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Ankle Injuries
mvpboxing |  May 04, 2017, 12:05PM
Ankle Inversion Sprain
  1. Definition and Occurrence
    1. The outside part of the ankle consists of three important ligaments that help stabilize the joint during movements. Many sports, especially boxing, require the athlete to be on their toes for extended periods of time. While in this position, the ankle joint is in its least stable position and the anterior talofibular ligament is at risk for injury. This is similar to when you “roll” your ankle inwards. The ligament that connects the outside bone of the lower leg to the foot bone (calcaneofibular ligament) can sometimes be injured with this type of sprain. Ankle sprains comprise 15% of all athletic injuries.
  2. Signs and Symptoms
    1. Three different levels of sprain can occur with injury.
      1. A grade 1 sprain involves a minor stretch of the ligaments and no tearing. There is minimal swelling or tenderness and no instability in the joint.
      2. A grade 2 sprain involves significant stretching of the ligaments and partial tearing. There will be moderate swelling and tenderness and some joint instability.
      3. A grade 3 sprain includes a full tear of the anterior talofibular ligament and sometimes the calcaneofibular ligament. Severe swelling and tenderness result, along with inability to bear weight on the involved leg.
  3. Treatment
    1. As soon as possible after the injury, RICE should be initiated (Rest, Ice, Compression, and Elevation). Depending on the severity of the sprain, the ankle should be immobilized, or at least supported, in a neutral ankle position. This allows the injured ligament to heal in a comfortable, slackened position without being stretched. Taping, bracing, or using a removable boot are options in this stage.
    2. Initiate range of motion exercises and early strengthening as the swelling and pain subside. Early strengthening exercises should be non weight-bearing to protect the healing tissues. Once full range of motion is achieved, strengthening exercises can be progressed.
    3. Calf stretching
    4. Progress exercises to weight bearing
      1. Balancing on injured leg on de-stabilizing surfaces: Progress to playing catch while standing on de-stabilizing surface
      2. Sport specific progression (initiate at end of treatment): Cutting, side stepping, figure eight running
  4. Prehab (Prevention)
    1. Lace up ankle braces can provide preventative ankle support for athletes participating in high risk sports. Boxers and MMA fighters are often seen with their ankles taped or wearing braces. It should be kept in mind that ankle taping is only providing stability for about the first 10 minutes that it is applied.
Peroneal Tendonitis
  1. Definition and Occurrence
    1. The peroneal muscles run on the outside part of the lower leg, around the outside part of the ankle bone, and attach on the foot. The tendons that run along the ankle bone assist the ligaments of the ankle in providing overall stability to the joint.
    2. If the ankle ligaments are injured through an ankle sprain, these tendons often become irritated from being overworked as ankle stabilizers. An initial ankle sprain is usually the cause of peroneal tendonitis. Prolonged running on uneven terrain could also cause the peroneal muscles to become overworked. Additionally, athletes with high arches are predisposed to this type of injury
  2. Signs and Symptoms
    1. Tenderness along the outside part of the lower leg and around the outside ankle bone.
    2. Pain with walking and running, especially on unstable surfaces
    3. Pain during active motion of the ankle joint outward
    4. Pain with passive motion of the ankle joint inward.
  3. Treatment
    1. Since this condition often manifests itself after an ankle inversion sprain, the treatment plan is similar to that condition
    2. Rest and Ice initially
    3. Stretching and range of motion exercises
    4. Progress strengthening exercises from open chain to closed chain, and eventually to dynamic strengthening trying to balance on destabilizing surfaces
    5. Sport specific exercises (ie cutting, side-stepping, figure eight running)
  4. Prehab (prevention)
    1. The athlete should constantly be strengthening their ankle muscles by performing their general strengthening routine while balancing on bosu balls or foam mats. Prolonged running on uneven surfaces should be avoided.
Stress Fracture
  1. Definition and Occurrence
    1. Stress fractures are small bone imperfections that most commonly occur from a combination of training mistakes, improper footwear, and nutritional deficiencies. In their initial stages, they often go undetected on x-rays and a bone scan is ordered to confirm the diagnoses.
    2. The most common sites for stress fractures in the foot are in the 5th metatarsal or the lateral bone of the foot and the heel bone.
    3. It is thought that stress fractures commonly result from the unrelenting pull of muscles on a bone or the impact of ground reaction forces being repetitively transferred to the bone.
  2. Signs and Symptoms
    1. Pain and swelling are primary symptoms
    2. With a stress fracture of the heel bone, pain will be more diffuse and difficult to pinpoint when compared to other injuries such as plantar fasciitis. Pain will occur when squeezing the entire heel bone.
    3. A stress fracture is typically diagnosed with the use of a bone scan or an MRI
    4. With a stress fracture of the metatarsal, pain will be localized and pinpoint.
  3. Treatment
    1. Just like any fracture, rest is necessary to allow the broken bone to develop a callous and heal. Casting or immobilization may be necessary if the fracture is at risk for displacement
    2. Cross training can be initiated immediately
      1. Swimming
      2. Aqua-jogging
      3. Anti-gravity treadmill
      4. Biking
      5. Upper body conditioning
    3. Return to activity
      1. Gradual return to activity after 2-3 weeks without pain and clearance from doctor
      2. Will need to strengthen the weakened musculature
      3. Proper footwear is important to avoid future stress fractures
      4. Avoid running on uneven or exclusively hard surfaces
      5. Re-examine training prior to injury to isolate cause of fracture
  4. Prehab (Prevention)
    1. Gradual progression in intensity and volume of training program
    2. Vary running surfaces
    3. Change running shoes every 3000 miles
Tibialis Posterior Tendonitis
  1. Definition and Occurrence
    1. Tibialis Posterior is a muscle that runs along the inside part of the lower leg with the tendon extending down the leg and along the inner aspect of the foot. The function of this muscle and tendon is to support the arch of the foot .This tendon can become injured with running and also if the foot pronates or collapses too much..In this particular instance, the tendon and muscle become overworked resulting in swelling and irritation of the tendon. It functions opposite of the peroneal muscle tendons to help roll the ankle inward. Irritation or inflammation of this muscle can ultimately lead to a rupture, causing an inability to perform a heel raise on the affected leg. This injury requires biomechanical assessment by a medical professional in order to resolve both aggravating factors and the injury.
    2. Traumatic ruptures of this muscle tendon are rare, as this is mostly overuse injury.
    3. Causes include: repetitive running on uneven surfaces, insufficient cushioning in training shoes, flat feet, or obesity.
  2. Signs and symptoms
    1. Fatigue and aching along inside part of lower leg and around inside part of the ankle joint
    2. Pain increased with heel raises and activity and subsides with rest.
  3. Treatment
    1. Rest, ice, and non-steroidal anti-inflammatory drugs
    2. Low impact cross training
    3. If the tendonitis progresses into a tendon rupture, the ankle will need to be stabilized through bracing to allow the tendon to heal at a normal length
  4. Prehab (Prevention)
    1. The athlete should constantly be strengthening their ankle muscles by performing their general strengthening routine while balancing on bosu balls or foam mats. Prolonged running on uneven surfaces should be avoided.

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