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

\