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