Ankle InjuriesAnkle Injuries

Ankle SprainsAnkle Sprains

Single most common injury in athletics caused Single most common injury in athletics caused by sudden inversion or eversion momentsby sudden inversion or eversion moments

TibiaTibia

Medial MalleolusMedial Malleolus

FibulaFibula

Lateral MalleolusLateral Malleolus

Medial AspectMedial Aspect

Bones Bones of of

Foot & AnkleFoot & Ankle

Head of TalusHead of Talus

Medial MalleolusMedial Malleolus

Foot & Ankle BonesFoot & Ankle Bones

CalcaneousCalcaneous

CuboidCuboid

TalusTalus

3rd - 5th 3rd - 5th MetatarsalsMetatarsals

Lateral ViewLateral ViewTarsal Tarsal sinussinus

Lateral LigamentsLateral Ligaments

Anterior Tibiofibular LigamentAnterior Tibiofibular Ligament PalpationPalpation

Locate area where tibia and Locate area where tibia and fibula meetfibula meet

Spring TestSpring Test

External Rotation TestExternal Rotation Test

Anterior Talofibular LigamentAnterior Talofibular Ligament Palpation Palpation

Superior to sinus tarsiSuperior to sinus tarsi Anterior Drawer TestAnterior Drawer Test

Anterior translation of talus under tibiaAnterior translation of talus under tibia May cause a clunking at end point May cause a clunking at end point Indicates laxityIndicates laxity

Posterior Talofibular LigamentPosterior Talofibular Ligament

Posterior Drawer Test Posterior Drawer Test Stabilize TibiaStabilize Tibia

Apply a posterior stress to the foot and ankleApply a posterior stress to the foot and ankle Posterior translation indicates ligament laxityPosterior translation indicates ligament laxity

Talar Tilt Test (Varus Stress)Talar Tilt Test (Varus Stress)

AssessmentAssessment Calcaneofibular ligamentCalcaneofibular ligament

Apply a varus stress to calcaneousApply a varus stress to calcaneous

Grade 1-3+Grade 1-3+

Feel for cluckFeel for cluck

Deltoid LigamentsDeltoid Ligaments

Valgus Stress TestValgus Stress Test

Inversion SprainsInversion Sprains Injury to the lateral ligamentsInjury to the lateral ligaments

Anterior talofibular ligament Anterior talofibular ligament

InversionInversion

Plantar flexion Plantar flexion

Internal rotationInternal rotation

Calcaneofibular ligament Calcaneofibular ligament

InversionInversion

Symptoms Symptoms Pain Pain

Active motionActive motion Resistive motionResistive motion Loss of functionLoss of function

SignsSigns Tenderness Tenderness SwellingSwelling EcchymosisEcchymosis

Inversion SprainInversion Sprain

Symptoms Symptoms Pain: mild Pain: mild

Active motionActive motion Resistive motionResistive motion Loss of functionLoss of function Weight bearing minimally impairedWeight bearing minimally impaired

SignsSigns Point Tenderness Point Tenderness SwellingSwelling EcchymosisEcchymosis No laxityNo laxity

1º Inversion Sprain1º Inversion Sprain1º Inversion Sprain1º Inversion Sprain ManagementManagement

RICERICE Weight bearing to toleranceWeight bearing to tolerance Tape or braceTape or brace Modalities as neededModalities as needed StrengtheningStrengthening Return to activity when functionalReturn to activity when functional Average return 7-10 daysAverage return 7-10 days

EtiologyEtiology Moderate inversion forceModerate inversion force

PathologyPathology Partial tearing of ligamentsPartial tearing of ligaments

Anterior TalofibularAnterior Talofibular CalcaneofibularCalcaneofibular

Signs and SymptomsSigns and Symptoms Pop or snap heard or feltPop or snap heard or felt Moderate painModerate pain Moderate disabilityModerate disability

Difficulty bearing weightDifficulty bearing weight TendernessTenderness EdemaEdema

2º Inversion Sprain2º Inversion Sprain ManagementManagement

RICE up to 72 hoursRICE up to 72 hours

X-ray if unable to weight bearX-ray if unable to weight bear

Crutches 5-10 daysCrutches 5-10 days

Progress to weight bearing Progress to weight bearing

Protective immobilizationProtective immobilization

Tape or braceTape or brace

Modalities as neededModalities as needed

Early ROM exercisesEarly ROM exercises

Strength & proprioception Strength & proprioception exercisesexercises

Return to activity when functionalReturn to activity when functional

Average return 7-10 daysAverage return 7-10 days

EtiologyEtiology Relatively uncommonRelatively uncommon

Significant inversion forceSignificant inversion force

Subluxation and relocationSubluxation and relocation

PathologyPathology Anterior talofibular ligamentAnterior talofibular ligament

Calcaneofibular ligamentCalcaneofibular ligament

Anterior tibiofibular ligamentAnterior tibiofibular ligament

3º Inversion Sprain3º Inversion Sprain

Signs and SymptomsSigns and Symptoms Severe painSevere pain EdemaEdema Hemarthrosis (blood in joint)Hemarthrosis (blood in joint) EcchymosisEcchymosis Inability to bear weightInability to bear weight Positive TestsPositive Tests

Anterior drawerAnterior drawer Talar TiltTalar Tilt

ManagementManagement RICERICE Refer to MDRefer to MD

Eversion SprainEversion Sprain EtiologyEtiology

Indirect Indirect Direct force Direct force Eversion of ankleEversion of ankle Inversion of ankleInversion of ankle

Crush injuryCrush injury SymptomsSymptoms

Pain Pain Active motionActive motion Resistive motionResistive motion Loss of functionLoss of function Weight bearingWeight bearing

Collapse of archCollapse of arch

SignsSigns Tenderness Tenderness

Deltoid ligamentsDeltoid ligaments SwellingSwelling EcchymosisEcchymosis

Special TestsSpecial Tests Valgus stressValgus stress External rotation testExternal rotation test

ManagementManagement Arch and ankle tapingArch and ankle taping OrthoticsOrthotics

Ankle Ankle DislocationDislocation

Assess neurovascular statusAssess neurovascular status