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March 1 ankle and lower legs.doc

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University of Alberta
Physical Education and Sport
Brad Kern

March 1 – Ankle and Lower Leg Graded Ankle Sprains Signs of Injury Grade 1 • Mild pain and disability; weight bearing is minimally impaired; point tenderness over ligaments and no laxity Grade 2 • Feel or hear pop or snap; moderate pain with difficulty bearing weight; tenderness and edema • Positive talar tilt and anterior drawer tests • Possible tearing of the anterior talofibular and calcaneofibular ligaments Grade 3 • Severe pain, swelling, hemarthrosis, discoloration • Unable to bear weight • Positive talar tilt and anterior drawer • Instability due to compete ligamentous rupture • We want to decrease pain and swelling by RICE Care for Ankle Sprains • Must manage pain and swelling • Apply horseshoe-shaped foam pad for focal compression • Apply wet compression wrap to facilitate passage of cold from ice packs surrounding ankle • Apply ice for 20 minutes and repeat every hour for 24 hours • Continue to apply ice over the course of the next 3 days • Keep foot elevated as much as possible • Avoid weight bearing for at least 24 hours • Begin weight bearing as soon as tolerated • Return to participation should be gradual and dictated by healing process. If you suspect a fracture, send the athlete in for an x-ray Ankle Fractures/ Dislocations Cause of Injury • Number of mechanisms – often similar to those seen in ankle sprains. This is why its hard to tell the difference between a sprain and fracture. Signs of Injury • Swelling and pain may be extreme with possible deformity Care • Splint and refer to physician for X-ray and examination • RICE to control hemorrhaging and swelling • Once swelling is reduced, a walking cast or brace may be applied with immobilization lasting 6-8 weeks • Rehabilitation is similar to that of ankle sprains once ROM is normal Tendinosis Cause of Injury • Singular cause or collection of mechanisms • Footwear, mechanics, trauma, overuse, limited flexibility Signs of Injury • Pain and inflammation • Crepitus • Pain with AROM and PROM Care • Rest is the best care and then, NSAIDs, modalities • Orthotics for foot mechanics Tibial and Fibular Fractures Cause of Injury • Result of direct blow or indirect trauma • Fibular fractures seen with tibial fractures or as the result of direct trauma. Fibula is stronger than the tibia Signs of Injury • Pain, swelling, soft tissue insult • Leg will appear hard and swollen (Volkman’s contracture) • Deformity – may be open or closed Care • Immediate treatment should include splinting to immobilize and ice, followed by medical referral • Restricted weight bearing for weeks/months depending on severity Stress Fracture of Tibia or Fibula Cause of Injury • Common overuse condition, particularly in those with structural and biomechanical insufficiencies • Result of repetitive loading during training and conditioning • The tibia undergoes more stress fracture because it bears more weight Signs of Injury • Pain with activity • Pain more intense after exercise than before • Point tenderness; difficult to discern bone and soft tissue pain • Bone scan results (stress fracture vs. Periostitis) • We need a bone scan to determine if its a stress fracture • We can take care of stress fractures from rest Care • Eliminate offending activity • Discontinue stress inducing activity 14 days • Use crutch for walking • Weight bearing may return when pain subsides • After pain free for 2 weeks athlete can gradually return to activity • Biomechanics must be addressed Medial Tibial Stress Syndrome (Shin Splints) Cause of Injury • Pain in anterior portion of shin • Stress fractures, muscle strains, chronic anterior compartment syndrome, periosteum irrita
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