Foot and Ankle Injuries
Ankle Sprains
Most common lower leg injury Classified as to degree of ligamentous
severity
Lateral ankle sprain
Mechanism: Inversion and plantar flexion
Anterior talofibular ligament (ATF) usually first structure to injury
Calcaneofibular ligament (CF) is usually secondary
Posterior talofibular ligament (PTF) rarely injured
Lateral ankle sprain
Signs/Symptoms: Obvious mech. of injury Report of “popping” or “tearing” of tissue Rapid swelling and point tenderness over soft
tissue Be careful of possible fracture
Medial ankle sprain
Less common
Mechanism: Eversion
Deltoid ligament injury
Medial ankle sprain
Signs/Symptoms: Pain and swelling not as evident Point tenderness over deltoid
Syndesmosis ankle sprain
Separation/widening of distal tibiofibular joint
Injury to Anterior/Posterior tibiofibular ligaments
Usually very disabling “High” ankle sprain Mechanism:
Dorsiflextion with inversion or eversion
Syndesmosis ankle sprain
Signs/Symptoms: Similar to lateral/medial ankle sprains Point tender at bony junction – top of ankle Swelling over medial/lateral malleoli
Fractures
May occur anywhere in foot Common at the base of 5th Metatarsal (Jones
Fracture) Usually result of forceful landing from jumping May be considered an avulsion fracture from an
inversion ankle sprain Treatment is extremely controversial
Turf Toe
First Metatarsaophalangeal (MTP) Sprain
Common with artificial surfaces
Mechanism: Hyperextending the MTP join or Contact with the shoe end
Turf Toe
Signs/Symptoms: Pain and Tenderness Swelling on the Plantar joint aspect Discomfort with toe extension
Treatment Cryotherapy, NSAIDS, Rest Protection from mechanism
CHRONIC CONDITIONS
Bunions (Hallux valgus)
Inflammation and thickening of the medial aspect of the MTP joint of the hallux
MTP joint becomes inflamed and causes lateral displacement of the hallux
As the condition progresses the 1st toe may overlap the 2nd toe
Predisposing factors High heels, pointed shoe box, poor shoe fit
Management Strapping of the hallux Wider toe box Surgical correction
Plantar Fasciitis (Bone spur)
Most common hindfoot problem in runners Main support for longitudinal arch Structurally weak near the origin
attachment Predisposing factors
Significant increase in training Excessive tightness in Achilles tendon Abnormal change in body weight Pes cavus (high arch)
Plantar Fasciitis (Bone spur)
Signs/Symptoms Pain is usually most sever during the first step in the morning Discomfort is reduced throughout the duration of the day Extreme point tenderness over origin
Management Therapeutic modalities (e-stim, ultrasound) Achilles tendon stretching NSAIDS Heel lifts, taping, orthodics Night splints MD referral
Achilles Tendonitis
Result of repetitive jumping or running (Loooooong distance runners)
Signs/Symptoms Thickening of surrounding tissues Crepitation with tendinous movement Reduced ROM
Management Ice therapy, NSAIDS Active stretching, Heel lifts Complete resolution of symptoms prior to return A chronic weakness will progress to rupture
Medial Tibial Stress Syndrome (Shin splints)
Early, painful component of first part of a training activity Associated with repetitive activity on hard surfaces Contributing factors
Muscled inflexibility Pes Planus (Low arch) Poor footwear Dramatic change in training or surface
Signs/Symptoms Pain along medial tibial border Usu. Lower 1/3 of shin Common for bilateral symptoms
Medial Tibial Stress Syndrome (Shin splints)
Management Rule out stress fractures Cryotherapy, NSAIDS Modification in training Pain free stretching of ankle/foot Change in footwear
ACUTE AND CHRONIC
Compartment Syndrome
Acute compartment syndrome results from a direct blow to the lower leg.
Chronic compartment syndrome results from increase in the intramuscular pressure during exercise
Most common in Anterior Leg Compartment
Compartment Syndrome
Signs/Symptoms Decreased distal pulse Swelling Pain and tenderness Numbness, significant muscle weakness Tight skin
Chronic – symptoms will reduce post-exercise
Compartment Syndrome
Treatment/Management ACUTE
Medical Emergency Immediate Referral to MD Ice
CHRONIC Ice, NSAIDS, Stretching, Alter activities If severe (or not improving) refer to MD
Surgical Fascia Release