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