Sports Med - Lower Leg Injuries

Medial ankle sprain - Symptoms

• Pain on medial side of ankle

• Pain when walking

• Restricted ROM

• Decreased strength

Medial ankle sprain - Special tests

• Kleiger's test

• Talar tilt eversion test

Medial ankle sprain - Affected structures

Deltoid ligaments

Medial ankle sprain - Common sports

• Volleyball

• Basketball

• Soccer

• Gymnastics

Calcaneus fracture - Symptoms

• Pain at the calcaneus (heel)

• Unable to walk (on heel), causes pain

• Unable to bear weight

• Swelling

• Bruising

*Usually from landing and falling from heights

Calcaneus fracture - Special tests

• Bump test

• Squeeze test

• Bilateral palpations

Calcaneus fracture - Affected structures

Calcaneus bone

Calcaneus fracture - Common sports

• Football

• Basketball

• Soccer

• Rugby

ATFL (anterior talofibular ligament) sprain - Symptoms

• Unable to walk, causes pain

• Pain when plantarflexing

• Pain on lateral ankle

• Swelling on lateral ankle

• Cannot balance

• Sounds/sensations (pop, tear)

ATFL (anterior talofibular ligament) sprain - Special tests

• Anterior drawer test

• Talar tilt test - inversion, plantarflex

ATFL (anterior talofibular ligament) sprain - Affected structures

Anterior talofibular ligament

ATFL (anterior talofibular ligament) sprain - Common sports

• Football

• Volleyball

• Basketball

• Soccer

Peroneal subluxation - Symptoms

• Pain in the area

• Popping sensation on lateral ankle

• Deformity

• Lateral tendon moves in and out of place

• Visibly see that the ligament is out of place

• Swelling

• Bruising

• Chronic lateral ankle sprains

Peroneal subluxation - Special tests

• Squeeze test: To rule out tibia and fibula fractures or high ankle sprain

• Bilateral palpations

Peroneal subluxation - Affected structures

Peroneal tendons

• Peroneal reticulum tendon

Peroneal subluxation - Common sports

• Volleyball

• Basketball

• Track

• Running

ATFL and CFL sprain - Symptoms

• Pain when walking

• Pain on lateral ankle

• Swelling

• Bruising

ATFL and CFL sprain - Special tests

• Talar tilt test: Neutral and plantarflexion

• Anterior drawer test

ATFL and CFL sprain - Affected structures

• Anterior talofibular ligament

• Calcaneofibular ligament

ATFL and CFL sprain - Common sports

• Football

• Volleyball

• Basketball

• Soccer

• Tennis

Talus fracture - Symptoms

• Pain at the talus

• Deep ankle pain

• Unable to bear weight

• Swelling

• Bruising

*Usually from severe inversion and dorsiflexion

Talus fracture - Special tests

• CT scan

• MRI scan

Talus fracture - Affected structures

Talus bone

Talus fracture - Common sports

High-impact sports

Achilles tendinitis - Symptoms

• Heel pain

• Unable to walk, run, or jump; causes pain

• Unable to squat, causes pain

• Over usage of the Achilles tendon

• Swelling

Achilles tendinitis - Special tests

Thompson test: To rule out Achilles tendon rupture

Achilles tendinitis - Affected structures

Achilles tendon

Achilles tendinitis - Common sports

• Volleyball

• Basketball

• Track

• Soccer

• Running

Achilles tendon rupture - Symptoms

• Sudden sharp pain

• Popping sensation

• No plantarflexion

• Swelling

• Unable to walk, causes pain

• Unable to squat, causes pain

• Unable to heel raise

Achilles tendon rupture - Special tests

• Thompson test

• X-ray scan

• MRI scan

Achilles tendon rupture - Affected structures

Achilles tendon

Achilles tendon rupture - Common sports

• Football

• Basketball

• Soccer

• Tennis

• Running

High ankle sprain / Syndesmotic ankle sprain - Symptoms

• Pain above ankle

• Pain when dorsiflexing

• Unable to bear weight

• Swelling

High ankle sprain / Syndesmotic ankle sprain - Special tests

• Kleiger’s test - dorsiflexion

• Squeeze test

• Tip-toe

• Walking on heels causes pain

High ankle sprain / Syndesmotic ankle sprain - Affected structures

Syndesmotic ligaments:

• Anterior tibiofibular ligament

• Posterior tibiofibular ligament

High ankle sprain / Syndesmotic ankle sprain - Common sports

• Football

• Hockey

• Skiing

Turf toe - Symptoms

• Pain around the base of the big toe

• Pain when walking

• Pain when tip-toe

• Pain with push-off

• Limited ROM

• Swelling

Turf toe - Special tests

• Tip-toe

• Bilateral palpations

Turf toe - Affected structures

MTP joint

Turf toe - Common sports

• Football

• Soccer

• Wrestling

• Track

• Rugby

Sesamoiditis - Symptoms

• Pain at the sesamoid (under big toe)

• Pain at head of the first metatarsal

• Swelling

• Pain worsens with pressure/activity

• Pain with ROM

Sesamoiditis - Special tests

• Tip-toe

• Bilateral palpations

Sesamoiditis - Affected structures

Sesamoid bones

Sesamoiditis - Common sports

• Tip-toe walkers

• Basketball

• Dance

• Water polo

Sesamoid Fracture - Symptoms

• Pain at the sesamoid

• Pain when bending or straightening

• Head of the first metatarsal

• Swelling

• Unable to bear weight

• Difficulty walking

• Discomfort with activity

• Morning pain

• “Pop” sensation

• Localized pain

Sesamoid Fracture - Special tests

• Bilateral palpations

• Tip-toe

• Can only walk on heels

• Plantarflexion

• X-ray scan

Sesamoid Fracture - Affected structures

Sesamoid bones

Sesamoid Fracture - Common sports

• Football

• Basketball

• Soccer

• Track

• Rugby

• Ballet

• Running and jumping sports

Arch Sprain/Strain - Symptoms

• Pain in the arch

• Swelling in the arch

• Pain when walking

• Unable to bear weight

• Bruising

Arch Sprain/Strain - Special tests

• Tip-toe

• Unable to walk, causes pain

Arch Sprain/Strain - Affected structures

• Arch of the foot

• Plantar fascia

Arch Sprain/Strain - Common sports

• Football

• Track

• Rugby

• Gymnastics

• Dance

• Running sports

Phalange Fracture - Symptoms

• Pain at the phalange(s)

• Limp, unnatural walking

• Deformity

• Sounds/sensations (crunching)

• Unable to bear weight

• Swelling

• Bruising

Phalange Fracture - Special tests

• Bilateral palpations

• Tip-toe

• X-ray

Phalange Fracture - Affected structures

Phalange bones

Phalange Fracture - Common sports

• Football

• Basketball

• Soccer

• Rugby

Lisfranc Injury - Symptoms

• Pain in mid-foot area

• Unable to bear weight

• Swelling

• Bruising

Lisfranc Injury - Special tests

• Walking

• Mid-foot squeeze test

• Bilateral palpations

• X-ray

Lisfranc Injury - Affected structures

• Joint between medial and middle cuneiforms

• Lisfranc ligament

Lisfranc Injury - Common sports

• Football

• Gymnastics

Avulsion Fracture - Symptoms

• Sharp pain at the injury site

• Pain when moving foot

• Swelling

• Bruising

Avulsion Fracture - Special tests

X-ray scan

Avulsion Fracture - Affected structures

Bone where ligament or tendon attaches

Avulsion Fracture - Common sports

• Basketball

• Soccer

• Gymnastics

Plantar Fasciitis - Symptoms

• Heel pain after activity

• Unable to walk, causes pain

• Morning pain

Plantar Fasciitis - Special tests

Bump test

Plantar Fasciitis - Affected structures

• Plantar fascia

• Calcaneus bone

Plantar Fasciitis - Common sports

• Cross country

• Track

• Basketball

• Dance

Medial Tibial Stress Syndrome / Shin Splints - Symptoms

• Pain on shins

• Pain while running

• Overusage along the inner tibia

Medial Tibial Stress Syndrome / Shin Splints - Special tests

• Bilateral palpations

• X-ray scan

Medial Tibial Stress Syndrome / Shin Splints - Affected structures

• Tibia

• Fibula

Medial Tibial Stress Syndrome / Shin Splints - Common sports

• Basketball

• Track

• Cross country

• Gymnastics

Tibia Fracture - Symptoms

• Pain at the tibia

• Unable to bear weight

• Swelling

• Bruising

Tibia Fracture - Special tests

• Bump test

• Squeeze test

• Bilateral palpations

• X-ray scan

Tibia Fracture - Affected structures

Tibia bone

Tibia Fracture - Common sports

• Football

• Basketball

• Soccer

• Rugby

• Skiing

Fibula Fracture - Symptoms

• Pain at the fibula

• Unable to tip-toe, causes pain

• Super sensitive to touch

• Very limpy walking

• Swelling

• Bruising

Fibula Fracture - Special tests

• Bump test

• Squeeze test

• Bilateral palpations

• Tip-toe

• X-ray scan

Fibula Fracture - Affected structures

Fibula bone

Fibula Fracture - Common sports

• Football

• Basketball

• Soccer

• Rugby

PTFL (Posterior talofibular ligaments) Sprain - Symptoms

Pain on posterior side (back of the ankle)

PTFL (Posterior talofibular ligaments) Sprain - Special tests

Talar tilt test

PTFL (Posterior talofibular ligaments) Sprain - Affected structures

Posterior talofibular ligament

PTFL (Posterior talofibular ligaments) Sprain - Common sports

• Football

• Volleyball

• Basketball

Lateral ankle sprain - Symptoms

• Pain on lateral side of ankle

• Pain when walking

• Swelling

• Restricted ROM (range of motion)

Lateral ankle sprain - Special tests

• Talar tilt inversion test

• Anterior drawer test

Lateral ankle sprain - Affected structures

• Calcaneofibular ligament

• Anterior talofibular ligament

• Posterior talofibular ligament

Lateral ankle sprain - Common sports

• Volleyball

• Basketball

• Soccer

Dislocation - Symptoms

• Numbness

• Tingling

• Joint is visibly out of place

• Unable to bear weight

• Pain

• Deformity

Dislocation - Special tests

X-ray scan

Dislocation - Affected structures

Tibia, fibula, talus, or ankle joint

Dislocation - Common sports

• Football

• Volleyball

• Basketball

• Soccer

• Gymnastics

Metatarsal fractures - Symptoms

• Pain on metatarsal(s)

• Pain on mid-foot or fore-foot

• Pain when walking

• Unable to bear weight

• Limited ROM

• Deformity

• Swelling

• Bruising

Metatarsal fractures - Special tests

• Observe their walking

• X-ray scan

Metatarsal fractures - Affected structures

Metatarsal bone(s)

Metatarsal fractures - Common sports

• Basketball

• Soccer

• Running sports

Tarsal fractures - Symptoms

• Pain at the tarsals

• Unable to bear weight

• Swelling

• Bruising

Tarsal fractures - Special tests

• Bilateral palpations

• X-ray scan

• CT scan

Tarsal fractures - Affected structures

Tarsals (calcaneus, talus, navicular, cuboid, the 3 cuneiforms)

Tarsal fractures - Common sports

• Football

• Basketball

• Soccer

• Rugby

• Running sports