Specific ankle injuries

Os Trigonum Injury

- Steida's process- posterior projection off talus -can be developmental or traumatic (non union or stress fracture to steidas process) -impinges on surrounding soft tissues causing symptoms typically gradual onset -if acute fracture, acute symptoms -Peri Achilles swelling point tenderness pain with terminal PF -visible on plain film radiograph

Os Trigonum

-A small round bone that sit behind the ankle joint - precent in about 5-15% of normal feet -occurs when 1 area of bone does not fuse with the rest of the talus during growth -most commonly seen in ballet dancers who assume pointe and demipointe position (this plantar flextion can cause the Os trigonum to become pinched in the space behind the ankle)

Achilles Tendon Rupture

-Avascular zone of tendon just proximal to calcaneal insertion point -Chronic degeneration may be die to inflammatory condition/ irritation contributed to tissue weakness- risk for rupture -Forceful, sudden contraction is most common mechanism of injury -Corticosteroid injection is a risk factor -Palpable and/or visible defect in tendon -altered gait pattern: unable to push off -Developing swelling -Ability to PF with secondary muscles but will be alot weaker -Positive thompson test -Most treated surgically

Medial ankle injuries include:

-Avulsion fracture of medial malleolus -Bimalleolar (Pott's) fracture) -Talus/ankle mortis chondral lesion

Peroneal Tendon Subluxation

-Due to sudden forceful DF/eversion or PF/inversion which ruptures retinaculum -May be visibly/ palpably move from behind lateral malleolus (become DF instead of normal PF function and can also contribute to development of biomechanical complications). -Local inflammatory symptoms at site of injury -May require surgical intervention

Anterior compartment syndrome

-Increased pressure w/in anterior compartment, traumatic or exertional -Traumatic: bleeding from direct blow to compartment muscles -Exertional: acute or chronic due to volumetric changes in muscle tissue and/or poor vascular function/ venous outflow secondary to arterial inflow -Compromises neurovascular supply to dorsal foot- inadequet blood supply to affected tissue -5 P's (Pain, Pallor/ redness, Pulselessness/ dorsal pedal artery, paresthesia/ deep peroneal nerve, paralysis/ deep peroneal nerve REQUIRES IMMEDIATE REFERRAL FOR TREATMENT MAY BE LIMB THREATENING

Lateral ankle sprain (inversion)

-Least stable in "loos packed position"-PF with inversion -progression of tissue damage with severity from ATF to CF to PTF -Most common and result in injury to the lateral ligaments -Occasionally the force is great enough for an avulsion fracture to occure

Medial ankle sprains

-Less common due to decreased eversion ROM and bony architecture -Eternal rotation is the most common MOI -Typically present with point tenderness and swelling -ROM/ strength deficits per MOI and tissue involved -Positive eversion stress test

Syndesmosis sprains

-More debilitating and difficult injury to recover -pain with DF/ER due to wider anterior dome of talus spreading distal tibfib joint -Must rule out involvement of fib fracture due to common mechanism (proximal 1/3 of fib fracture from rotational stress that can cause syndesmosis injury)

Lateral ankle sprain Signs and symptoms

-Point tenderness to involved structures( ATF, CF, PTF) -Pain and swelling to lateral ankle -ROM limited due to pain, eversion and dorsiflexion -Strength deficits due to pain -Positive ligamentous stress test/s

Leg cramps

-Sudden, violent, involuntary contraction, either clonic (intermittent) or tonic (sustained) in nature Etiology: difficult to determine; fatigue, loss of fluids, electrolyte imbalance, inadequate reciprocal muscle coordination Signs and symptoms: cramping w/ pain and contraction of calf muscle

Lateral ankle sprain predisposing factor

-decreased proprioception -decreased muscle strength -Lack of muscle coordination -Tight gastroc soleus complex

Lateral ankle injuries include:

-impingment of medial joint capsule/ ligaments -peroneal tendon strain/ rupture -medial malleolar "push off" fracture -avulsion fracture of 5 metatarsal or lateral malleolus -talus/ ankle mortus chondral lesion -superficial branch of peroneal nerve injuries

Stress Fractures

-mictotraumatic accumulative events -may affect the tibia, fibula, or talus -Not visible of xray until 3 weeks post onset -If advanced may have a + bump or squeeze tests -Tuning fork test -May have same symptoms of MTSS or compartment syndrome

What percent of all ankle sprains are medial/ eversion?

5-10%

Achilles Tendon Rupture (etiology and Signs and symptoms)

ETIOLOGY: Occurs with sudden stop and go; forceful plantarflexion w/ knee moving into full etension. Commonly seen in athletes>= to 30 years old. Generaly has a history of chronic inflammation Signs and Symptoms: Sudden SNAP (kick in the leg) with immediate pain which rapidly subsides. Point tender, swelling, discoloration, decreased ROM. Obvious indication and positive thompson test. Occures 2-6cm proximal the calcaneal insertion

Ankle Fractures/ dislocations

ETIOLOGY: number of mechanisms... Signs and symptoms: Swelling and pain may be extreme with possible deformity

Posterior Tibialis Tendinitis

Etiology: Common overuse condition in runners with foot hypermobiliy or over pronation. Repetitive microtrauma Signs and Symptoms: Pain and swelling in area of medial malleolus. Edema, PT and increased pain during resistive inversion and plantar flexion

Stress Fractures Etiology and S&S

Etiology: Common overuse condition, ecspecially in those with structural and biomechaical insufficiencies. Runners tend to develope in lower third of lower leg, (dancers in middle 3rd). Most time in unconditiond/ unexperienced individuals. Females. Signs and Symptoms: Pain more intense after exercise than before. Point tender; difficult to discern bone and soft tissue pain. Bone scan results (stress fracture vs periostitis)

Anterior Tibialis Tendinits

Etiology: Commonly occurs after extensive down hill running Signs and Symptoms: Point tenderness over anterior tibialis tendon

Muscle contusions

Etiology: Contusion of leg, particularly in the region of the gastrocnemius Signs and symptoms: Bruise may develop, pain, weakness, and partial loss of limb function. Palpation reveals hard, ridged, inflexible area due to internal hemorrhaging and muscle gaurding

Shin Contusion

Etiology: Direct blow to lower leg (impacting periosteum anteriorly) Signs and Symptoms: Intense pain, rapidly forming hematoma with jelly like consistency

Achilles Tendonitis

Etiology: Inflammatory condition involving tendon. Tendon is overloaded due to extensive stress. Presents with gradual onset and worsens with continued use. Decreased flexibility exacerbates condition Signs and symptoms: Generalized pain and stiffness, localized proximal to calcaneal insertion. May limit strength. Crepitus with active plantar flexion and passive dorsiflexion. Chronic inflammation may lead to thickening

Peroneal Tendinitis

Etiology: Not common but can be found in athletes with pes cavus due to excessive supination placing stress on the peroneal tendon Signs and symptoms: pain behind the lateral malleolus during push off or when rising on ball of foot. Pain along distolateral aspect of calcaneus and beneath the cuboid

Grade 3 Lateral ankle sprain

Etiology: Relatively uncommon but is extremely disabling. caused by significant force inverting resulting in spontaneous subluxion and reduction. causes damage to the ATF, PTF and calcaneofibular ligaments as well as capsule Signs and symptoms: severe pain, swelling, hemarthrosis, discoloration. Unable to bear weight. positive talar tilt and anterior drawer test.

Gastrocnemius Strain

Etiology: Susceptible to strain near musculotendinous attachment. Caused by quick start or stop, jumping Signs and Symptoms: Depending on grade, variable amount of swelling, pain, muscle disability. May feel like being "hit in leg with a stick". Edema, point tenderness and functional loss of strength.

Medial (eversion) ankle sprain

Etiology: bony protection and ligament strength decrease the likelihood of injury. Eversion of foot results in deltoid ligament and possible fibula fracture. Deltoid can also be impinged and contused w/ INVERSION sprains. May to longer to heal. Foot that is pronated, hypermobile or has a depressed medial longitudinal arch is more predisposed to eversion/ medial sprains Signs and symptoms: Pain may be severe; unable to bear weight; and pain with abduction and adduction but not direct pressure on bottom of foot

Acute Achilles strain

Etiology: common in sports and often occurs with sprains or excessive dorsiflexion Signs and Symptoms: Pain may be mild to severe. Most severe injury is partial/ complete avulsion or rupturing of the Achilles.

Acute leg fractures

Etiology: fibula has highest incidence of fracture, occurs primarily in the middle third. Tibial fractures occur predominately in the lower third. Results from direct blow or indirect trauma. Signs and Symptoms: Pain, Swelling, Soft tissue insult. Leg will appear hard and swollen (Volkmans contracture)

Syndesmosis sprains Etiology and Signs&symptoms

Etiology: injury to the distal tiliofemoral joint (ant./post. tiliofibular ligament) Torn w/ increased external rotation or dorsiflexion. Injured in conjunction w/ medial and lateral ligaments Signs and symptoms: severe pain, loss of function; passive external rotation and dorsiflexion cause pain. Pain is usually anterolaterally located

Grade 2 Lateral ankle sprain

Etiology: moderate inversion force causing great deal of disability bearing weight with many days of lost time Signs and symptoms: feel or hear pop or snap; moderate pain with edema. Positive talar tilt and anterior drawer tests. Possible tearing of the anterior talofibular and calcaneofibular ligaments

Osteochondritis Dissecans

Etiology: occur in superior medial articular surface of the talar dome. One or several fragments of articular cartilage, w/ underlying subchondular bone partially or completely detached and moving within the joint space. Mechanism may be single or repeated traumas. Signs and symptoms: may be a complaint of pain and effusion with signs of atrophy. May be catching locking, or giving way.

Peroneal Tendon Subluxation/dislocation Etiology and S&S

Etiology: occurs in sports with dynamic forces being applied to the ankle. May also be caused by dramatic blow to posterior lateral malleolus, moderate/ severe inversion ankle sprain resulting in tearing of peroneal retinaculum Signs and Symptoms: Complain of snapping in and out of groove w/ activity. Eversion against manual resistance replicates subluxation. Recurrent pain, snapping and instability. Present with ecchymosis, edema, tenderness, and crepitus over the tendon

Grade 1 Lateral ankle sprain

Etiology: occurs with inversion plantar flexion and adduction. causes stretching of the ATF ligament Signs and symptoms: mild pain and disability; weight bearing is minimally impaired; point tenderness over ligaments and no laxity

medial Tibial stress syndrom (Shin splints)

Etiology: pain in anterior portion of shin. Catch all for stress fractures, muscle strains, chronic anterior compartment syndrome. Accounts for 10%-15% of all running injuries, 60% of leg pain in athletes. Caused by repetitve micro trauma. Weak muscles improper foot wear, training errors, varus foot, tight heel cord, hypermobile or pronated feet and even forefoot supination can contribute to MTSS. May also involve stress fractures or exertional compartment syndrome Signs and symptoms: Four grades of pain: -pain after activity -pain before and after activity and not affecting performance -pain before during and after affecting performance -pain so severe performance is impossible

Compartment Syndrome

Etiology: rare acute traumatic syndrome due to direct blow or excessive exercise Signs and Symptoms: Excessive swelling compresses muscles, blood supply and nerves (increase in fluid accumulation could lead to permanent disability). Chronic cases appear gradual and then subside when activity is over. Weakness w/ foot and toe extension and occasionally numbness in dorsal region of foot

What is Achilles Tendonitis?

Vascular issues -Paratenon (highly vascular structure surrounding tendon) irritated causing nperitendonitis Risk factors: biomechanics, tight triceps surae/ hamstrings, rearfoot valgus, hyperpronation