Spring Lower Extremity Ligamentous & Muscular Injuries (Ankle sprains to Plantar Fasciitis)
- Physical Therapy International Service
- 6 days ago
- 5 min read
Authors: Jenna Little and Ella Bonner
In the springtime, the weather is getting nicer, leading to more activities outside and the beginning of spring sports season. As exciting as this is, there are various risks for injuries that can occur because of this.
The ankle consists of three main sets of ligaments: the medial ligaments, the lateral ligaments, and the syndesmotic ligaments. The medial ligaments consist of four different ligaments that start at the bottom end of the tibia or the medial malleolus. These are the anterior tibiotalar ligament, tibionavicular ligament, tibiocalcaneal ligament, and the posterior tibiotalar ligament. Lateral ligaments consist of three ligaments that start at the lateral malleolus. These are the anterior talofibular ligament, calcaneofibular ligament, and the posterior talofibular ligament. The lateral malleolus connects to the talus and calcaneus. Lastly, the syndesmotic ligaments consist of four ligaments that connect to the tibia and the fibula. These are the anterior inferior tibiofibular ligament (ATFL), posterior inferior tibiofibular ligament (PTFL), inferior transverse ligament, and interosseous ligament. The foot consists of many different ligaments, with the main ones including the plantar calcaneonavicular ligament, calcaneocuboid ligament, and lisfranc ligaments.
The muscles in the ankle and foot are made of soft tissue and are broken up into two groups: plantar and dorsal. The muscles that cause plantarflexion, pointing the foot downward, are split into subgroups: lateral, central, and medial. The lateral muscles are the abductor digiti minimi, flexor digiti minimi brevis, and the opponens digiti minimi. The central muscles are the flexor digitorum brevis, quadratus plantae, four lumbricals, three plantar interossei, and four dorsal interossei muscles. Lastly, the medial plantar muscles are the abductor hallucis, adductor hallucis, and flexor hallucis brevis muscles. As for the dorsal groups, there are the extensor digitorum brevis and extensor hallucis brevis muscles.
An ankle sprain occurs when the supporting ligaments in the ankle are stretched too far causing muscular tearing. There are different levels of sprains, but what makes them different is how many ligaments are damaged and how badly. Causes of an ankle sprain can vary but are often caused by traumatic events like wearing ill-fitting shoes, falling, awkward landing, or exercising on insatiable surfaces. There are two different types of ankle sprains: eversion and inversion ankle sprains. Eversion ankle sprains occur when the ankle rolls out, and inversion ankle sprains occur when the ankle rolls in. Inversion tends to be the more common type of ankle sprain. Lateral ankle sprains cause injury to the ligaments that keep the foot from rolling in, so the anterior talofibular ligament, calcaneofibular ligament, and the posterior talofibular ligament. Medial ankle sprains cause injury to the ligaments that keep the foot from rolling out, so the anterior tibiotalar ligament, tibionavicular ligament, tibiocalcaneal ligament, and the posterior tibiotalar ligament. High ankle sprains cause injury to the ligaments that hold the tibia and fibula together, which are the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, inferior transverse ligament, and interosseous ligament.
Most lower-level sprains can be treated conservatively and can follow a three-phase guide for treatment. Phase one begins with immobilizing, resting, and icing the area to help calm down any swelling and pain. Weight-bearing is recommended as able. For higher-level sprains, supportive wear will be beneficial, so using things like braces, boots, crutches, or even casts is helpful. Phase two involves rehabilitation to work on range of motion, lower-level strengthening (isometrics), and balance. At this point, movement is necessary to prevent any stiffening of the ankle, so immobilization should stop in phase two. Phase three has components of more advanced strengthening and balance while progressing to activities performed before the injury. Working on exercises that limit twisting and turning is crucial to start, and once able, add exercises that work with sharp and sudden movements. Some of the higher-level activities may need some ankle stabilization tools like tape or bracing. At-home treatments may be more appropriate for some low-level sprains that do not require the 3-phase protocol, so using RICE (rest, ice, compression, and elevation) and NSAIDs are recommended. Additionally, physical therapy is a suggested treatment for phases 2 and 3 of recovery to work on mobilization, strengthening, balance, and agility.
For ankle sprains that do not get better with conservative treatment, or if the sprain is persistent in pain or instability after consistent rehabilitation, surgery is performed. However, this is a rare case. It is also more likely for cases of high ankle sprains or sprains with added injuries to areas like the cartilage or tendons. Types of surgery include arthroscopy which involves looking into the ankle joint with a camera and using small tools to remove loose parts of bone, cartilage, and ligaments. Another type of surgery is repair or reconstruction, which is when the surgeon repairs the ligament with sutures. Other ways to repair it could be replacing the ligament with grafts of tissue from other ligaments in the surrounding area. Following surgery, immobilization and rehabilitation are the processes to take to get the ankle feeling good again.
There is a band of tissue that is at the bottom of our feet called plantar fascia. Plantar fasciitis is inflammation of this band of tissue. It can feel like a stabbing pain especially when first walking in the morning or sitting down for a long time. There is not a clear cause of plantar fasciitis but because the band absorbs shock in the foot when walking or running, as it supports the arch of the foot, lots of stress or tension on it can cause tears that inflame the tissue. Some risk factors of plantar fasciitis include exercise that stresses the tissue such as running long distances and some dance styles. Walking a different way or having high arches or flat feet can also put extra stress on the tissue. Ages between forty and sixty years old are risk factors as well as obesity with the extra weight leading to stress on the tissue.
There are various treatment plans for plantar fasciitis ranging from basic to extreme. The most basic ones for minimal pain are application of ice, stretching, medications, physical therapy, arch supports, or a walking boot. In more extreme cases, injections of steroids or minimally invasive surgery can also be used as treatment. In terms of physical therapy, it can be used to help stretch the tissue as well as strengthen the muscles around it to minimize inflammation in the affected area.
Spring is a beautiful season as the weather starts to get nicer and outside sports begin again. This can be exciting but can also lead to various common injuries within the season. These injuries can include ankle, elbow, and knee injuries, strains in hamstring muscles, and shin splints. A common way to prevent any of these is including a proper warmup before conditioning, having the proper footwear and equipment for each activity, and not going too hard too quickly. If wintertime was an off-season, it is important to make a gradual return to activity as your fitness level may not be the same as before a break, and going too hard too quickly can lead to some of the listed common injuries.
To summarize, springtime is a great awakening of many outside activities that can also lead to injuries due to lack of conditioning over winter, lack of warmup, or overstress on the body. Physical therapy is a helpful tool if you find yourself or someone you may know who has an injury that needs to be evaluated and treated.
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Body 4: https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846
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