Common Ankle Disorders Flashcards
What joint region is most frequently injured?
ankle joint region in athletics
Where do most sprains occur in the ankle region?
Usually @ lateral ligamentous complex
= 85% of all ligament sprains
What ligament is usually the culprit of lateral ankle sprains?
Anterior-talofibular ligament (ATFL)
- the least elastic of the lateral ligaments
- Involved in the 60-70% of all ankle sprains
What are the other ligaments involved in a lateral ankle sprain?
20% usually involve the ATFL and calcaneofibular ligament (CFL)
What is the sequence of tears regarding a lateral ankle sprain?
- ATFL
- Anterolateral capsule
- Distal tibfib ligament
- CFL
- Posterior talo-fibular ligament (PTFL)
The PTFL is the strongest of the lateral ligaments
What are the different criterions of a grade 1 ankle sprain?
Location of tenderness, edema, WB ability, ligament damage, instability
- ATFL is tender
- slight and local edema
- full or partial WB
- stretched ligament
- no instability
What are the different criterions of a grade 2 ankle sprain?
Location of tenderness, edema, WB ability, ligament damage, instability
- ATFL and CFL tenderness
- Moderate and local edema
- Difficult gait w/o crutches
- Partial tear
- none or slight instability
What are the different criterions of a grade 3 ankle sprain?
Location of tenderness, edema, WB ability, ligament damage, instability
- ATFL, CFL, PTFL tender
- Clearly swollen and diffuse
- Impossible gait w/o significant pain
- Complete tear
- Clear instability
What is the pathology of a high ankle sprain?
When the tough, fibrous ligaments just above the ankle is stretched and torn
Referred to as the syndesmosis
What are the structures that are involved in a high ankle sprain?
- interosseous ligament and the anterior inferior tibiofibular ligament (AITFL)
- posterior inferior tibiofibular ligament (PITFL)
- Transverse ligament
the transverse ligament runs across the front of the ankle
What is the mechanism of injury for high ankle sprains?
extreme external rotation or dorsiflexion of the talus
in more significant high ankle sprains: excessive twisting force -> widening of the space between tib and fib = possibly affecting the deltoid ligaments on the inside ankle
How does a wider dome of the talus in the anterior aspect affect the mechanism of injury for high ankle sprains?
Injury occurs with extreme ER or DF of talus:
= the movement force part the medial and lateral aspect of the mortise (the tibial and fibular malleoli)
What population/sport does high ankle sprain occur and accompanied with?
High contact sports like football, soccer or hockey
- frequently accompanied by a fracture of the fibula
How is the recovery for a Syndesmotic ankle sprain
Syndesmotic (high ankle sprain)
2x as long than a typical ankle sprain
Although less common, what is the mechanism of injury for a medial ankle sprain?
Excessive eversion and DF
DF opens the joint making it easier to roll
What is the result of a medial ankle sprain?
Injury to the deltoid ligament
- if a lateral sprain is bad enough = possible bone bruise @ medial aspect of the ankle
The recovery for a bone bruise is around 6 months
Where is the subjective pain located to warrant the Ottawa Rules?
Any pain in the malleolar zone and any of the:
1. bone tenderness at the posterior edge of the lateral malleolus
2. bone tenderness at the posterior edge of the medial malleolus
3. Inability to bear any weight right away and in the casualy/ER department
When is a foot x-ray required?
When there is any pain in the midfoot zone or any of:
- bone tenderness at the navicular
- bone tenderness at the base of the 5th MT
- inability to bear weight
What is the treatment for acute stage of ankle sprain?
- decrease the swelling
- encourage early protected motion (ankle pumps in pain free range)
- early supported/protected WBAT
- help with protected return to activity
- prevention of reinjury
Trying cryotherapy, compression and elevation
What is the treatment for subacute stage of ankle sprain?
around 4-14 days
- start dynamic balance
- proprioceptive exercises
- open chain resistive exercises w/ elastic tubing
- stationary bike
What is the treatment for advanced healing stage of ankle sprain?
around 2-4 weeks post-injury
- goal: get normal AROM
- normalize gait without assistance
- pain free w/ FWB functional activities
- enhance and increase proprioception
Clinical note: full ligament strength is NOT regained for a couple of months or longer
What are the interventions of phase 1?
- pain and edema control (R.I.C.E or peace and love / toe curls and ankle pumps)
- temporary immobilization/stabilization (short leg cast, splint, brace)
- NWB with crutches
What are the interventions of phase 2?
Usually with pain and swelling subside
PWB w/ assistance
- patient can walk PWB without pain
- Lower level balance training
- Lower level strengthening w/ theraband
What are the intervention of phase 3?
Amb w/ FWB without pain
- possibly still needing protecting from brace
- unilateral balance training
- progress to single heel raises
- treadmill walking or over ground walking
- progress to fast walking
What are the intervention of phase 4?
Should be able to perform heel raises in unilateral stance
- fast pain free walking
- jog to run progression
- shuttle runs and cutting
- sport-specific training
What is chronic ankle instability (CAI)?
Repeated acute inversion injuries/laxity
- frequent ankle sprains
- pt reports of ankle “giving away”
- also chronic ankle weakness, pain, and/or instability
What is the conservative treatment for CAI?
Physical therapy and splints
- evidence show that there is benefits of balance and strength training through proper PT progression
What is the surgical treatment for CAI?
Primary repair/ reconstructive procedures
What is CAI characterized by in a patient?
- more than 12 months from the first LAS
- tendencies of recurrent ankle sprains
- frequent episodes or perceptions of the ankle giving away
- constant sx: pain, swelling, limited ROM, weakness and decreased function
How are recurrent ankle sprains confirmed by via tests?
- ankle instability instrument (all): yes to at least 5 yes/no questions
- Cumberland ankle instability tool (CAIT): < 24
- identification of functional ankle instability (IdFAI): > 11
What are the needed results for diagnosing CAI through self-reported impairment levels of disability?
- foot and ankle ability measure (FAAM): ADL scale < 90% / sport scale < 80%
- Foot and ankle outcome measure: < 75% in 3 or more categories
What is the pathology associate with osteochondrotitis dissecans of the talus?
The anterolateral and posteromedial locations on the talus is susceptible to injury
= when the talocrural joint goes through a torsional stress because of either: impact or cyclical loading
What is the mechanism of injury regarding osteochondrotitis dissecans of the talus?
a twisting injury to the ankle = which have fractures of the joint surface
What does the patient present and the diagnosis with osteochondrotitis dissecans of the talus?
Presents: with constant pain and swelling with stiffness
Diagnosis: clinical tenderness, diffuse swelling
What is the treatment with osteochondrotitis dissecans of the talus
Has undisplaced and displaced lesions
Undisplaced lesions = rest and cast immobilization
Displaced lesions = arthroscopic removal/drilling
