The Ankle & Lower Leg  Bones:  Tibia (Medial Malleolus)  Fibula (Lateral Malleolus)  TalusCalcaneus (Heel Bone)  Ankle Ligaments (Lateral & Medial)  Lower leg muscles (Gastrocnemius = Calf Muscle)

Ankle Sprains (cont.)  Eversion Sprain: Less common, Injury to MEDIAL side  They are less common because the tibia is stronger than the fibula and the ligaments are stronger on the inside  Signs/Symptoms: (Remember, Sprains have Grades 1, 2, and 3)  Pain, Swelling, Stiffness, Pain during walking, Ecchymosis (Black & Blue discoloration)  Treatment: R.I.C.E. Rest Ice Compression Elevation  X-Ray if severe pain is present, pain along the bone, Positive Fracture tests

Ankle Sprain: One of the most common injuries seen in athletics  3 Types: Inversion & Eversion & High Ankle Sprain  Inversion: Most common, Injury to LATERAL side  “Rolling” your ankle is an inversion Sprain

Ankle Sprain (Cont.)

Ankle Sprains (cont.)

Ankle Injuries: Sprains Signs and symptoms depend on degree of sprain.  1 st degree: Pain, mild disability, point tenderness, little laxity, little or no swelling  2 nd degree: Pain, mild to moderate disability, point tenderness, loss of function, some laxity, swelling (mild to moderate)  3 rd degree: Pain and severe disability, point tenderness, loss of function, laxity, moderate to severe swelling

Ankle Injuries: Sprains (cont.) First Aid  Apply ice and compression.  Elevate.  Apply a horseshoe- or doughnut-shaped pad. Courtesy of Brent Mangus

Ankle Injuries: Sprains (cont.) First Aid (cont.) Have athlete use crutches with three- or four-point gait if a second- or third- degree sprain has occurred. If there is any question regarding the severity of the sprain, refer athlete to a medical facility for physician’s evaluation.

Ankle Injuries: Sprains (cont.) Tibiofibular (tib-fib) Sprains  These injuries are often treated inappropriately as lateral ankle sprains, hindering recovery.  The difference is the mechanism of injury. Tib-fib sprains involve dorsiflexion followed by axial loading with external rotation of the foot.  Symptoms include a positive sprain test, but athlete is also in great pain. “Squeeze test” elicits pain in syndesmosis area.

Ankle Injuries: Sprains (cont.) First Aid  Immediately apply ice and compression, and elevate the leg.  Apply a doughnut-shaped pad kept in place with an elastic bandage to provide compression.  Have athlete rest and use crutches for first 72 hours, followed by wearing a walking boot for 3 to 7 days.

Preventing Ankle Injuries  Taping or bracing will reduce the number of ankle injuries.  Prophylactic adhesive taping supports the ankle only for a short time.  Bracing may be better than taping.  Bracing combined with some high-top shoes may be helpful. Courtesy of McDavid

Ankle Sprain Treatment (cont.)  Athlete should be fitted for crutches to avoid weight bearing  Rehabilitation exercises should be performed before return to Practice/Games  Ankle Taping / Bracing to provide support

Tibia / Fibula Fracture  Fractures are common to the Tibia & Fibula  MOI: Acute Trauma, Strike to the Lower Leg, Sudden Rotation  S/Sx: Immediate pain, Swelling, Deformity (Open vs. Closed)  Tx: Immediate referral for X- Rays, by ambulance if necessary  Immobilization/Cast Weeks to Months depending on severity  Possible Surgery

Tibia / Fibula Fracture

Stress Fracture  Usually result of repetitive Overuse  (Running, Cross Country, Soccer, Basketball, etc.)  S/Sx: Pain along bone, May be worse after activity, night pain  Tx: Referral for X-Rays, Bone Scan, REST!, Immobilization

Shin Splints  Refers to any type of shin pain? No!  Medical Term: Medial Tibial Stress Syndrome  Condition involving pain along the inside (Medial) tibia  Involves a muscle called the Posterior Tibialis  Can be caused by foot mechanics (high arch or flat foot)  Muscle tightness or weakness, Improper shoes, Surface

Shin Splints (cont.) & Shin Contusion  Signs/Symptoms: Pain along the medial tibia  Treatment: Refer to doctor to rule out stress fracture, Rest, Foot Orthotics, Ice, Stretching, Taping, Medication  Shin Contusion  The tibia lies just below the skin in the shin, it is vulnerable to kicks/hits  No protection from fat or muscle  S/Sx: Pain, Swelling, Hematoma (Space filled with blood)  Prevention is important (especially in soccer…shinguards)  Tx: Compression wrap, Ice, Elevation  Aspiration (Draining by doctor with needle), Padding/Taping

Achilles’ Tendonitis  “-itis” means “Inflammation of”  Inflammation of Achilles’ Tendon, the thick cord you can feel in the back of the ankle (Attaches the calf muscles to the heel bone)  Causes: Repetitive Stresses (running/jumping)  S/Sx: Pain & Stiffness along the Achilles’ Tendon, Swelling  Treatment: RICE, Stretching, Heel Lift, Medication, Taping

Achilles’ Tendonitis

Achilles Tendon Rupture (Tear)  Largest Tendon in Body  Caused by sudden, forceful plantarflexion  Common in athlete’s above 35, activities with lots of ballistic (quick sprinting) movements  S/Sx: Athlete may feel or hear a “pop” and feel like they were kicked in the back of the leg; Pain, Palpable defect  Ability to plantarflex will be painful or impossible

Achilles’ Tendon Rupture (cont.)  Treatment: Surgery vs. No Surgery  Immobilization for 6-8 Weeks  Special Test : Thompson Test