Common Injuries of the Ankle

• Fracture of the Ankle/Lower Leg
  • Fibula Fracture: most common seen in sport activities
  • Talus Fracture: least common but can be mistaken as ankle sprains
  • Tibia Fracture: can be very serious and debilitating due to its status as the primary weight bearing bone
• Fractures
  • MOI: Direct force against bone or indirect abuse such as twisting motion
  • S&S
  • High levels of pain
  • Swelling and discoloration
  • Obvious deformity
  • Inability to bear weight
  • Decrease strength and range of motion
  • Treatment:
  • Splint
  • Immobilize
  • Non weight bear (NWB)
  • Surgical interventions
• Stress Fractures
  • Stress fx in the tibia and fibula are significant in their occurrence rates in athletics
  • 
  • S&S
  • Pain that has developed gradually and increased in severity
  • Pain likely to be worse after activity rather than during motion
  • Pain localized to one specific point
  • Treatment
  • Bone Scan may be necessary
  • Remove from sport, NWB or PWB for 4-6 weeks
  • Cross training regimen
  • Immobilization
  • Insoles, new shoes, orthotics to correct biomechanics
  • Diet
• Ankle Dislocation
  • MOI: twisting motion during full weight bearing, ankle sprain mechanism
  • The talus will tear the supporting ligaments and often fractures either or both of the malleoli because the talar dome is forcibly removed from its normal position
  • Sometimes a dislocation can include a tibia/fibula fx
  • 
  • S&S
  • Extreme pain
  • Obvious deformity
  • Swelling and discoloration
  • Loss of ROM and strength
  • Treatment
  • Immediate splinting and referral
  • Surgical intervention
  • Crutches and immobilization 4-6 weeks with RTP 4-6 months
• Shin Splints
  • Also called Medial Tibial Stress Syndrome
  • MOI: occurs as a result of a sudden increase in duration of intensity of training
  • Location is commonly in the anterior compartment of the lower leg
  • Can include tibialis anterior strain, microtears in the muscle, microfractures in the tibia or even stress fx
  • 
  • S&S
  • Pain increasing with running and dorsiflexion
  • No obvious traumatic mechanism
  • Treatment
  • Cold modalities: ice massage, cold whirlpool
  • Massage
  • Stretching and strengthening
  • Compression
  • Insoles or orthotics
• Compartment Syndrome
  • Anterior muscle compartment is contained within layers of fascial tissue that help maintain position and muscle shape
  • Compartment Syndrome may occur either through acute trauma or chronic overuse
  • MOI: increase in fluid pressure within the facial tissue that then compresses the muscles, nerves and blood vessels
  • The compression causes a loss of oxygen to the muscle which can result in tissue death and serious complication
  • Chronic is typically found in runners and causes pain and muscle ischemia during activity and then subsides once the activity is ceased.
  • Many individuals with compartment syndrome complain of foot numbness or tingling during activity caused by increased tissue pressure
  • 
  • S&S
  • Pain that increases with activity
  • Numbness/tingling in foot
  • Foot drop resulting from neurovascular damage in the lower leg
  • Pain subsides during rest
  • May occur bilaterally
  • Treatment
  • Refer to physician
  • Surgical intervention
  • Cross training
• Ankle Sprains
  • One of the most common injury in athletics
  • Three ligament structured are associated with the ankle joint
  • Anterior Talofibular Ligament (ATF) -> Inversion Ankle Sprain
    • Lateral Ankle Sprain
    • 
    • MOI: when ankle is forcibly moved into inversion and plantarflexion
    • ATF: first to be injured because it is the weakest of the three ligaments due to its anterior position
    • S&S
    • Swelling, discoloration, pain
    • Joint laxity
    • Decreased ROM
    • Decreased ability to WB
  • Deltoid Ligament -> Eversion Ankle Sprain
    • MOI: Excessive eversion and dorsiflexion
    • Medial Ankle Sprain
    • 
    • Occurs in 5% of all ankle sprains
    • S&S
    • Pain and discomfort
    • Decreased ROM
    • Decreased ability to WB
    • Swelling and discoloration
  • Tibiofibular Ligament (TFL)-> High Ankle Sprain
    • MOI: forced dorsiflexion and rotation of the ankle at the talar dome that causes separation of the tibia and fibula
    • 
    • S&S
    • Pain in high ankle/lower leg
    • Pain with WB
    • Slight to no swelling
    • Decreased ROM
    • Decreased strength
  • Treatment for Ankle Sprains
  • RICE
  • Immobilization if necessary
  • Rehab: Ankle pumps, ABCs (ROM is key)
  • Strengthening Exercises
  • Proprioception Neuromuscular Control
  • Cold whirlpool
  • Horse shoe pad
• Achilles Rupture
  • Most commonly seen in adults older than 30 years who have lost general flexibility or individuals starting new training program after being sedentary for an extended period of time
  • 
  • MOI: pushing off or inversion/plantarflexion (ankle sprain)
  • S&S
  • Disruption of the structure and rolling of the tendon upward toward the muscle belly
  • Pain (intense at the onset of the injury)
  • Treatment
  • Surgical intervention
  • 1 year long recovery

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