Ankle Anatomy and Associated Injuries/conditions

Fracture Types Spiral Comminuted Compound Stress Longitudinal (linear) Transverse Oblique Epiphyseal Greenstick Impacted

Spiral Creates a spiral effect or S shape

Comminuted More than two pieces – Often displaced

Compound Fracture with break in the skin

Stress microfractures

Longitudinal Parallel to the shaft of the bone

Transverse Perpendicular to the shaft of the bone

Oblique Diagonal to the shaft of the bone

Epiphyseal Through or across the growth plate. Can also be a crush.

Greenstick Force to one side splits bone on opposite side

Impacted Bone is shortening in a crush-type fracture

Sesamoiditis Etiology: repetitive stress, repetitive hyperextension of the hallux Signs and Symptoms: pain and tenderness under hallux, especially during push off Management: orthotics, padding or walking boot Complications: can lead to strain of the tendon or possible rupture, or fracture of the sesamoid bone.

Jones Fracture Etiology: inversion and plantarflexion; direct force (getting stepped on); repetitive stress Anatomy: Diaphysis (shaft) of the 5 th metatarsal Signs and Symptoms: immediate swelling & pain over 5 th metatarsal, pain with pounding Complications: high nonunion rate, slow healing

Metatarsal Stress Fracture (March Fracture) Etiology: Chronic fx to the 4 th or 5 th metatarsal from; changing training patterns (shoes, intensity, surfaces) or structural (hallux valgus) Signs and Symptoms; pain with pounding that slowly increases Special considerations: often missed on x-ray, must use bone scan or MRI to diagnose

Medial Tibial Stress Syndrome “shinsplints” Etiology: repetitive stress/trauma, hard surfaces, foot posture that causes inflammation and possible microfracture to the Tibia Signs and Symptoms: pain in the anterior lower leg – (1; after activity, 2; during and after but no affecting performance, 3; during and after performance, 4; too painful to perform) Management: role out stress fracture (stress reaction)

Sprains, Strains and Fibrocartilage Tears

Dislocation Occurs when the articulation between two or more bones in a joint is disrupted, often occurs from trauma Is always associated with_____

Subluxation Partial or incomplete dislocation of a joint, or dislocation with spontaneous and immediate relocation.

Sprain Tear or partial tear of a ligament – 1 st degree: micro to minimal of ligament tearing with little functional loss and inflammation – 2 nd degree: minimal to moderate ligament tearing with mild joint laxity (movement), inflammation, and significant functional loss – 3 rd degree: moderate to complete tearing of the ligament with significant joint laxity, functional loss, pain and swelling

Strain Tear or partial tear of a tendon, muscle or muscle-tendon junction

Anterior or Lateral Compartment Syndrome Etiology: extreme swelling in the anterior or lateral lower leg (typically from a blow to the leg or severe strain) causing decreased circulation and sensation to the lower leg and foot. S&S: pain or possibly numbness, decreased dorsal pedal pulse, decreased or inability to dorsiflex or evert the ankle. TX: Medical emergency, may release pressure with surgery Chronic compartment syndrome exists due to tight fascia and follows a conservative tx plan

Ankle Sprains Lateral Ankle Sprain Medial Ankle Sprain Syndesmotic (High) Ankle Sprain

Lateral Ankle Sprain Etiology: ATF, CF and PTF injury from forced inversion S&S: pain, swelling on lateral joint line Lateral laxity TX: RICE, possible surgery

Medial Ankle Sprain Etiology: damage to the deltoid ligament with forced eversion of the ankle S&S: inflammation on the medial joint line may have medial joint laxity *often associated with fibular fractures

Syndesmotic Ankle Sprain Etiology: injury to anterior and/or posterior tibiofibular ligament. Severe twisting or hyperdorsiflexion S&S pain with weight bearing especially with external rotation of the foot * If not treated properly may tear up the sydesmotic liagment (interosseous membrane) and require surgery

Ankle Dislocation

Etiology: injury to all lateral and/or all medial ligaments disrupting the talotibial and talofibular joints. Typically foot planted and blow from any direction. S&S: obvious deformity, pain, inability to move foot *Medical emergency because of possible vascular and neural compromise

Fallen Arch Etiology: The 1 st and 5 th Metatarsal heads bear more weight. Excessive weight on the medial arch can cause the medial longitudinal ligament to tear or stretching. S&S: Arch appears to “Fall” with weight bearing, pain on medial arch.

Tarsometatarsal Dislocation Lisfranc (midfoot dislocation) Etiology: uncommon but can cause long term injury/complication. Occurs when foot is plantarflexed with rearfoot (heel) is locked and you have forced dorsiflexion. Causes dislocation between the metatarsals and the tarsals. S&S: deformity, laxity in midfoot, pain and/or inability to push off with toes Requires surgery and may never fully recover

Morton’s Neuroma Etiology: Plantar nerve becomes irritated because of repetitive compression/pinching/irritation and becomes inflamed. Most common in the 1 st and 2 nd metatarsals S&S: burning, stinging pain, eventually numbness in the distal foot. *can cause permanent nerve damage over time

Hallux Valgus Etiology: laxity of the medial joint line of the metatarsophalangeal joint of the great (1 st ) toe causing the toe to point laterally and the development of a bump on the distal 1 st metatarsal. S&S: pain, deformity, inflammation of the metatarsophalngeal joint. Can cause degeneration of the joint over time. TX: toe wedge, surgery