RN

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