Kinesiology 312 (Sports Injuries)

The Ankle

The ankle joint is composed of the tibia, fibula & talus. The talocrural joint allows
plantarflexion & dorsiflexion. The subtalar joint allows inversion & eversion.

Ankle Sprains
Ankle sprains include inversion (big toe up) & eversion (big toe down) sprains as a result
of stepping incorrectly.

Cause of Injury Signs & Symptoms Care

 Inversion sprain: injury to the  Grade 1 (mild) sprain  PRICE
lateral ligaments caused by  Grade 2 (moderate) sprain  Ice: for 20min
sudden inversion or eversion  Grade 3 (rupture) sprain and repeat
(Forcefully inverted) every 24 hours
 Eversion sprain: may involve  Ankle taping
an avulsion fracture of the  Protective ankle
tibia before the deltoid brace
ligaments tear  Gradual progression
 High Ankle sprains of functional
(syndermotic sprain): forced activities
hyperdorsiflexion & external  Surgical repair for
rotation of the foot Grade 3 tear
(Distal tibiofemoral joint)  Grade 1 & 2 sprains
should focus on
strengthening the
 muscles
surrounding the
joint
 Horseshoe shaped
foam pad for local
compression
 Avoid weight
bearing exercises

Ankle Fractures

Cause of Injury Signs & Symptoms Care

 Inversion Injury: fracture of  Immediate swelling  Splint the ankle
medial malleolus & sprain of  Point tenderness over  Refer athlete to a
the lateral ligaments the bone physician for X-ray
 Eversion Injury: fracture of  Trouble with weight examination &
the lateral malleolus & sprain bearing immobilization
of the deltoid ligament  Potential deformity  Cast the leg in a short
 With avulsion fracture= walking cast for 6
ligaments ↑ rehab time weeks with early
 Similar to sprains weight bearing
 Gradually progress to
functional activities

 Tendinosis
Tendinosis is a chronic injury of the tendons due to overuse without inflammation.
Common sites include the anterior tibialis tendon, posterior tibialis tendon & fibularis
tendon

Cause of Injury Signs & Symptoms Care

 Faulty foot mechanics  Pain with active  Rest & ice
 Poor footwear movement & passive  Anti-inflammatory
 Tightness in the heel cord stretching medication
complex  Swelling  Orthotic device to
 Training errors  Crepitus correct biomechanics
 Acute trauma  Stiffness & pain  Taping the foot
 Limited flexibility  Possible
inflammation→
Tendinitis
 Tibial & Fibular Fractures

Cause of Injury Signs & Symptoms Care

 Direct or indirect trauma  Tibial fractures: pain,  Splint to immobilize
such as a combination of swelling & deformity the fracture along with
rotatory/ compressive force  Fibular fractures ice followed by
 Fractures of the fibula are (closed): pain & point immediate medical
usually seen in combination tenderness referral
with a tibial fracture or  The leg appears hard  Immobilization and
because of direct trauma to and swollen non-weight bearing for
the area  Deformity (open or weeks/months
closed) depending on the
severity
 Tibial & Fibular Stress Fractures
A fracture of the tibia or fibular due to repeated stress over time.

Cause of Injury Signs & Symptoms Care

 Repetitive loading during  Pain with activity (pain  Immediate elimination
training & conditioning more intense after of the offending
 Shoes/ faulty foot & ankle exercise than before) activity
biomechanics  Focal point tenderness  Recuperation period of
 Prevalent in athletes involved on the bone 2 weeks
in jumping  Gradually ↑ stresses &
 Common overuse condition, strains on the bone
particularly in those with  Crutch for walking
structural & biomechanical  Biomechanics must be
insufficiencies addressed
 Shin Splints (Medial Tibial Stress Syndrome)
Acute pain felt in the shin & lower leg caused by prolonged running, typically on hard
surfaces.

Cause of Injury Signs & Symptoms Care

 Strain of the posterior tibialis  Morning pain  Activity modification
muscle & its fascial sheath at  Stiffness  Correction of
its attachment to the  Pain while running abnormal foot
periosteum of the distal tibia  Can progress to stress mechanics during
during running activities fracture walking & running
 Ice massage
 Faulty foot mechanics  Supportive taping
 Tightness of the Achilles  Stretching program for
complex the Achilles complex
 Muscle weakness  Flexibility program for
 Training error gastric-soleus complex
 Tight heal cord
 Hypermobile or pronated feet
 Pain in anterior portion of
shin
 Stress fractures, muscle
strains, chronic anterior
compartment syndrome,
periosteum irritation
 Repetitive microtrauma
Shin Contusions

A direct blow to the shins causing a bruise. The tibia is very sensitive & vulnerable
because it lacks adipose & muscle tissue.

Cause of Injury Signs & Symptoms Care

 Direct blow to the shin  Intense pain  Ice
causing a bruise because of  Swelling  Elevation
the absence of muscular or  ↑ warmth  Aspirate the hematoma
adipose padding  Bulging hematoma  Doughnut pad
 Rapidly forming  NSAIDS
haematoma  Compression for
haematoma
 Compartment Syndrome

Compartment syndrome is a dangerous condition caused by pressure build-up from internal

bleeding or swelling of tissues. It includes acute compartment syndrome, acute exertional
compartment syndrome & chronic compartment syndrome

Cause of Injury Signs & Symptoms Care

 ↑ pressure within 1 of the 4  Deep aching pain  Ice
compartments of the lower  Tightness  Elevation
leg causes compression of the  Swelling  Surgical procedure to release
muscular & neurovascular  Pain with passive pressure for both acute &
structures stretching acute exertional
compartment syndrome
(fasciotomy)
 Most common = anterior &  ↓ circulation &  Chronic compartment
deep posterior compartment sensory sensation syndrome is managed
 Rare acute traumatic to the foot conservatively with activity
syndrome due to direct blow  Weakness with modification, icing &
or excessive exercise foot and toe stretching
extension &  NSAIDS
occasionally 
numbness in
dorsal region of
 foot

Achilles Tendinitis/ Tendinosis

A condition whereby the Achilles tendon becomes inflamed & irritated.

Cause of Injury Signs & Symptoms Care

 Inflammation of the Achilles  Morning stiffness  Aggressive stretching
tendon due to repetitive  ↑ warmth of the Achilles tendon
stresses & strains place on  Painful to palpation complex (heel lift)
the tendon (e.g. running &  Tendon may thicken  Taping techniques to
jumping)  Pain & stiffness provide support to the
 Uphill running  Localized proximal to Achilles tendon
 Decreased flexibility the calcaneal insertion  Anti-inflammatory
exacerbates the condition medication
 Achilles tendinosis
may eventually
predispose the athlete
to rupture of the
Achilles tendon
 Orthotics, mechanics,
and flexibility
 Resistant to quick
resolution due to the
slow healing nature of
the tendon
 Achilles Tendon Rupture
An Achilles tendon rupture involves the complete tearing of the Achilles tendon. The
rupture can occur due to repetitive actions involving explosive acceleration, such as
pushing off or jumping.

Cause of Injury Signs & Symptoms Care

 Sudden forceful  Athletes may feel or  Surgical repair vs cast
plantarflexion of the ankle hear a pop immobilization
 Occurs in activities requiring  Palpable defect will be  Surgical repair may
ballistic movement, such as noted along the length require 6-8 weeks
tennis & basketball of the tendon immobilization for
 Sudden stop and go  Sudden snap with proper tendon healing
 Knee moving to full immediate pain (non-weight bearing
extension which subsides for 6 weeks)
 History of chronic  Point tenderness,  Regain normal muscle
inflammation swelling, function through
discoloration, controlled progressive
decreased range of strengthening exercises
motion