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THE ANKLE

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Title: THE ANKLE Author: Jeff Palmquist Last modified by: JWILLS Created Date: 4/18/2002 6:00:08 PM Document presentation format: On-screen Show Other titles – PowerPoint PPT presentation

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Title: THE ANKLE


1
THE ANKLE
  • The Ankle and Lower Leg

2
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?

3
Anatomy of the Ankle
  • What bone make up the Ankle joint?
  • Tibia
  • Fibula
  • Talus
  • Calcaneus

4
Anatomy of the Ankle
  • What type of joint is the Ankle?
  • The Ankle joint is a HINGE JOINT
  • The TALOCRURAL Joint

5
Major Ligaments of the Ankle
  • LATERAL ASPECT
  • Anterior Tibiofibular
  • Anterior Talofibular- 3
  • Calcaneofibular- 6
  • Posterior Talofibular- 9

6
Major Ligaments of the Ankle
  • MEDIAL ASPECT
  • Posterior Talotibial
  • Posterior Talocalcaneal
  • Deltoid

7
Muscles and Tendons around the Ankle
  • Achilles Tendon
  • Peroneal Tendinitis
  • Anterior Tibialis Tendinitis
  • Posterior Tibialis Tendinitis

8
Common Ankle Injuries
  • Inverted Ankle Sprain
  • Everted Ankle Sprain
  • Ankle Dislocation
  • Muscle and Tendon Strains

9
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

10
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.

11
Ankle Dislocation/Fracture
  • Ankle Dislocation -Fracture
  • Medical Emergency
  • Usually the foot is inverted.
  • Frequently both the Tibia and Fibula are
    fractured.

12
Ankle Dislocation/Fracture - Medical Emergency
13
Muscle and Tendon Strains
  • Most common is the Achilles Tendon Strain.
  • THOMPSON Test the Achilles.
  • Peroneal tendon sometimes damaged with inversion
    ankle sprain.

14
Compression Test
Percussion Test
Homans Test
Thompson Test
15
Anterior Drawer Test
Talar Tilt Test
16
  • 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

17
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

18
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

19
  • 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

20
  • 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

21
  • 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

22
  • 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

23
  • 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

24
Rehab/Treatment Plan for Sprained Ankles
  • RICE
  • Modalities
  • Exercises

25
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

26
Goals of RICE
  • Limit Swelling
  • Reduce pain
  • Return to sport/activity quicker

27
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

28
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.

29
Rehab Exercises
  • Range of Motion ABCs
  • One leg Stands
  • BAPS Board
  • Towel Curls
  • Toe Pickups
  • Toe Rises
  • Theraband

30
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

31
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.

32
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.

33
Ankle Braces
34
Ankle Braces
35
Ankle Braces
36
Questions Over Ankle
  • Notes
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