Download THE ANKLE

THE ANKLE
The Ankle and Lower Leg
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?
Anatomy of the Ankle
 What bone make up the
Ankle joint?
 Tibia
 Fibula
 Talus
 Calcaneus
Anatomy of the Ankle
 What type of joint is
the Ankle?
 The Ankle joint is a
HINGE JOINT
 The TALOCRURAL
Joint
Major Ligaments of the Ankle
 LATERAL ASPECT
 Anterior Tibiofibular
 Anterior Talofibular- 3
 Calcaneofibular- 6
 Posterior Talofibular- 9
Major Ligaments of the Ankle
 MEDIAL ASPECT
 Posterior Talotibial
 Posterior
Talocalcaneal
 Deltoid
Muscles and Tendons around the
Ankle
 Achilles Tendon
 Peroneal Tendinitis
 Anterior Tibialis Tendinitis
 Posterior Tibialis Tendinitis
Common Ankle Injuries
 Inverted Ankle Sprain
 Everted Ankle Sprain
 Ankle Dislocation
 Muscle and Tendon Strains
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
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.
Ankle Dislocation/Fracture
 Ankle Dislocation -
Fracture
 Medical Emergency
 Usually the foot is
inverted.
 Frequently both the
Tibia and Fibula are
fractured.
Ankle Dislocation/Fracture
- Medical Emergency
Muscle and Tendon Strains
 Most common is
the Achilles
Tendon Strain.
 THOMPSON Test
the Achilles.
 Peroneal tendon
sometimes
damaged with
inversion ankle
sprain.
Compression Test
Homan’s Test
Percussion Test
Thompson Test
Anterior Drawer Test
Talar Tilt Test

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
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
Grading Scales for Sprained
Ankles
 GRADE I
Most common ankle sprain.
Mild pain, still weight baring.
 GRADE II
More painful, report popping sound.
Can not bear weight.
Stretching of lateral ligaments of the ankle.
 GRADE III
Extreme pain. Usually complete tear of one of
the ankle ligaments.
Sometimes fracture occurs also.

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


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
– 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


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

– 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

Rehab/Treatment Plan for Sprained Ankles
 RICE
 Modalities
 Exercises
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
Goals of RICE
 Limit Swelling
 Reduce pain
 Return to
sport/activity
quicker
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
Modalities Used
 HIGH VOLTAGE Assists in activating pain killing




receptors.
Assists in muscle stimulation
around ankle joint to aid in edema
removal.
ULTRASOUNDAssists in edema removal.
Assists in bringing digestive
enzymes to clean debris cells of
the injured ankle.
Rehab Exercises
 Range of Motion ABC’s
 One leg Stands
 BAPS Board
 Towel Curls
 Toe Pickups
 Toe Rises
 Theraband
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
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.
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.
Ankle Braces
Ankle Braces
Ankle Braces
Questions Over Ankle
 Notes: