Ankle The ankle is the most commonly injured joint in athletics The bony structure of the ankle is very strong With moderate ligament support And poor muscular support

Bones Tibia (Medial Malleolus) Fibula (Lateral Malleolus) Calcaneus Talus

Lateral Ligaments Anterior talofibular Calcaneofibular Posterior talofibular

Medial ligaments Deltoid Ligaments

Ankle re-injury Tight Achilles tendon is the major cause of recurrent ankle sprains

Prevention Stretch musculature of the ankle Resistive strengthening of the musculature Inversion Eversion Plantar flexion dorsiflexion

Mechanism of injury Inversion eversion

Inversion Stepping in a hole Stepping on another persons foot Stepping on a rock Anterior talofibular ligament injured

Eversion ankle sprain Stepping in a hole Stepping on another persons foot Stepping on a rock Deltoid ligament injured

1 st degree (Mild) ankle sprain Ligaments are stretched Minor discomfort Point tenderness Mild swelling

2 nd Degree (Moderate) Ankle Sprain Ligaments are stretched and/or Partially torn Moderate pain Point tenderness Some loss of function Slight abnormal movement at the joint

3 rd degree (Severe) Ankle sprain Ligaments are completely torn Extreme pain Total loss of function Point tenderness Rapid swelling

Evaluation H istory O bservation/Inspection P alpation S pecific testing S ubjective O bjective A ction taken P lan

History How did it happen When did it happen Did you hear or feel a pop Where you able to walk on it right away

Observation Bleeding Swelling Discoloration Deformity Bilaterally comparison

Palpation Look at bony landmarks Soft tissue Bilateral comparison

Fracture Direct pain Indirect pain Deformity Grating sounds (Crepitation) Testing Compression Percussion Tuning fork

Functional Testing Passive ROM Active ROM Resistive ROM

Sports Specific Testing Hop 10 times on injured limb Walk Run straight Run circles Figure 8’s Zig zag 90 degree cutting

Treatment Rest Ice 20 minutes every two hours Compression with horseshoe/elastic wrap Elevation Avoid heat in any form Remove elastic wrap before bedtime Follow this treatment for 1-72 hours

Once the bleeding has stopped Apply heat before activity and ice after to… Remove waste product from injured area Promote healing Increase ROM

Rehabilitation Recovery is: Absence of pain Full ROM Full Strength Full flexibility

Range of motion Working toward complete pain free ROM Flex & Plantarflex foot as far as possible Invert and evert foot as far as possible Circular motion clockwise and counter Write capital letters with the toes Achilles tendon stretch

Resistive Exercises Walk on hells and toes (toes up, out, & in) Pick up marbles with toes Towel toe curl Isometric inversion and eversion with chair legs Calf (heel) raises with feet straight in & out

Resistive Exercises continued Closed chain kinetic exercises BOSU ball exercises Trapoline exercises Dinodisc exercises Voo doo board exercises

Return to activity Do all of the following at 50,75, & 100% Hop 10 times on injured limb Walk Run straight Run circles Figure 8’s Zig zag 90 degree cutting

Heel Bruise Heel and arch receives, absorbs and transfers most of the impact Heel Bruise is one of the most disabling contusions

Heel bruise Treatment Heel lift (poss. donut hole) Cold application before and ice after Activity

Plantar Fasciitis Wide inelastic ligament that supports the arch of the foot

Cause of plantar Fasciitis Overuse Overweight Tight Achilles Improper shoe support Running on hard surface

Signs of plantar fasciitis Pain and tenderness on the bottom of the foot near the heal

Treatment plantar fasciitis RICE Tape support (slipper)

Heel Spur Bony growth on Calcaneus Cause Flat feet

Turf toe Sprain of the great toe (MP joint) The great toe is important in movement, balance and speed Cause Foot sliding back on a slippery surface Hyperextension of the big toe Treatment RICE Taping Turf toe taping

Taping Tests Slipper Turf toe Achilles