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

• 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