The Ankle and Lower Leg Injuries Prevention Heel

The Ankle and Lower Leg Injuries

• Prevention: – Heel cord stretching • Before and after activity – Strength training • Achieving static & dynamic joint stability – Neuromuscular control • Enhanced by locomotion on uneven surfaces or balance board – Footwear • Shoes for which they are intended – Taping vs. bracing • Prophylactic protection

• Functional Exam – If the following movements aggravate a recent injury, they should be avoided • • Walks on toes (tests PF) Walks on heels (tests DF) Walks on lateral border of feet (inversion) Walks on medial border of feet (eversion) Hops on injured ankle Start/stop run motion Changing directions quickly Figure 8’s

Ankle Sprains

• Ankle Sprains Inversion or lateral ankle sprain

Cause: inversion with plantar flexion S&S: swelling; pt. tenderness; discoloration; joint Instability; sprain grades 1, 2, 3 Care: RICE; ice first 72 hrs (20 min on, 1 hr off); ace wrap (begin distal to proximal) NSAIDs; horseshoe; splint; crutches; rehab focusing on balancing

• Eversion ankle sprains – Represent only about 510% of all ankle sprains – Less common due to bony and ligamentous anatomy – Takes longer to heal due to the strength of the deltoid ligaments

S&S: medial pain; unable to weight bear; grades 1, 2, 3 Care: xray to rule out fracture; RICE; NSAIDs; rehab; same as lateral ankle

• Ankle fractures Cause: same mechanism as sprain S&S: immediate swelling; pt. tenderness over bone; apprehension to wt. bear Care: splint; referral for xray; immobilization 6 -8 wks

• Tibial and Fibular fx Cause: tibia = most common; indirect or direct trauma; S&S: immediate pain; swelling; deformity Care: referral; immobilization for wks - mo.

• Tibial and fibular stress fracture Cause: tibia>fibula; repetitive loading; biomechanical foot problems; training errors; nutritional deficiencies S&S: pain with activity; worse when stopped; focal pt. tenderness; swelling Care: REST; walking boot

• Medial Tibial Stress Syndrome (MTSS) Cause: repetitive microtrauma; muscle weakness; shoes; changing surfaces; malalignment; heel cord tightness S&S: diffuse pain; initial pain = after activity; as condition progresses = constant Care: r/o stress fracture; G/S stretching; ice; strengthening; correct foot mechanics; taping

• Compartment Syndrome Cause: acute or chronic; increase in pressure causes compression of muscle and neurovascular structures S&S: deep aching pain; tightness/swelling of compartment; neurological involvement is rare; weakness in foot and toe extension Care: rest; ice; NSAIDs; surgery (return usually in 10 days)

• Achilles Tendon Rupture Cause: sudden, forceful plantar flexion; usually occurs in 30+ y. o. S&S: feels snap/pop; reports feeling “kicked in calf”; plantar flexion = painful and limited; palpable defect Care: surgery; 6 -8 wks immobilization

• Achilles tendinitis Cause: repetitive stress/strains; in duration/intensity is too soon; hill workouts pain S&S: pain; stiffness; gradual onset; warm and painful to palpation; thickening; crepitus Care: activity; gastroc/soleus stretch; shoes; transverse friction massage; taping

• Shin Contusions Cause: forceful blow to anterior leg S&S: intense pain; hematoma forms; possible compartment syndrome or fracture Care: RICE; NSAIDs; padding; massage once swelling has subsided

• Leg cramps and spasms – Once an athlete receives a cramp they are likely to keep recurring during activity – In some cases it is best to stop activity to prevent further injury Cause: fatigue; dehydration; electrolyte imbalance S&S: pain with contraction of the calf muscle Care: mild, gradual stretching; ice massage; water/electrolyte replacement

• Gastrocnemius strain Cause: stop and go; jumping; medial head most susceptible S&S: pain; swelling; muscle disability; Care: RICE; NSAIDs; gentle stretching; heel wedge; elastic wrap