Ankle Injuries

Question 1

how does the prevalence of ankle injuries compare to the prevalence of injuries to other joints

Answer 1

the second highest prevalence behind knee injuries

Question 2

what type of ankle injury is most common

Answer 2

inversion injury

Question 3

what was the incidence of ankle sprain injury in a study held in the west midlands

Answer 3

60.9 per 10,000

Question 4

what two movements combine to produce supination of the foot

Answer 4

plantarflexion and inversion

Question 5

what two movements combine to produce pronation of the foot

Answer 5

dorsiflexion and eversion

Question 6

what is the secondary action of both tibialis posterior and anterior

Answer 6

inversion

Question 7

name the ligament found on the anterior aspect of the ankle which is commonly damaged in a ‘high ankle sprain’

Answer 7

syndesmotic ligament

Also damages interossious membrane

Question 8

name the ligament found on the medial aspect of the ankle

Answer 8

deltoid ligament

Question 9

name the three ligaments found on the lateral aspect of the ankle and which is these is most commonly ruptured during an ankle sprain

Answer 9

anterior talofibular ligament
posterior talofibular ligament
calcaeofibular ligament

most commonly damaged is ATFL

Question 10

according to the Ottowa ankle rules, when should a patient who has twisted their ankle be sent for an ankle X-Ray?

Answer 10

tip of posterior lateral malleolus
tip of posterior medial malleolus
inability to weight bear

Question 11

according to the ottowa ankle rules when should a patient be sent for a foot X-ray

Answer 11

pain over the navicular
pain over the base of the 5th metatarsal
inability to weight bear

Question 12

give signs and symptoms of an inversion ligamentous sprain

Answer 12

snap or pop sound
pain and swelling around lateral malleolus
pain or inability to walk

Question 13

outline the anatomical grading system for lateral ankle sprain

Answer 13

1 =  ATFL 
2 = PTFL + ATFL 
3 = CFL + PTFL + ATFL

Question 14

what ligament does the anterior draw test detect damage in, how is it performed and what will be seen if there is damage

Answer 14

ATFL

hold foot slightly plantarflexed and stabalise tibia with other hand

pull the foot forwards

anterior translation = damage

Question 15

what ligament does the talar tilt test detect damage in, how is it performed and what will be seen if there is damage

Answer 15

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

Question 16

what is the common mechanism for suffering a high ankle sprain

Answer 16

excessive inversion and dorsiflexion

Question 17

describe three test, in which pain being caused indicates high ankle sprain

Answer 17

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

Question 18

what is the treatment of a high ankle sprain or a sprain with a minor fracture and what is the aim of this treatment

Answer 18

walker boot and crutches to avoid weight bearing

avoids re-stretching of syndesmotic ligament and interossious membrane

Question 19

what is the long term management for grade 1 and 2 ankle ligament tears

what is the goal of this treatment

Answer 19

conservative functional exercises

improve flexability strength balance proprioception range of motion and stability

Question 20

what is the aim of operative management of a grade 3 ligament tear and what is the reasoning for this

Answer 20

operative treatment is an option to prevent recurrent instability and pain on activity

Question 21

why is there a growing consensus that conservative management is better for grade 3 ankle ligament injuries

Answer 21

no surgical complication

doesn’t cause symptoms of late surgical repair

Question 22

why is immobalisation never used in the treatment of lateral ligament injury

Answer 22

causes joint stiffness, muscle atrophy and loss of proprioception

Question 23

what are the signs and symptoms of achilles tendon rupture

Answer 23

sudden pain 
popping sound 
swollen and bruised heal
unable to walk 
palpable defect in the tendon  
buldge of calf muscle close to knee joint

Question 24

describe the Thompson test for achilles tendon rupture and what would be seen if the injury was present

Answer 24

patient lies face down on the bed with feet hanging off the end
squeeze the calf
foot will not move (should usually plantarflex)

Question 25

how does the management of achilles tendon rupture differ, depending on the location of the rupture

Answer 25

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

Question 26

outline the early rehab after surgery on the achilles tendon

Answer 26

wear a boot for 12 weeks

boot starts off in slight plantarflexion and gradually adjusted back to the normal position

Question 27

give some intrinsic risk factors for ankle inversion injury

Answer 27

previous injury
overweight
laterally shifted center of plantar pressure
inferior single leg balance

Question 28

give some extrinsic risk factors for ankle inversion injury

Answer 28

use of shoes with air cells
no stretching as part of warm up
artificial turf
increased exercise intensity

Question 29

explain how incorrect landing position leads to ankle inversion injury

Answer 29

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

Question 30

when does the peak VGRF occur during an ankle sprain

Answer 30

40 milliseconds

Question 31

when is an ankle supination sprain injury likely to occur

Answer 31

when the ankle is not fully loaded

Question 32

what are the two common mechanisms for ankle supination sprain injury

Answer 32

impact on the medial side of the leg during a tackle

forced plantarflexion when the player kicks the tackler’s foot

Question 33

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

Answer 33

4 = pain is the major problem

5 = instability is the major problem