Ankle Injuries Flashcards
how does the prevalence of ankle injuries compare to the prevalence of injuries to other joints
the second highest prevalence behind knee injuries
what type of ankle injury is most common
inversion injury
what was the incidence of ankle sprain injury in a study held in the west midlands
60.9 per 10,000
what two movements combine to produce supination of the foot
plantarflexion and inversion
what two movements combine to produce pronation of the foot
dorsiflexion and eversion
what is the secondary action of both tibialis posterior and anterior
inversion
name the ligament found on the anterior aspect of the ankle which is commonly damaged in a ‘high ankle sprain’
syndesmotic ligament
Also damages interossious membrane
name the ligament found on the medial aspect of the ankle
deltoid ligament
name the three ligaments found on the lateral aspect of the ankle and which is these is most commonly ruptured during an ankle sprain
anterior talofibular ligament
posterior talofibular ligament
calcaeofibular ligament
most commonly damaged is ATFL
according to the Ottowa ankle rules, when should a patient who has twisted their ankle be sent for an ankle X-Ray?
tip of posterior lateral malleolus
tip of posterior medial malleolus
inability to weight bear
according to the ottowa ankle rules when should a patient be sent for a foot X-ray
pain over the navicular
pain over the base of the 5th metatarsal
inability to weight bear
give signs and symptoms of an inversion ligamentous sprain
snap or pop sound
pain and swelling around lateral malleolus
pain or inability to walk
outline the anatomical grading system for lateral ankle sprain
1 = ATFL 2 = PTFL + ATFL 3 = CFL + PTFL + ATFL
what ligament does the anterior draw test detect damage in, how is it performed and what will be seen if there is damage
ATFL
hold foot slightly plantarflexed and stabalise tibia with other hand
pull the foot forwards
anterior translation = damage
what ligament does the talar tilt test detect damage in, how is it performed and what will be seen if there is damage
CFL
hold foot in a neutral position, attempt to invert the hindfoot
will be separation of the articular surfaces if the ligament has been damaged
what is the common mechanism for suffering a high ankle sprain
excessive inversion and dorsiflexion
describe three test, in which pain being caused indicates high ankle sprain
1) flex knee to 90 and the rotate ankle outwards
2) compress the tibia and fibular at the mid-calf region
3) allow patient to sit on a chair and cross affected leg over their knee, then apply pressure to the medial knee of the affected leg
what is the treatment of a high ankle sprain or a sprain with a minor fracture and what is the aim of this treatment
walker boot and crutches to avoid weight bearing
avoids re-stretching of syndesmotic ligament and interossious membrane
what is the long term management for grade 1 and 2 ankle ligament tears
what is the goal of this treatment
conservative functional exercises
improve flexability strength balance proprioception range of motion and stability
what is the aim of operative management of a grade 3 ligament tear and what is the reasoning for this
operative treatment is an option to prevent recurrent instability and pain on activity
why is there a growing consensus that conservative management is better for grade 3 ankle ligament injuries
no surgical complication
doesn’t cause symptoms of late surgical repair
why is immobalisation never used in the treatment of lateral ligament injury
causes joint stiffness, muscle atrophy and loss of proprioception
what are the signs and symptoms of achilles tendon rupture
sudden pain popping sound swollen and bruised heal unable to walk palpable defect in the tendon buldge of calf muscle close to knee joint
describe the Thompson test for achilles tendon rupture and what would be seen if the injury was present
patient lies face down on the bed with feet hanging off the end
squeeze the calf
foot will not move (should usually plantarflex)
how does the management of achilles tendon rupture differ, depending on the location of the rupture
if in the middle the two ends can be sewn back together
if at the insertion, a tunnel is drilled into the calcaneus and the tendon fixed in it
outline the early rehab after surgery on the achilles tendon
wear a boot for 12 weeks
boot starts off in slight plantarflexion and gradually adjusted back to the normal position
give some intrinsic risk factors for ankle inversion injury
previous injury
overweight
laterally shifted center of plantar pressure
inferior single leg balance
give some extrinsic risk factors for ankle inversion injury
use of shoes with air cells
no stretching as part of warm up
artificial turf
increased exercise intensity
explain how incorrect landing position leads to ankle inversion injury
ground reaction force is laterally poistioned, pointing to the medial side
this creates a twisting force because it doesn’t go through the joint centre
ligament is stretched very quickly and therefore is damaged
when does the peak VGRF occur during an ankle sprain
40 milliseconds
when is an ankle supination sprain injury likely to occur
when the ankle is not fully loaded
what are the two common mechanisms for ankle supination sprain injury
impact on the medial side of the leg during a tackle
forced plantarflexion when the player kicks the tackler’s foot
what is the difference in terms of long term consequence between someone who has sprained their ankle 4 times and someone who has done it 5 times
4 = pain is the major problem
5 = instability is the major problem
