Ankle Anatomy and Associated
Injuries/conditions
Fracture Types
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Spiral
Comminuted
Compound
Stress
Longitudinal (linear)
Transverse
Oblique
Epiphyseal
Greenstick
Impacted
Spiral
• Creates a spiral
effect or S shape
Comminuted
• More than two pieces
– Often displaced
Compound
• Fracture with
break in the skin
Stress
• microfractures
Longitudinal
• Parallel to the shaft of the bone
Transverse
• Perpendicular to the
shaft of the bone
Oblique
• Diagonal to the shaft of the
bone
Epiphyseal
• Through or across the
growth plate. Can also be a crush.
Greenstick
• Force to one side splits
bone on opposite side
Impacted
• Bone is shortening in a crush-type
fracture
Sesamoiditis
• Etiology: repetitive stress, repetitive hyperextension
of the hallux
• Signs and Symptoms: pain and tenderness under
hallux, especially during push off
• Management: orthotics, padding or walking boot
• Complications: can lead to strain of the tendon or
possible rupture, or fracture of the sesamoid bone.
Jones Fracture
• Etiology: inversion and plantarflexion; direct force
(getting stepped on); repetitive stress
• Anatomy: Diaphysis (shaft) of the 5th metatarsal
• Signs and Symptoms: immediate swelling & pain
over 5th metatarsal, pain with pounding
• Complications: high nonunion rate, slow healing
Metatarsal
Stress Fracture
(March Fracture)
• Etiology: Chronic fx to the 4th or 5th metatarsal
from; changing training patterns (shoes, intensity,
surfaces) or structural (hallux valgus)
• Signs and Symptoms; pain with pounding that
slowly increases
• Special considerations: often missed on x-ray, must
use bone scan or MRI to diagnose
Medial Tibial Stress
Syndrome
• “shinsplints”
• Etiology: repetitive stress/trauma, hard surfaces, foot
posture that causes inflammation and possible
microfracture to the Tibia
• Signs and Symptoms: pain in the anterior lower leg
– (1; after activity, 2; during and after but no affecting
performance, 3; during and after performance, 4; too painful
to perform)
• Management: role out stress fracture (stress reaction)
Sprains,
Strains and
Fibrocartilage
Tears
Dislocation
• Occurs when the articulation between
two or more bones in a joint is
disrupted, often occurs from trauma
• Is always associated with_____
Subluxation
• Partial or incomplete dislocation of a joint, or
dislocation with spontaneous and immediate
relocation.
Sprain
• Tear or partial tear of a ligament
– 1st degree: micro to minimal of ligament tearing with little
functional loss and inflammation
– 2nd degree: minimal to moderate ligament tearing with mild
joint laxity (movement), inflammation, and significant
functional loss
– 3rd degree: moderate to complete tearing of the ligament
with significant joint laxity, functional loss, pain and swelling
Strain
• Tear or partial tear of a tendon, muscle
or muscle-tendon junction
Anterior or Lateral Compartment
Syndrome
• Etiology: extreme swelling in the anterior
or lateral lower leg (typically from a blow
to the leg or severe strain) causing
decreased circulation and sensation to the
lower leg and foot.
• S&S: pain or possibly numbness,
decreased dorsal pedal pulse, decreased
or inability to dorsiflex or evert the ankle.
• TX: Medical emergency, may release
pressure with surgery
• Chronic compartment syndrome exists
due to tight fascia and follows a
conservative tx plan
Ankle Sprains
• Lateral Ankle Sprain
• Medial Ankle Sprain
• Syndesmotic (High)
Ankle Sprain
Lateral Ankle Sprain
• Etiology: ATF, CF and PTF injury
from forced inversion
• S&S: pain, swelling on lateral joint
line Lateral laxity
• TX: RICE, possible surgery
Medial Ankle Sprain
• Etiology: damage to
the deltoid ligament
with forced eversion
of the ankle
• S&S: inflammation
on the medial joint
line may have medial
joint laxity
• *often associated
with fibular fractures
Syndesmotic Ankle
Sprain
• Etiology: injury to anterior
and/or posterior tibiofibular
ligament. Severe twisting or
hyperdorsiflexion
• S&S pain with weight bearing
especially with external rotation
of the foot
• * If not treated properly may
tear up the sydesmotic liagment
(interosseous membrane) and
require surgery
Ankle Dislocation
Ankle Dislocation
• Etiology: injury to all lateral
and/or all medial ligaments
disrupting the talotibial and
talofibular joints. Typically
foot planted and blow from
any direction.
• S&S: obvious deformity, pain,
inability to move foot
• *Medical emergency because
of possible vascular and
neural compromise
Fallen Arch
• Etiology: The 1st and 5th
Metatarsal heads bear more
weight. Excessive weight on
the medial arch can cause the
medial longitudinal ligament
to tear or stretching.
• S&S: Arch appears to “Fall”
with weight bearing, pain on
medial arch.
Tarsometatarsal Dislocation
Lisfranc (midfoot dislocation)
• Etiology: uncommon but can
cause long term
injury/complication. Occurs
when foot is plantarflexed
with rearfoot (heel) is locked
and you have forced
dorsiflexion. Causes
dislocation between the
metatarsals and the tarsals.
• S&S: deformity, laxity in
midfoot, pain and/or inability
to push off with toes
• Requires surgery and may
never fully recover
Morton’s Neuroma
• Etiology: Plantar nerve becomes irritated
because of repetitive
compression/pinching/irritation and becomes
inflamed. Most common in the 1st and 2nd
metatarsals
• S&S: burning, stinging pain, eventually numbness
in the distal foot.
• *can cause permanent nerve damage over time
Hallux Valgus
• Etiology: laxity of the medial
joint line of the
metatarsophalangeal joint of
the great (1st) toe causing the
toe to point laterally and the
development of a bump on the
distal 1st metatarsal.
• S&S: pain, deformity,
inflammation of the
metatarsophalngeal joint. Can
cause degeneration of the joint
over time.
• TX: toe wedge, surgery