Foot and Ankle Injuries in the Adolescent Athlete
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1 Foot and Ankle Injuries in the Adolescent Athlete Kevin Latz, MD Children s Mercy Hospital Center for Sports Medicine Foot and Ankle Injuries Very common Influenced by the unique properties of growth plates Significant source of disability Prognosis determined by effective non operative mgmt Epidemiology of Foot and Ankle Injuries Most common injuries among all three levels of NCAA athletes (5 X more common than ACL, 3 X more common than concussion) Most common injury in high school basketball athletes (40%) Most common injury in Athens Olympics, 2 nd most common injury in Salt Lake Olympics 1
2 Initial Evaluation of the Injured Athlete History to determine mechanism of injury Examination of the entire foot and ankle Comparison examination of the other limb Specific Injuries Syndesmosis injuries (high ankle sprain) Lateral ankle sprains Peroneal tendon injury and instability Lisfranc injuries Fifth metatarsal fractures (jones fractures) Osteochondral injuries of the Talus Fractures Properties of the Distal Tibia/Fibula Physis Males 15-16, females Distal tibia closes central, medial, lateral Distal fibula physis more vulnerable than lateral ligaments Unique fractures juvenile tilleaux and triplane 2
3 Juvenile Tilleaux Fracture Tibiofibular Syndesmosis Injuries Result of forced external rotation injury on dorsiflexed foot 1%, longer recovery, residual symptoms Stable v unstable Clinical findings Physical exam findings Radiographic findings Syndesmosis Injury Physical Exam 3
4 Syndesmosis Injuries Radiographs Management of Stable Syndesmosic Injuries Immobilization until able to weight bear Physical therapy focusing on range of motion, strengthening, and proprioception Symptoms lingering beyond 6 weeks Supervised return to sport Management of Unstable Syndesmosis Injuries Surgical Fixation with screw(s) or suture Controversy re: removal of screws High rate of mal-reduction 4
5 Lateral Ankle Sprain (Inversion Injury) Grading of Lateral Ankle Sprain (AMA 66) Grade I Stretched lateral ligament Grade II Partial tear of lateral ligament Grade III Complete tear of lateral ligament DDx of Lateral Ankle Sprain 5
6 Acute Lateral Instablity Common injury In competition mgmt Treatment t non surgical with RICE, mobilization, strengthening, supervised return to sport Associated injuries osteochondral talus or peroneal tendon Recurrent/Chronic Lateral Ankle Instability Surgical Mgmt of Chronic Lateral Ankle Instability 6
7 Surgical Mgmt of Chronic Lateral Instability Peroneal Tendon Injury Can be associated with lateral ankle sprain Variability between athletes Role of immobilization/bracing Surgical mgmt Peroneal Tendon Instability 7
8 Case Scenario - PB Lisfranc (Midfoot injuries) Result of axial injury to the heal of a dorsiflexed foot History c/w pop Pain with palpation, WB, and stress Stable v unstable Lisfranc Anatomy 8
9 Lisfranc Imaging- Radiographs v MRI Management of Lisfranc Injuries Non operative mgmt of stable injuries Protected weight bearing Rehabilitation with focus on range of motion and strengthening Supervised return to sports Prolonged convalescence Talus Osteochondral Injuries Acute or Chronic Acute Anterolateral Chronic Anteromedial Management based on chronicity of lesion 9
10 Acute Osteochondral Injuries of the Talus Associated with lateral ankle sprain Lateral in location Accompanied by ankle hemarthrosis, inability to weight bear Treatment is surgical Chronic Osteochondral Injuries of the Talus? Repetitive microtrauma Medial in location Vague, poorly localized pain Identified by radiographs Staged by MRI Role for non operative mgmt 5 th Metatarsal Fracture (Jones) Associated with ankle sprain Diaphyseal fracture waterhd shed Consider surgical mgmt 10
11 Jones Fracture Prevention of Foot and Ankle Injuries Injury Surveillance break away bases Modification of shoe wear Modification of playing surface Utility of high top shoes, taping, and braces Utility of injury prevention programs 11
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