Foot and Ankle Injuries

Ankle Sprains

Most common lower leg injury Classified as to degree of ligamentous

severity

Lateral ankle sprain

Mechanism: Inversion and plantar flexion

Anterior talofibular ligament (ATF) usually first structure to injury

Calcaneofibular ligament (CF) is usually secondary

Posterior talofibular ligament (PTF) rarely injured

Lateral ankle sprain

Signs/Symptoms: Obvious mech. of injury Report of “popping” or “tearing” of tissue Rapid swelling and point tenderness over soft

tissue Be careful of possible fracture

Medial ankle sprain

Less common

Mechanism: Eversion

Deltoid ligament injury

Medial ankle sprain

Signs/Symptoms: Pain and swelling not as evident Point tenderness over deltoid

Syndesmosis ankle sprain

Separation/widening of distal tibiofibular joint

Injury to Anterior/Posterior tibiofibular ligaments

Usually very disabling “High” ankle sprain Mechanism:

Dorsiflextion with inversion or eversion

Syndesmosis ankle sprain

Signs/Symptoms: Similar to lateral/medial ankle sprains Point tender at bony junction – top of ankle Swelling over medial/lateral malleoli

Fractures

May occur anywhere in foot Common at the base of 5th Metatarsal (Jones

Fracture) Usually result of forceful landing from jumping May be considered an avulsion fracture from an

inversion ankle sprain Treatment is extremely controversial

Turf Toe

First Metatarsaophalangeal (MTP) Sprain

Common with artificial surfaces

Mechanism: Hyperextending the MTP join or Contact with the shoe end

Turf Toe

Signs/Symptoms: Pain and Tenderness Swelling on the Plantar joint aspect Discomfort with toe extension

Treatment Cryotherapy, NSAIDS, Rest Protection from mechanism

CHRONIC CONDITIONS

Bunions (Hallux valgus)

Inflammation and thickening of the medial aspect of the MTP joint of the hallux

MTP joint becomes inflamed and causes lateral displacement of the hallux

As the condition progresses the 1st toe may overlap the 2nd toe

Predisposing factors High heels, pointed shoe box, poor shoe fit

Management Strapping of the hallux Wider toe box Surgical correction

Plantar Fasciitis (Bone spur)

Most common hindfoot problem in runners Main support for longitudinal arch Structurally weak near the origin

attachment Predisposing factors

Significant increase in training Excessive tightness in Achilles tendon Abnormal change in body weight Pes cavus (high arch)

Plantar Fasciitis (Bone spur)

Signs/Symptoms Pain is usually most sever during the first step in the morning Discomfort is reduced throughout the duration of the day Extreme point tenderness over origin

Management Therapeutic modalities (e-stim, ultrasound) Achilles tendon stretching NSAIDS Heel lifts, taping, orthodics Night splints MD referral

Achilles Tendonitis

Result of repetitive jumping or running (Loooooong distance runners)

Signs/Symptoms Thickening of surrounding tissues Crepitation with tendinous movement Reduced ROM

Management Ice therapy, NSAIDS Active stretching, Heel lifts Complete resolution of symptoms prior to return A chronic weakness will progress to rupture

Medial Tibial Stress Syndrome (Shin splints)

Early, painful component of first part of a training activity Associated with repetitive activity on hard surfaces Contributing factors

Muscled inflexibility Pes Planus (Low arch) Poor footwear Dramatic change in training or surface

Signs/Symptoms Pain along medial tibial border Usu. Lower 1/3 of shin Common for bilateral symptoms

Medial Tibial Stress Syndrome (Shin splints)

Management Rule out stress fractures Cryotherapy, NSAIDS Modification in training Pain free stretching of ankle/foot Change in footwear

ACUTE AND CHRONIC

Compartment Syndrome

Acute compartment syndrome results from a direct blow to the lower leg.

Chronic compartment syndrome results from increase in the intramuscular pressure during exercise

Most common in Anterior Leg Compartment

Compartment Syndrome

Signs/Symptoms Decreased distal pulse Swelling Pain and tenderness Numbness, significant muscle weakness Tight skin

Chronic – symptoms will reduce post-exercise

Compartment Syndrome

Treatment/Management ACUTE

Medical Emergency Immediate Referral to MD Ice

CHRONIC Ice, NSAIDS, Stretching, Alter activities If severe (or not improving) refer to MD

Surgical Fascia Release