Disorders of the ankle

Question 1

Ankle is supported by

Answer 1

medial (deltoid) and lateral ligament (can injure isolated parts).

• Ligament holds the tibiofibular joint together- otherwise fibular and tibia would be pulled apart

Question 2

If you have only broken one bone/ ruptured one ligament

Answer 2

stable fracture

Question 3

If you break two parts of the bone/ ruptured two ligaments

Answer 3

unstable fracture

Question 4

What is talar shift?

Answer 4

• Gap on medial side created by fracture of fibula
• Usually an equal gap all the way round the ankle joint
• Medial ligaments resist talar shift

Question 5

Normally the talus bone sits

Answer 5

firmly in a mortise made up of both the medial (tibia) and lateral (fibula) malleoli.

Question 6

Eversion/external rotation of the ankle injury

Answer 6

– this is where the lateral malleolus is fractured (due to the compression forces during forceful eversion of the ankle), which then pulls on the medial/deltoid ligament of the ankle, which can then cause medial/deltoid ligament rupture and/or a bimalleolar fracture.

Question 7

Inversion/internal rotation of the ankle injury

Answer 7

– this is where the medial malleolus is fractured, which then pulls on the lateral side of the ankle, causing the lateral ligament rupture and/or a bimalleolar fracture.

Question 8

Bimalleolar (medial and lateral malleoli) and trimalleolar (medial and lateral malleoli and posterior aspect of the tibia) fractures are also known as

Answer 8

Pott’s fractures.

Question 9

Pott’s fractures

Answer 9

Pott’s fractures are far more common than fracturing a single malleolus because of the ligaments that secure the mortise of the ankle joint. A force applied in one direction often cause ligamentous damage on the other side of the ankle due to talar shift, which can cause a fracture at the attachments of the ligaments.

Question 10

diagnosis of an ankle fracture

Answer 10

Ankle fractures are diagnosed using x-rays.

Question 11

Treatment of an stable ankle fracture

Answer 11

require a cast/boot (mainly for comfort) and have a very low rate of complications or arthritis.

Question 12

treatment of unstable ankle fracture

Answer 13

An ankle sprain is a partial or complete tear of one or more of the ankle ligaments.

*similar mechanism of to ankle fractures but ligaments fail first

Question 14

Ankle sprain mode of injury is usually

Answer 14

excessive external rotation, eversion or inversion of the ankle.

Question 15

most common ankle sprain

Answer 15

the most common of these is an inversion injury of a plantar-flexed and weight bearing ankle (e.g. rolling the ankle in when running), which leads to an anterior talofibular ligament sprain.

Question 16

In a severe sprain

Answer 16

it is possible to get a secondary complication of a 5th metatarsal avulsion (injury to the bone in a location where a tendon or ligament attaches to the bone) fracture, caused by the pull of fibularis brevis or tertius.

Question 17

prognosis of ankle sprain

Answer 17

The vast majority (90%) of ankle sprains heal with rest over time and those that don’t are diagnosed as unstable ankle fractures and are treated accordingly.

Question 18

Achilles Tendinitis

Answer 18

This is the inflammation of the Achilles tendon (the combined tendon of the soleus and gastrocnemius muscles that inserts into calcaneus).

Question 19

Common causes of Achilles tendinitis include:

Answer 19

Over-training or unaccustomed use – “too much too soon”.

A sudden change in training surface – e.g. grass to bitumen.

Flat (overpronated) feet.

Question 20

Achilles tendinitis can be divided into 2 types:

Answer 20

1. Non-insertional tendinitis (involves fibres of the middle portion of the tendon) – which occurs most commonly in young active people
2. Insertional tendinitis (involves fibres at the point of insertion to calcaneus) – which can occur at any age

Question 21

presentation of achilles tendinitis

Answer 21

Patients presents with pain and stiffness of the back of the ankle that worsens with activity, and thickening of the tendon.

Question 22

Treatment of achilles tendinitis i

Answer 22

s easily remembered by the mnemonic RICE:

Rest

Ice

Compression

Elevation

Question 23

Achilles Tendon Rupture

Answer 23

The act of tearing the Achilles tendon.

Question 24

achilles tendon rupture is most common in

Answer 24

This is most common in middle aged people (especially those with pre-existing tendinitis) and often occurs during recreational sport – this group of people can often be referred to as ‘weekend warriors’. However, it is important to remember that it can occur at any age.

Question 25

what is more common with an achilles rupture

Answer 25

A complete tear is more common than a partial tear

Question 26

presentation of achilles tendon rupture

Answer 26

and patients often experience sudden pain and a popping/snapping sensation. They present with pain, swelling and a palpable gap in the tendon.

Question 27

who ruptures their achilles tendon

Answer 27

30-50 yr old weekend warriers

Question 28

Diagnosis of achilles tendon is done using the

Answer 28

Simmonds-Thompson test – the patient is asked to lie face down on the bed with their feet hanging off the edge, then their calf is squeezed towards the knee. If their Achilles tendon is intact there will be movement of the foot at the ankle; this will not occur at all if the tendon is completely torn and will be weak if the tendon is partially torn. Ultrasound/MRI scans can be used to view the tendon also.

Question 29

Treatment of achilles tendon tear

Answer 29

is usually non-surgical and a cast/walking boot (used to keep the ankle flexed for the first few weeks) and rest is advised. If surgical intervention is required, the procedure generally involves making an incision in the back of the lower leg and stitching the torn tendon together. Physical therapy follows either treatment, and it can take many months to heal.