Physical Education
Sports-Related Ankle & Lower Leg Injuries
Field Tests, Determining the Severity of the Injury, & Means of Transportation
Ankle and lower leg injuries are common in a variety of sports. Some injuries are minor but all should be investigated as seemingly minor injuries often turn out to be larger problems. Many ankle injuries are occur due to overexertion or during high velocity movements or shifts in momentum. The following common injuries and rehabilitation can help reduce injury severity and training loss.
The Rolled Ankle
When an athlete rolls an ankle this can occur in many different scenarios and you will need to ask certain questions to determine the severity and type of injury.
- How did you create the injury? (Knowing how the injury occurred can reveal the type of damage that has occurred i.e., running rolled foot backward creating a sprain.
- How did you twist your foot inward, backward, or outward? (By asking this question, one can determine if the injury is an eversion ankle sprain or inversion sprain. This can show where the sight of actual injury and will provide information for how to treat.
- Can you stand on the foot? (The ability to place weight on the foot shows the severity of the injury. If the injury is so severe that weight cannot be maintained then there is the possibility of a break or fracture.)
- Which directions can you turn your foot if at all? (Being able to turn the foot in specific directions can indicate the site of damage and the severity.)
- Where is the location of the pain? Where does it hurt? (This shows the site of pain.)
- Is the pain sharp, stabbing, or burning? (This question can determine the type of injury because sharp pains are indicative of breaks whereas burning pain is more indicative of torn ligaments or cartilage.)
Field Tests, Determining the Severity of the Injury, & Means of Transportation
Testing for the severity of the injury there are three tests that can be used.
Anterior Drawer Test- This test evaluates the anterior talofibular ligament by securing the leg with one hand and applying an anterior pull on the heel with the foot held at the plantar flexion a forward shift of more than 8 mm is indicative of ligament tears.
Eversion test- This test checks the deltoid ligament and the muscles in that area for any damage. To perform this test, bend your knee at a right angle and hold your heel from below with one hand. Use your other hand to hold your lower leg. Push your heel outward and your lower leg inward with your hands. This will cause your foot to rotate outward, which is called eversion.
Inversion (Supination)- This test checks the plantarflexion, anterior talofibular ligament, dorsiflexion, and calcaneofibular ligament for any damage. To perform this test, bend your knee at a right angle and hold your heel from below with one hand. Use your other hand to hold your lower leg. Push your heel inward and your lower leg outward with your hands. This will cause your foot to rotate inward, which is called inversion.
Depending upon the severity of the pain and the ability of the injured athlete to move, crutches could be used. If any movement seems too painful, a stretcher should be used in order to avoid further damage.
Achilles Tendon Rupture
Symptoms of Tingling around the back and side of his ankle, but the pain seemed to quickly dissipate. Immediate swelling was visible in the posterior ankle area and the gastrocnemius and soleus (calf) muscles. The athlete was unable to put weight on his left foot, and could only move taking “baby steps” with all of his body weight on the right leg.
High speed shifts in direction such as basketball players running full speed across a court and shifting directions on one foot present a danger of injury. If an injury occurs in these types of situations, a loud popping sound may be heard and possible sense of being kicked in the back of the heel resulting in the leg buckling when the athlete attempts to move. In this instanced, the likelihood of Achilles Tendon Rupture is high and common symptoms of this injury include:
- sudden pain at the back of the ankle
- aloud popping noise is often reported
- inability to contract the calf muscles or point the foot away from the body
One would assess this injury by asking the injured athlete to move the foot inward and outward and judge the degree of damage. One would have the athlete discontinue further activity in the sport because this type of injury requires medical attention. Issue the athlete crutches and begin icing. The athlete will need to be transported to a medical professional or hospital. Treatment may include either surgical repair of the tendon, or casting.
Medial Tibial Stress Syndrome (MTSS) or Shin Splints
Most athletes develop MTSS due to overtraining. The medial tibial stress syndrome (MTSS), is also known as “shin splints” and the treatment and rehabilitation for this injury includes:
- Ice massage and Achilles tendon stretching 3 to 4 times a day. Nonsteroidal anti-inflammatories such as aspirin are recommended to relieve inflammation and pain.
- Gentle stretching of the leg muscles that includes the calf, heel cord, and hamstring is essential before and after exercising to treat MTSS.
- Orthotics may be used in instances where the foot has other issues such as arch problems.
- Gentle flexibility and strengthening exercises for the muscles involved should also be added to the workout.
The primary treatment for MTSS is rest. Continuing to take part in the sport or activity that caused the injury will not allow it to heal. After the pain has subsided, low impact and stress training exercises can begin. For instance, swimming would be an alternative to running. After progressing through low impact exercises the athlete can begin his or her sport but at a less intense pace. Lower intensity workouts should last for three to six weeks in order to avoid relapses. Recurring pain is the signal that the intensity of exercise is too high or that not enough rest has been allocated for the injury.
Ankle Rehabilitation Exercises
Five exercises used in the rehabilitation of the ankle that progress from simple to advanced include the alphabets, windshield wiper, seated calf raises, single leg stand, and eversion and inversion isometrics.
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Here are five exercises that can help an athlete recover from an ankle injury. They range from simple to advanced, and they should do them two to three times a day.
Exercise 1: The Alphabets
- Sit with your foot flat on the floor and facing straight.
- Use your big toe as a “pen” and draw each letter of the alphabet by moving your injured ankle.
- Do two sets of 10 to 15 letters.
Exercise 2: Windshield Wiper
- Sit with the edge of your heel on the floor.
- Rotate your foot like a windshield wiper blade: from side to side.
- Do two sets of 10 to 15 rotations.
Exercise 3: Seated Calf Raise
- Sit with your injured foot flat on the floor.
- Lift your heel as high as you can while keeping your toes on the floor.
- Lower your heel back to the floor.
- Do two sets of 10 to 15 lifts.
Exercise 4: Single Leg Stand
- Stand with one hand on a table for support.
- Shift some of your weight to your injured foot and hold for 15 seconds.
- Gradually increase the time by 15 seconds until you can hold for 45 seconds.
- Gradually increase the weight on your injured foot until you can support your full body weight.
- Do two sets of 10 to 15 stands.
Exercise 5: Eversion and Inversion Isometrics
- Stand and place the outside of your injured foot against a stable object, such as a table leg.
- Push your foot outward against the object for 2 to 3 seconds. This is eversion.
- Do two sets of 10 to 15 pushes.
- Stand and place the inside of your injured foot against a stable object, such as a table leg.
- Push your foot inward against the object for 2 to 3 seconds. This is inversion.
- Do two sets of 10 to 15 pushes.
Perhaps the most effective way to reduce injuries of the lower leg and ankle is to monitor training to make sure the athlete does not over train. Identifying and treating injuries immediately will also have the positive impact of reducing loss of training and for certain worsening injuries.
