The Ankle

1. The Ankle The most commonly injured major joint in athletics

2. Anatomy of the ankle • The ankle joint is structurally very strong • Four bones form the ankle • Tibia • Fibula • Talus • Calcaneus • The bony knobs on either side of the ankle are called malleoli • They are the distal heads of the tibia (medially) and the fibula (laterally) • What type of joint is the ankle? • Hinge joint • The joint is more stable in which position? • dorsiflexion

3. Anatomy of the ankle • Ligaments most commonly injured • Anterior and posterior talofibular (lateral) • Deltoid (Medial) • Peroneus muscle group • On lateral side on leg and foot, attaches under foot • It causes the foot to evert • Prevents evertion sprains

5. Mechanism of ankle injuries • Most common injury is sprain • Most common mechanism of sprain is excessive inversion and plantar flexion • Ligament most often injured is the anterior talofibular • Less common sprain is the eversion sprain • On the medial side of the ankle is the tough, thick deltoid ligament, which helps prevent excessive eversion movement

6. Degree of ankle sprains • First degree • Ligaments and tissues are stretched • Minor discomfort, swelling, and pt • Second degree • Portion of one or more ligaments is torn • Pain, swelling, pt, and loss of function • Third degree • One or more ligaments is completely torn • Extreme pain, loss of function pt, rapid swelling • Accompanying fracture is possible

8. How to deal with sprains • Taping • Purpose is to keep joint moving from side to side • Strengthening exercises • Athletes need to do their part by strengthening their ankles • Exercises should be done before an injury occurs, do not wait till you get injured!

9. Evaluating an ankle injury • 1st: Look for signs of a fracture • Direct and/or indirect pain • Deformity • Grating sound at the injury site • History, observation, palpate • Palpate area away from injury site and work towards injury • Determine severity of injury • If fracture is suspected: • Stop eval, splint the ankle, transport to dr. • A common, but inappropriate practice: • Having the athlete walk on the injured ankle • This can cause more pain and damage

10. Treatment • Standard immediate tx: • ICE • Ice every hour for 20 minutes • Elastic wrap can be used for compression • Elevate ankle as much as possible, even while sleeping. Do this by propping ankle up on pillows • If athlete can’t walk without a limp, what should be used? • Crutches • Tape daily to prevent further injury

11. Ankle rehabilitation • ROM should be established • ROM exercises • Resistance exercises • When these exercises can be done without pain, do the following exercises with ankle taped • Healing is complete when there is absence of pain during stressful activities and when strength and full ROM returns

12. Prevention of ankle injuries • Once an ankle is sprained, the odds of re-injury go up drastically • Wrapping and taping • Average time missed due to ankle injuries was reduced from 6 days to 3 ½ days when unprotected ankles were wrapped with cloth wraps (ace bandage) • How can the athlete take an active part in preventing injuries? • Strength and flexibility exercises

13. More info… • Ankle Taping

14. Special Tests • Goniometer • Used to measure the angle of ROM • Use on injured and uninjured side • ROM tests • Inversion • Eversion • Plantar Flexion • Dorsal Felxion • 18-40

15. Special Tests • Talar Tilt Test • Special Tests