Ch 19- Specific Injuries

5-10% of ankle sprains

Etiology
· uncommon bc bony protection and ligament strength
· Eversion force damages deltoid and possible fibula fx
· Inversion can also hurt deltoid
· More susceptible if promated, hypermobile, or depressed medial longitudinal arch

Signs/ Symptoms
· severe pain, inability to weight bear
· pain with abduction and adduction

Management
· RICE, xray to rule out fx, posterior splint tape, NSAIDs
· same treatment as inversion
· Grade 2 or high cause more instability, and excessive pronation

Etiology
· injury to distal tibiofemoral joint  and ligaments (ant/pos tib fib ligament)
· torn w/ external rotation or dorsiflexion

Signs/Symptoms
· loss of function
· pain w/ passive external rotation and dorsiflexion - usually anterolaterally

Management
· difficult to treat bc cant strengthen anything around it
· same treatment as sprains but longer immobilization and rehab
· surgery possible

Etiology
· avulsion, bi-malleolar fx

Signs/Symptoms
· Swelling, pain, extreme deformity

Management
· RICE
· after swelling- walking cast/brace
· immobilization 6-8 weeks

· develops after 1/3 of ankle sprains
Mechanical- naturally loose

Functional- person feels unstable bc of proprioception and/or neuromusclar deficits
--- rehab works on this

Etiology
· in superior medial articular surface of talar dome
· fragment(s) of atricular caritlage w/ detachment of bone moving in joint space
· from single or multiple traumas

Signs/Symptoms
· pain and effusion w/ signs of atrophy
· ***catching, locking, giving away

Managment
· dx through xray
· non displacement- immobilization and earl ROM
· if displaced- surgery

Etiology
· Common
· Often occurs w/ sprain or excessive dorsiflexion

Signs/Symptoms
· mild- severe pain
· most severe- partial avulsion of Achilles

Management
· Pressure and RICE
· After hemorrhaging- apply elastic wrap
· Conservative treatment bc usually problems usually chronic
· Heel lift, stretching/ strengthening of Achilles

· Inflammation of tendon, sheath  or paratenon
· causes fibrosis and scaring that restricts tendon motion
· can cause tendinosis

Etiology
· doesnt present w/ inflammation, abnormal apperanace w/ cell disorganization and scaring
· Overloaded tendon bc of extensive stress
· gradually gets worse
· decreased flexibility worsens it

Signs/ Symptoms
· generalized pain/ stiffness, localized proximal to calaneal insertion
· Warm, thick, painful
· Morning stiffness
· Crepitus w/ active plantar flexion and passive dorsiflexion

Management
· reduce stress on tendon and address structural problems
· use anti-inflammatories
· Cross friction massage break down scar tissue
· Progressive strengthening so dont aggravate tendon

Etiology
· Sudden stop and go; forceful plantar flexion w/ knee in full extension
· see in >30
· history of chronic inflammation

Signs/ Symptoms
·** sudden snap
· pt tenderness, swelling, discoloration, indentation, decreased ROM
· positive Thompson test
· at calcaneal insertion

Management
· serious- surgery
· RICE< NSAIDs, analgesics, non weight bearing cast 6 weeks, walking cast 2 weeks
· Rehab 6 mo- ROM, PRE
· heel lift

Etiology
· dynamic force to ankle
· dramatic blow to posterior lateral malleolus
· mod/severe inversion ankle sprain resulting in tearing fibularis retinaculum
· tendon may rupture

Signs/Symptoms
· snapping/ instability
· eversion against manual resistance replicates subluxation
· present w/ ecchymosis, edema, tenderness and crepitus over tendon

Management
· compression w/ felt horseshoe
· reinforce compression w/ rigid plastic or plastic until signs subside
· RICE, NSAIDs, analgesics
· conservative treatment 5-6 weeks, then gradual rehab
· surgery possible