendon of a muscle (or a ligament) detaching from either it’s insertion or origin while pulling a piece of bone with it.

Ottawa Ankle Rules

• When dealing with the foot, an Athletic Trainer should always rule out a fracture first.

• Some things to check first:– The Lateral Malleolus at the growth plate and around the

anterior and posterior edges.– The Medial Malleolus at the growth plate and around the

anterior and posterior edges.– The 5th Metatarsal, specifically at the styloid process.– The navicular bone (from the medial, plantar and dorsal

surfaces)– Test and athletes ability to bare weight.

Ottawa Ankle Rules

Fractures- Jone’s Fracture:

- A Jone’s Fracture is a fracture of the proximal portion of the 5th metatarsal.

- Limited blood supply to the base of the 5th metatarsal, and sometimes needs to have a screw placed not only for bone structure and healing, but also to innovate the area with some blood flow.

Jone’s Fracture

Navicular Stress Fracture

• The Navicular is a bone that is difficult to fracture, but is not that uncommon with athletes who are jumping repeatedly.

• Basketball players are a common victim of this injury due to the fact that they are jumping and landing with great force AND because they are typically larger and heavier players who are putting a lot of force on the bones.

Fracture Mechanisms

• Mechanism of injury = what happened to cause the injury.

• Fractures are usually a result of a direct blow causing the bone to “crack”

• Fractures can also occur if a tendon pulls off a piece of bone due to weak bone at the insertion point, an intense burst of the muscle attached OR a combination of both.

Shin Splints

• Shin Splints often times come as a result of starting up an intense running program without the properly allowing your body to adjust gradually.

• Shins splints are intense inflammation of the lower leg muscles at their originations.

• They can also be a result of flat feet, or over pronating, and general overuse of the muscles.

• This “overuse” can be a result of just too much training, or other supporting muscles are weak and forcing these muscles to be over worked.

Shin Splints

• Running on hard surfaces such as pavement or concrete sidewalks can also contribute to shin splints.

• A better alternative would be running on a rubber track and/or grass instead.

• If not taken seriously, shin splints can eventually lead to “stress fractures” or “micro-fractures” of the tibia.

• Rest is really the best, and only true way to allow shin splints to heal most efficiently.

Lateral Ankle Sprain

• The most common form of an ankle sprain.

• Mechanism of injury is usually plantar flexion and inversion of the ankle.

Lateral Ankle Sprain

• The ligament that is most often the primary victim is the Anterior Talo-Fibular Ligament(ATF).

• The deeper into inversion your ankle goes, the more damage that can be done to the other lateral ligaments (CF and PTF).

• NOTE: it is common to have the peroneal tendons affected as well based on the mechanism.

Medial Ankle Sprain

High Ankle Sprain

Plantar Faciitis

Arch Sprain

Achilles Tendonitis and Ruptures

Turf Toe

Great Toe Sprain

Hammer Toe

Anterior Compartment Syndrome

Athlete’s Foot