Common injuries of the ankle

Question 1

Ankle function

Answer 1

• Mobile adaptor
• Spring-like lever
• Reliant on complex system of bones, joints and muscles
• Balance and dynamic function
• Local system must be intact
• Well-tuned, efficient and strong neuromuscular system

Question 2

Foot and ankle structure

Answer 2

• Talocrural joint: Talus/inferior tibia
• Inferior tibiofibular joint: Distal tibia/distal fibula
• Subtalar joint: Talus/calcaneus
• Proximal tarsals: Navicular/cuboid
• Distal tarsals: Medial/intermediate/lateral cuniforms
• Metatarsals and phalanges
• Loose packed position: Plantarflexion
• Joint congruency essential for stability
• Closed packed position: Dorsiflexion

Question 3

Efficient gait relies on the 3-rocker system

Answer 3

• Talocrural mortice
• Calcaneus
• 1st metatarsal head

Question 4

Differences between walking and running

Answer 4

• Progressive reduction in foot contact time
• Progressive increase in vertical/horizontal GRFs
• Change in foot contact
• Heel to mid-foot
• Front of body to below body

Question 5

Biomechanics of running

Answer 5

• Minimising foot contact is important in both access and max velocity
• MT unit initially works isometrically to generate a ‘stiff F&A complex and brace the limb for impact’
• Tendon then harnesses elastic energy via elongation

Question 6

Multidirectional issues

Answer 6

• Rocker and spring models work with saggital plane models
• F&A strength must be sufficient to adapt rapidly to external forces and alterations in surface
• Increases in foot muscle activation

Question 7

Lateral ankle sprain

Answer 7

• Mechanism (PF and inversion)
• ATFL weakest of the ligaments
• Grade 3

Question 8

Medial ankle sprain

Answer 8

• Mechanism (Eversion)
• Strongest ligament in body
• Less common than lateral
• Associated with boney issues due to the amount of force required to strain
• Return twice as long as lateral

Question 9

High ankle sprain

Answer 9

• Mechanism (dorsiflexion/eversion/excessive plantar flexion/inversion)
• Grade 1 - conservative (boot)
• Grade 2 conservative/surgical
• Grade 3 surgical

Question 10

Calf strain (tendon/muscle)

Answer 10

• Protection
• Ankle&calf mobility
• Leg muscle activation
• Balance
• Use of kinetic chain
• Use of concentric jumps

Question 11

Rehab considerations (measures)

Answer 11

• Early mobilisation is key
• Gait re-education
• Balance
• Dynamic crossover neural
• Unaffected limb

Question 12

Rehab considerations (intermediate)

Answer 12

ROM:
- Painfree 90% of baseline
- Symmetry in static balance
- No reaction to low load functional training

Question 13

Rehab considerations (late)

Answer 13

• Force absorption and reactivity
• Progressive landing drills
• Short shuttles to develop deceleration
• Multi function -plyometric drills