Question | Answer |
- most common injury in physically active people
- caused by sudden inv or ev moments | Ankle sprain |
Ligaments that can be sprained with inversion moment | - ant talofibular by inv, PF, and IR
- rotary ankle instab (talus rotates about long axis in transverse plain)
- post talofibular & calcaneal (with increased force)
- avulsion fracture at lat mall
- deltoid lig can impinged & contused |
- occurs with inv PF
- stretches ant talofibular lig
- mild pain, disability, minimally impaired WB
- point tenderness over lig with no laxity | Grade I ligament sprain |
- moderate inv force causing great deal of disability
- feel or hear pop or snap
- moderate pain with difficulty WB
- tenderness & edema present | Grade II ligament sprain |
- relatively uncommon but extremely disabling
- caused by significant inv force resulting in subluxation & reduction
- damage ant/post talofibular & calcaneofibular lig and capsule
- severe pain, swelling, hemarthrosis, discoloration
- unable to WB | Grade III ligament sprain |
- represent 5-10% of all ankle sprain bc bony protection & lig strength decrease likelihood
- pain may be severe, unable to WB, pain ABD/ADD | Eversion sprains |
Ligaments that can be sprained/common injuries with eversion moments | - deltoid lig
- possible fracture to fibula |
- injury to the dist tibiofibular jt, ant/post tibiofibular lig
- increased ER or DF
- med & lat collateral ligs injured in conjunction
- severe pain (usually located anterolaterally), loss of function
- passive ER & DF causes pain | Syndesmotic sprain |
Develops following 1/3 of all acute ankle sprains | Chronic ankle instability |
Laxity that physically allows for mvmt beyond the physiologic limit of ankleâs ROM | Mechanical Instability |
A subjective feeling that the ankle is unstable. Attributed to proprioceptive and/or neuromuscular deficits that negatively impacted postural control = stability & balance | Functional Instability |
- caused by a number of mechanisms
- avulsion & bimalleolar fractures
- swelling & pain may be extreme with possibly no deformity | Ankle fractures/dislocations |
- used to determine need for radiograph:
- pain in malleolar or midfoot
- inability to WB for 4 steps at time of injury & examination
- tenderness over inf/post pole of either malleoli, base of 5th MT, navicular bone | Ottawa Ankle Rules |
- occurs in sup med articular surface of talar dome
- one/several fragments of articular cartilage w/ underlying subchondral bone partially/completely detached & moving within jt space
- single or repeated trauma
- pain, effusion, catching, locking, givi | Osteochondritis Dissecans |
- common in sports, often occurs with sprains or excessive DF
- pain may be mild to severe
- most severe injury is partial/complete avulsion or rupture of Achilles | Injury to the Achilles |
(1/2)
- inflammatory cond to tendon or its sheath (paratendon); referred to as tenosynovitis
- causes fibrosis & scarring that can restrict motion in sheath; may lead to tendinosis
- typically no inflammation present, lost normal appearance, cell disorg/ | Achilles Tendinosis |
(2/2)
- tendon overloaded to extensive stress
- decreased flexibility exacerbates cond
- generalized pain/stiffness, localized prox to calcaneal insertion
- limited strength, restricted mvmt (esp in morning)
- crepitus with active PF & passive DF
- chron | Achilles Tendinosis |
- occurs with sudden stop & go (eccentric load!!), forceful PF with knee moving into full ext
- common in athletes 30 yr & older
- predisposition: history of chronic inflam
- immediate pain which rapidly subsides (window shade)
- point tenderness, swelli | Achilles Tendon Rupture |
- occurs with dynamic forces applied to ankle
- dramatic blow to post lat mall
- mod/severe inv sprain resulting in tearing of fibularis retinaculum; potential for tendon rupture
- complain of snapping in & out of groove with activity
- ev against manua | Peroneal (fibularis) Tendon Subluxation/Dislocation |
- commonly occurs after extensive down-hill running (eccentric!)
- point tenderness over ant tib tendon | Anterior Tibialis Tendinitis |
- direct blow to lower leg (impacting periosteum anteriorly)
- intense pain & rapidly forming hematoma with jelly-like consistency | Shin Contusion |
- common overuse injury in runners with foot hypermobility or over pronation
- repetitive microtrauma
- pain & swelling in med mall
- edema, point tenderness, & increased pain during resistive inv & PF | Posterior Tibialis Tendinitis |
- contusion of leg, particularly in gastroc region
- bruise may develop causing pain, weakness, & partial loss of limb func
- palpation will reveal hard, rigid, inflexible area due to internal hemorrhaging & muscle guarding | Muscle Contusions |
- susceptible to strain near musculotendinous attachment
- caused by quick start, stop, or jumping
- variable amount of swelling, pain muscle disability
- may feel like being âhit in the leg with a stickâ
- edema, point tenderness, and func loss of s | Gastrocnemius Strain |
- fibula has highest incidence of fracture in middle third
- tibia fractures occur predominately in the lower third
- result of direct blow or indirect trauma
- pain, swelling, soft-tissue insult
- leg will appear hard & swollen | Acute Leg Fractures |
- pain in ant shin
- accounts for 10-15% of all running injuries & 60% of leg pain in athletes
- caused by repetitive microtrauma
- weak muscles, improper footwear, training errors, varus foot, tight heel cord, hypermobile or pronated feet, and forefoot | Medial Tibial Stress Syndrome (MTSS)/Shin-splints
- stress fractures
- muscle strains
- ant compartment syndrome |
Four Grades of Pain of MTSS | - pain after activity
- pain before & after activity, not affecting performance
- pain before, during, & after activity, affecting performance
- pain so severe performance is impossible |
- complain of deep aching pain & tightness due to pressure & swelling
- reduced circulation & sensation
- must be recognized & treated early | Compartment Syndrome |
Type of Compartment Syndrome that occurs secondary to direct trauma or medical emergency | Acute Compartment Syndrome |
Type of Compartment Syndrome that evolves with minimal to moderate activity | Acute Exertional Compartment Syndrome |
Type of Compartment Syndrome where symptoms arise consistently at a certain point during activity | Chronic Compartment Syndrome |
- common overuse cond, in those with structural/biomechanical insufficiencies
- Runners = lower third, Dancers = middle third
- often occurs in nonconditioned & inexperienced individuals, training errors
- component of female athlete triad
- pain more in | Stress Fracture of Tibia or Fibula |