Ankle

• lateral is the most common
• Plantarfexion and inversion
• grade 1-3

little to no trearing of ATF (anterior talofibular)

anterior talofibular ligament complete tear and partial tear of calcaneofibular

complete tear or anterior talofibular ligament and calcaneofibular with partial tear of posterior talofibular

• Anterior Drawer - aft intergity
• Talar Tilt Test - CF integrity

• onset is usually a traumatic twisting injury
• pt can identify specific event
• may hear a pop or snap

• antalgic gait
• significant swelling - track with tape measure
• Active movements gaurded and apprehensive - ROM limited (wont want to do platarflexion or inversion
• Pt complains of unstable feeling
• Tender with palpation

• X-ray - rules out fracture, stress views may be needed
• MRI

• Post traumatic edema
• Pain with weight bearing
• Instability or "giving way" of joint
• tenderness with palpation of injured ligaments

• Joint protection - brace, tape, casting
• Limit edema - cold and compression modalities
• early protected weight bearing encouraged - use assistive device as long as gait pattern is altered and pt has pain
• Begin AROM and progress

• Grade 1 & 2 - 2 weeks to return to activity
• Grade 3 - immoblize for 3 weeks in shortened position
• Chronics may require surgery
• Entire rehab process - 3 month

• Injury to tibulofibular ligaments
• 10% of the time

• overuse injury
• common problem
• repeated eccentric loading of tendon
• Results in microtrauma and inflammation of the achilles tendon

• Improper foot mechanics
• Poor training
• Inadequate conditioning techniques
• tight posterior calf muscles

• Gradual onset of symptoms
• Insidious onset
• Unaccustomed activity
• mild symptoms - progress to severe complaints taht prevent activity

• Dull aching pain in the area of the achilles tendon - proximal to insertaion into calcanus, pain at rest but most often with activity
• Observable palpable edema and thickening of the tendon
• Crepitus may be felt on repeated PF/DF
• Pain with movement

• No routine tests - lateral x-rays may show changes or a loss of a distinct outline of the tendon
• MRI - shows soft tissue changes

check integrity of musculotendinous unit and rule out partial complete tear

Rules out DVT

• Modalties - US/phono/ionto, ice massage over tendon
• NSAID's
• Stop aggravating motions
• May add felt heel lift to take stress off tendon
• Pt edf for proper footwear, orthotics

• Modalities - ice, cryo, us, ionto
• AROM
• Stretching - sustained
• gentle passive stretch with knee extended and flexed, towel stretch as pain allows, standing heel cord stretches once towel stretch is ok, standing heel cord stretch once appropriate
• Strengthening - initially limit ROM and do submaximal exericse -most full ROM strengthening and stretching exercises cause pain
• Progress to threaband for plantarflexion eccentrics

• As symptoms resolve can add concentric exercises such as heel raises
• Continue with general aerobic conditioing
• Gradual return to sports

• slow becuase tendon has low metabolic rate with prolongs healing 6-10weeks
• can see cycle of heal and reinjury becuase of return to activity too soon
• Need to educate patient

• Tramatic injury - acceleration
• 30-40 years old
• 20:1 male to female
• may see gap in tendon
• Treated nonoperatively casted for 8 weeks
• Suprgical repair is sometimes needed

• From sports or traume
• Increased pressure in the fascial compartment
• there are 4 compartments

• Trauma will incrase pressure secondary to swelling/bleeding wihtin the fascial compartment
• severe dull or sharp pain in the cmpartment
• May see superficial contusion
• Passive stretch increases symptoms
• Parathesia foot - numb, irreversible nerve damge possible

• Exertional compartment syndrome
• Numbness
• Pain - ischemic
• See numbness foot and or anterior lateral leg depending on nerve involved
• Mimics stress fracture

• Emergency fascial surgical release
• Treat inlammation with meds, elevation, decrease weight bearing and modalities
• ROM day 2-3 post-op
• Gradual progressive weight bearing to FWB

6-8 weeks

• Chronic inflammation of the plantar fasica (aponeurosis) with or without an associated calcaneal heel spur
• Repetitive cycle of microtraume leading to injury attemped repair and chronic inflammation
• Inflammation is a reaction due to chronic traction on fasica at its insertion into the calcanues

• gradual insidious onset of complaints
• Occasionally complaint of acute onset of "strain" of the arch during vigorous activities
• Symptoms progress if not treated

• Acute pain after prolonged sitting or with the initial weightbearing in the morning "physiologial creep" (facial in none weight bearing will shorten)
• Pain localized at the proximal attachemnt of the fascia and may radiate along the length of the fascia distally - pain on palpation of the medial tubercle of the calcaneus
• Heel pain with weight-bearing

• Pes planus, pes cavus - flat foot or high arch
• Obesity
• Tight achilles tendon
• Calcaneal valgus

Routine x-ray may reveal a dypertrophied spur formation at the medial calcaneal tubercle

• NSAIDS
• Modalities to decrease inflammation
• Plastic heel cup, soft orthotic inserts
• Arch taping or specific taping for plantar fascitis
• May need night splints
• Stretch fscia with roller

• may need night splints
• Stretch fascia with roller
• Specific stretching for heel sord toe, extension stretches
• Steroid injections
• May need surgery - fascial release
• Pt ed

• Shin Splints is not a specific diagnosis
• Pain has many differnt origins
• Better to describe pain by the location and etiology
• Lower medial tibial pain resulting from periosititis

• Abnormal biomechaniacal alignment
• Poor condition
• Improper training methods

• stress fractures of tibai and fibula
• Ischemia disorders
• Deep compartment syndrome

• Pain management and edema control
• Activity modification - orthotics, pt ed about proper training methods and prevention of reoccurrence
• Stretching
• Strengthening exercises