THE ANKLE

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THE ANKLE

• The Ankle and Lower Leg

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Introduction

• Have you ever sprained your ankle, or do you
  know anyone who has?
• What did you do for it?
• How long did the pain last?
• Do you have any problems with that ankle?

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Anatomy of the Ankle

• What bone make up the Ankle joint?
• Tibia
• Fibula
• Talus
• Calcaneus

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Anatomy of the Ankle

• What type of joint is the Ankle?
• The Ankle joint is a HINGE JOINT
• The TALOCRURAL Joint

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Major Ligaments of the Ankle

• LATERAL ASPECT
• Anterior Tibiofibular
• Anterior Talofibular- 3
• Calcaneofibular- 6
• Posterior Talofibular- 9

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Major Ligaments of the Ankle

• MEDIAL ASPECT
• Posterior Talotibial
• Posterior Talocalcaneal
• Deltoid

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Muscles and Tendons around the Ankle

• Achilles Tendon
• Peroneal Tendinitis
• Anterior Tibialis Tendinitis
• Posterior Tibialis Tendinitis

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Common Ankle Injuries

• Inverted Ankle Sprain
• Everted Ankle Sprain
• Ankle Dislocation
• Muscle and Tendon Strains

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Inverted Ankle Sprain

• Inversion Ankle Sprain- the foot turns inward
  rolling over the lateral aspect of the ankle.
• Most common ankle sprain- about 85 of all ankle
  sprains

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Everted Ankle Sprain

• Eversion Ankle Sprain- the turns inward. The
  ankle rolls in medially.
• Uncommon sprain due to bone support.
• Occurs in about 10-15 of ankle sprains.

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Ankle Dislocation/Fracture

• Ankle Dislocation -Fracture
• Medical Emergency
• Usually the foot is inverted.
• Frequently both the Tibia and Fibula are
  fractured.

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Ankle Dislocation/Fracture - Medical Emergency
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Muscle and Tendon Strains

• Most common is the Achilles Tendon Strain.
• THOMPSON Test the Achilles.
• Peroneal tendon sometimes damaged with inversion
  ankle sprain.

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Compression Test
Percussion Test
Homans Test
Thompson Test
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Anterior Drawer Test
Talar Tilt Test
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• Functional Tests
• While weight bearing the following should be
  performed
• Walk on toes (plantar flexion)
• Walk on heels (dorsiflexion)
• Walk on lateral borders of feet (inversion)
• Walk on medial borders of feet (eversion)
• Hops on injured ankle
• Passive, active and resistive movements should be
  manually applied to determine joint integrity and
  muscle function
• If any of these are painful they should be avoided

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Prevention of Injury to the Ankle

• Stretching of the Achilles tendon
• Strengthening of the surrounding muscles
• Proprioceptive training balance exercises and
  agility
• Wearing proper footwear and or tape when
  appropriate

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Grading Scales for Sprained Ankles

• Most common ankle sprain.
• Mild pain, still weight baring.
• More painful, report popping sound.
• Can not bear weight.
• Stretching of lateral ligaments of the ankle.
• Extreme pain. Usually complete tear of one of
  the ankle ligaments.
• Sometimes fracture occurs also.

• GRADE I
• GRADE II
• GRADE III

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• Grade 1 Inversion Ankle Sprain
• Etiology
• Occurs with inversion plantar flexion and
  adduction
• Causes stretching of the anterior talofibular
  ligament
• Signs and Symptoms
• Mild pain and disability weight bearing is
  minimally impaired point tenderness over
  ligaments and no laxity
• Management
• RICE for 1-2 days limited weight bearing
  initially and then aggressive rehab
• Tape may provide some additional support
• Return to activity in 7-10 days

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• Grade 2 Inversion Ankle Sprain
• Etiology
• Moderate inversion force causing great deal of
  disability with many days of lost time
• Signs and Symptoms
• Feel or hear pop or snap moderate pain w/
  difficulty bearing weight tenderness and edema
• Positive talar tilt and anterior drawer tests
• Possible tearing of the anterior talofibular and
  calcaneofibular ligaments
• Management
• RICE for at least first 72 hours X-ray exam to
  rule out fx crutches 5-10 days, progressing to
  weight bearing

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• Management (continued)
• Will require protective immobilization but begin
  ROM exercises early to aid in maintenance of
  motion and proprioception
• Taping will provide support during early stages
  of walking and running
• Long term disability will include chronic
  instability with injury recurrence potentially
  leading to joint degeneration
• Must continue to engage in rehab to prevent
  against re-injury

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• Grade 3 Inversion Ankle Sprain
• Etiology
• Relatively uncommon but is extremely disabling
• Caused by significant force (inversion) resulting
  in spontaneous subluxation and reduction
• Causes damage to the anterior/posterior
  talofibular and calcaneofibular ligaments as well
  as the capsule
• Signs and Symptoms
• Severe pain, swelling, hemarthrosis,
  discoloration
• Unable to bear weight
• Positive talar tilt and anterior drawer

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• Management
• RICE, X-ray (physician may apply dorsiflexion
  splint for 3-6 weeks)
• Crutches are provided after cast removal
• Isometrics in cast ROM, PRE and balance exercise
  once out
• Surgery may be warranted to stabilize ankle due
  to increased laxity and instability

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Rehab/Treatment Plan for Sprained Ankles

• RICE
• Modalities
• Exercises

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RICE

• Rest- stay off the Ankle, crutches may be needed
• Ice- 15 minutes a 4 to 5 times a day
• Compression- ace wrap with horseshoe keeps the
  swelling down
• Elevation- keep ankle above heart level when
  possible, allows gravity to pump out swelling

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Goals of RICE

• Limit Swelling
• Reduce pain
• Return to sport/activity quicker

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Modalities Used

• COLD WHIRLPOOL-
• 15 minutes a couple times a day
• Vasoconstrictors vessels around ankle
• Stimulates pain killing receptors
• Slows cell metabolism
• Aids in reducing swelling

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Modalities Used

• HIGH VOLTAGE-
• Assists in activating pain killing receptors.
• Assists in muscle stimulation around ankle joint
  to aid in edema removal.
• ULTRASOUND-
• Assists in edema removal.
• Assists in bringing digestive enzymes to clean
  debris cells of the injured ankle.

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Rehab Exercises

• Range of Motion ABCs
• One leg Stands
• BAPS Board
• Towel Curls
• Toe Pickups
• Toe Rises
• Theraband

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Taping Vs. Wrapping

• TAPING-
• Psychologically better feeling to the athlete
• Tight fitting at first
• Tape looses a large percentage of its support
  within the first 15-20 minutes of competition

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Taping Vs. Wrapping

• WRAPPING-
• Purpose in wrapping is injury prevention.
• Wrapping will not eliminate sprained ankle, but
  it does minimize the severity of the sprain.

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Ankle Braces

• ANKLE BRACES-
• Many varieties and types.
• Lace Up
• Hinged
• Air Casts
• All offer different levels of support.
• Large and competitive business market for ankle
  braces.

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Ankle Braces
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Ankle Braces
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Ankle Braces
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Questions Over Ankle

• Notes