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The Ankle. The most commonly injured major joint in athletics. 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
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The Ankle The most commonly injured major joint in athletics
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
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
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
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
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!
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
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
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
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
More info… • Ankle Taping
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
Special Tests • Talar Tilt Test • Special Tests