Ankle injuries in the realm of sports.ppt

ankle injuries

1. Common Injuries Common Injuries
of the Foot and Ankleof the Foot and Ankle

2. Ankle jointAnkle joint

3. SprainSprain

Definition: A sprain is a stretch or Definition: A sprain is a stretch or
tearing of one or more ligaments of the tearing of one or more ligaments of the
ankle. Sprains are generally graded on a ankle. Sprains are generally graded on a
scale of I to III depending on their scale of I to III depending on their
severity.severity.

4. 
Grade I: slight stretching of ligaments, may have some Grade I: slight stretching of ligaments, may have some
pain, no significant swelling or discoloration.pain, no significant swelling or discoloration.

Grade II: moderate stretching of ligaments, some Grade II: moderate stretching of ligaments, some
swelling and discoloration, orthopedic tests will reveal swelling and discoloration, orthopedic tests will reveal
a “soft” endpoint.a “soft” endpoint.

Grade III: fibers of the ligament are completely torn, Grade III: fibers of the ligament are completely torn,
usually severe and immediate swelling, orthopedic usually severe and immediate swelling, orthopedic
tests will reveal no endpointtests will reveal no endpoint

6. Inversion SprainInversion Sprain

Most common mechanism for ankle Most common mechanism for ankle
sprains.sprains.

Involves one or more of the lateral Involves one or more of the lateral
ligaments of the ankleligaments of the ankle

7. Eversion SprainEversion Sprain

Not that common due to strength of the Not that common due to strength of the
deltoid (medial) ligament and bony deltoid (medial) ligament and bony
structure.structure.

Severe sprains often are accompanied by Severe sprains often are accompanied by
fractures of the fibula.fractures of the fibula.

8. SprainSprain
Treatment:Treatment:

The immediate treatment for any The immediate treatment for any
degree of sprain is rest, ice, degree of sprain is rest, ice,
compression and elevation.compression and elevation.

NSAID’s may be taken for pain and NSAID’s may be taken for pain and
swelling.swelling.

Doctor referral if fracture is suspected.Doctor referral if fracture is suspected.

9. Achilles BursitisAchilles Bursitis

Definition: A bursa is a fluid-filled Definition: A bursa is a fluid-filled
membrane that lubricates between membrane that lubricates between
areas of friction(bone-to-tendon or areas of friction(bone-to-tendon or
bone-to-ligament). Bursitis is occurs bone-to-ligament). Bursitis is occurs
when the bursa becomes inflamed.when the bursa becomes inflamed.

10. Achilles BursitisAchilles Bursitis
S/Sx: S/Sx:

Point tenderness over attachment of Point tenderness over attachment of
Achilles to the heel.Achilles to the heel.

Swelling may be present.Swelling may be present.

Usually has a gradual onsetUsually has a gradual onset

11. Achilles Bursitis

12. Achilles BursitisAchilles Bursitis
Treatment: Treatment:

Heat before activityHeat before activity

Ice after activityIce after activity

NSAID’sNSAID’s

Gentle stretching of Achilles tendonGentle stretching of Achilles tendon

Lingering cases should be referred to a Lingering cases should be referred to a
doctor.doctor.

13. Achilles TendonitisAchilles Tendonitis

Def: Inflammation of the achilles tendonDef: Inflammation of the achilles tendon

MOI: may be from a single incident but MOI: may be from a single incident but
more often from an accumulation of more often from an accumulation of
smaller stressessmaller stresses

14. Achilles TendonitisAchilles Tendonitis
S/Sx:S/Sx:

Usually gradual onset of S/SxUsually gradual onset of S/Sx

Early on, pain occurs only during Early on, pain occurs only during
activity and slowly progresses to pain activity and slowly progresses to pain
all of the timeall of the time

Point tenderness over tendonPoint tenderness over tendon

Swelling may be presentSwelling may be present

15. Achilles Tendonitis

16. Achilles TendonitisAchilles Tendonitis
Treatment:Treatment:

Rest, ice and NSAID’sRest, ice and NSAID’s

Gentle stretching of tendonGentle stretching of tendon

Heat before activity/Ice after activityHeat before activity/Ice after activity

Taping and/or heel lift Taping and/or heel lift

UltrasoundUltrasound

Possible doctor referral Possible doctor referral

17. Heel ContusionHeel Contusion

Bruise to the heelBruise to the heel

MOI: stop and go activities or jumping MOI: stop and go activities or jumping
movementsmovements

S/Sx: Severe pain on bottom of heel, pain S/Sx: Severe pain on bottom of heel, pain
with weight-bearing with weight-bearing

Tx: RICE, taping, donut pad, ultrasound, Tx: RICE, taping, donut pad, ultrasound,
whirlpoolwhirlpool

18. Turf ToeTurf Toe

Def: Sprain of the 1Def: Sprain of the 1
stst
MP joint MP joint

MOI: kicking object, stubbing toe, MOI: kicking object, stubbing toe,
dropping heavy object on it, fields with dropping heavy object on it, fields with
turf. Occurs as foot is planted and the foot turf. Occurs as foot is planted and the foot
and ankle is dorsiflexed. As the shoe and ankle is dorsiflexed. As the shoe
grasps the playing surface, body weight grasps the playing surface, body weight
and forward momentum force the 1and forward momentum force the 1
stst
MP MP
joint into hyperextension.joint into hyperextension.

19. Turf ToeTurf Toe

20. Turf ToeTurf Toe

S/Sx: pain during push-off phase of gait, S/Sx: pain during push-off phase of gait,
active joint motion or manual resistance. active joint motion or manual resistance.
Pain when attempting quick stops . Point Pain when attempting quick stops . Point
tenderness over MP joint, limited ROMtenderness over MP joint, limited ROM

Tx: RICE, NSAIDs, Tx: RICE, NSAIDs,
ultrasound, tapeultrasound, tape

21. Medial Tibial SyndromeMedial Tibial Syndrome

Def:Def: Shin splints: a general term applied to a Shin splints: a general term applied to a
variety of conditions that seasonally plague variety of conditions that seasonally plague
many athletesmany athletes

MOI: factors that may lead to an increase MOI: factors that may lead to an increase
incidence of shin splints are:incidence of shin splints are:

Biomechanical factorsBiomechanical factors

Change in intensity, duration, or frequency Change in intensity, duration, or frequency
of workoutsof workouts

Improper or worn footwearImproper or worn footwear

Change in surfaceChange in surface

Improper warm-up and cool-downImproper warm-up and cool-down

Change in type of workoutChange in type of workout

23. Anterior Compartment SyndromeAnterior Compartment Syndrome

Soft tissue injuries at the muscular origin and Soft tissue injuries at the muscular origin and
bony or periosteal interface of the bone and bony or periosteal interface of the bone and
muscle origin. muscle origin.

Due to micro tears of the Tibialis Anterior either Due to micro tears of the Tibialis Anterior either
at the origin or in the fibers themselves.at the origin or in the fibers themselves.

Or microtrauma to the bone structure itself. Or microtrauma to the bone structure itself.

Stress fractures can also occur in this area. Stress fractures can also occur in this area.

24. Exertional Compartment Exertional Compartment
SyndromeSyndrome

Caused by the muscles swelling within a closed compartment Caused by the muscles swelling within a closed compartment
with a resultant increase in pressure in the compartment. with a resultant increase in pressure in the compartment.

The blood supply can be compromised and muscle injury and The blood supply can be compromised and muscle injury and
pain may occur. pain may occur.

Abnormal compartment pressure:Abnormal compartment pressure:

A resting pressure greater than 20 mm Hg; orA resting pressure greater than 20 mm Hg; or

An exertional pressure greater than 30 mm Hg; orAn exertional pressure greater than 30 mm Hg; or

A pressure of 25 mm Hg or higher 5 minutes after A pressure of 25 mm Hg or higher 5 minutes after
stopping exercise. stopping exercise.

This may require surgical decompression of the compartmentThis may require surgical decompression of the compartment. .

25. Key CausesKey Causes

Tight posterior muscles Tight posterior muscles

Imbalance between the posterior and anterior Imbalance between the posterior and anterior
muscles muscles

Running on concrete or other hard surfaces Running on concrete or other hard surfaces

Improper Shoes - inadequate shock protection Improper Shoes - inadequate shock protection

Overtraining Overtraining

26. Shin SplintsShin Splints

S/Sx: S/Sx:

Grade I: pain after activityGrade I: pain after activity

GradeII: pain before and after activity GradeII: pain before and after activity
not affecting performancenot affecting performance

Grade III: pain before, during and after Grade III: pain before, during and after
activityand affecting performanceactivityand affecting performance

Grade IV: pain so sever that Grade IV: pain so sever that
performance is impossibleperformance is impossible

27. Shin SplintShin Splint

28. Shin SplintsShin Splints

Tx: varies by individualTx: varies by individual

Constant heat (whirlpools and US) with Constant heat (whirlpools and US) with
tapingtaping

NSAIDsNSAIDs

Ice massage before or afterIce massage before or after

Stretching of anterior and posterior Stretching of anterior and posterior
structuresstructures

29. TreatmentTreatment

Rest. The sooner you rest the sooner it will heal. Rest. The sooner you rest the sooner it will heal.

Apply Apply ice 10-15 minutes for 2-3x per day in the 10-15 minutes for 2-3x per day in the
early stages when it is very painful. early stages when it is very painful.

Anti inflammatory drugs Anti inflammatory drugs

Wear Wear shock absorbing insoles in shoes. in shoes.

Maintain fitness with other non weight bearing Maintain fitness with other non weight bearing
exercises. exercises.

Apply heat and use a Apply heat and use a heat retainer after the initial after the initial
acute stage, particularly before training. acute stage, particularly before training.

30. Stress FracturesStress Fractures

Bone remodelingBone remodeling

Repetitive stress weakens the boneRepetitive stress weakens the bone

10-20% of injuries to athletes10-20% of injuries to athletes

Most common locations: tibia, fibula and Most common locations: tibia, fibula and
metatarsals.metatarsals.

Tibial and fibular stress fractures can develop Tibial and fibular stress fractures can develop
from “shin splints”from “shin splints”

31. Causes of Stress FracturesCauses of Stress Fractures

Training errorsTraining errors

Abnormal limb lengthAbnormal limb length

Low body weight (< 75% of ideal)Low body weight (< 75% of ideal)

Eating disordersEating disorders

Previous inactivityPrevious inactivity

White raceWhite race

FemaleFemale

32. FracturesFractures
Definitions:Definitions:

Fractures of the foot and ankle can occur Fractures of the foot and ankle can occur
in any number of places.in any number of places.

The fibula is a non-weightbearing and can The fibula is a non-weightbearing and can
be fractured by a direct blow. be fractured by a direct blow.

Fractures of the tibia are often Fractures of the tibia are often
accompanied by a fracture of the fibula. accompanied by a fracture of the fibula.

34. FracturesFractures
S/Sx:S/Sx:

Fractures of the fibula may not display Fractures of the fibula may not display
any gross deformities. There will be any gross deformities. There will be
point tenderness and a positive point tenderness and a positive
percussion test. The person may be able percussion test. The person may be able
walk.walk.

Tib/Fib fractures will have a gross Tib/Fib fractures will have a gross
deformity. The athlete will not be able to deformity. The athlete will not be able to
bear weight. bear weight.

36. FracturesFractures
Treatment:Treatment:

For a suspected fibular fracture, the For a suspected fibular fracture, the
athlete should be immobilized and athlete should be immobilized and
referred to a doctor.referred to a doctor.

For a Tib/Fib fracture, try to calm the For a Tib/Fib fracture, try to calm the
athlete down and monitor for signs of athlete down and monitor for signs of
shock. Check for pulse and sensation shock. Check for pulse and sensation
distal to the injury site. Splint and send distal to the injury site. Splint and send
immediately to a hospital (or call 9-1-1)immediately to a hospital (or call 9-1-1)

37. Metatarsal FractureMetatarsal Fracture
CAUSES:
Decreased density of the bones (eg. osteoporosis)
Unusual stress on a metatarsal due to mal position or
another forefoot deformity (eg. bunion)
Abnormal foot structure or mechanics (eg. flatfoot,
over inversion)

38. Tib/Fib fracture at moment of
impact