Foot and Ankle- Other Sprains and CAI Flashcards
What is the etiology of medial sprains?
excessive EV
What are the ligamentous structures involved with a medial ankle sprain?
- deltoid
> 3 that connect tibia with talus, calcaneus, and navicular
What do the deltoid ligaments do to the medial arch?
reinforces
What other ligaments can be involved with a medial ankle sprain?
- subtalar or talocalcaneal ligaments
> intraarticular: posterior interosseous
> Extraarticular: medial talocalcaneal
What bony structures are involved with a medial sprain?
- avulsion fx of medial malleolus
- fx of lateral malleolus due to compression with excessive EV
What can happen with the epiphyseal plate with a medial sprain?
- medial malleolus epiphyseal plate involved
What muscles and tendons can be involved with a medial sprain?
- possible tibialis posterior strain and/or subluxation if flexor retinaculum torn
What are some symptoms of a medial sprain?
- sudden onset with trauma with foot turning outward
- medial ankle pain/swelling
- limited and painful ROM, especially turning outward
- difficult and painful weight-bearing
What are some signs with observation of a medial sprain?
- swelling and possible ecchymosis
- antalgic and asymmetrical gait
What CDR determines the need for radiographs for medial sprains?
- Ottawa and Bernese Ankle CDR
What will we find in signs with ROM with medial sprains?
- primary limited and painful EV
What will we find in signs for resisted/MMT for medial sprains?
- possible weak and painful IV
What are some special tests for medial sprains?
- medial ligamentous tests
> talocrural
> subtalar
What are the talocrural special tests?
- generally, with anterior and reverse anterior drawer
- specific medial ligament tests for deltoid ligaments
What glide is used for subtalar medial sprains and what ligaments is it stressing?
- generally, with medial calcaneal glide
- specific with posterior interosseous and medial lig tests
Where will we have TTP with medial ankle sprains?
- TTP over involved structures
What is another term for syndesmotic sprains?
high ankle sprain
What is the etiology of a syndesmotic sprain?
- primarily DF (talus wider anteriorly than posteriorly), so excessive talar posterior glide with ER aka peeling mechanism, possibly EV
What is the peeling mechanism?
- the talus is shoved posteriorly and ER, which pushes the bones apart
What is the 1st ligament involved in syndesmotic sprains?
- Anterior Inferior Tibiofibular Ligament (AITFL)
What is the 2nd ligament involved in a syndesmotic sprain?
- Interosseous membrane or syndesmosis
What is the 3rd ligament involved in a syndesmotic sprain?
- Posterior Inferior Tibiofibular Ligament (PITFL)
What is the 4th ligament involved in a syndesmotic sprain?
- Deltoid Lig
What bones are a part of the syndesmotic sprains?
- talar or distal tibia/fibular fx
Is a syndesmotic sprain a sudden or gradual onset?
Sudden with trauma
What are some symptoms of a syndesmotic sprain?
- sudden onset with trauma, typically with ankle bent up
- Often anterior ankle pain/swelling
- Limited and painful ROM, especially bending ankle up
- Difficult and painful WB
What are some signs with observation of a syndesmotic sprain?
- swelling and possible ecchymosis
- Antalgic and asymmetrical gait
What are some signs with ROM for a syndesmotic sprain?
- primarily limited and painful DF and possibly EV
What are some resisted/MMT signs with a syndesmotic sprain?
- possibly weak and painful, no real specific direction
What are some special tests for syndesmotic sprains?
- ligamentous tests for inferior tibfib (reverse posterior drawer)
- Possibly same as medial sprain
- Single leg hop test if able
What are the ligamentous tests for the inferior tibfib?
- generally with reverse posterior drawer
- specific with fibular ant/post translation
Where will we have TTP with syndesmotic sprains?
- over involved structures
What is chronic ankle instability (CAI) defined as?
- presence of functional or mechanical instability
What are risk factors for CAI?
- incresed talar curvature
- lack of external support
- lack of coordination training following a prior sprain
What is the etiology of CAI?
- past severe and/or recurrent sprains
What is the re-injury rate following an InV sprain? (%)
80%!!!!
What are S&S of CAI?
- possible acute S&S if aggravated, otherwise may be asymptomatic
- decrease postural stability/proprioception and plantar sensation
- Altered muscle activation patters
- Aberrant joint motion
- Fibula is significantly more lateral from tibia, could use caliper to measure
How successful is PT for CAI and sprains?
90% successful
What can be useful for CAI as far as immobilization??
- possibly brief period of immobilization and/or assistive device
What modalities are useful for CAI and sprains?
- cryotherapy benefits with pain, swelling, needing less meds, and gait
- weak evidence for diathermy and LASER
- conflicting evidence for electrotherapy
- US should NOT be used for acute sprains
- Acupuncture: conflicting evidence
What can bracing do for sprains?
protect/help with function; reduce risk and frequency but NOT severity with basketball
What can standard tape do for sprains?
- mechanical support significantly decreased after 30 minutes of exercise
What taping technique can limit the anterior glide with sprain?
- talar technique
What indicates the distal tib-fib taping technique for sprains?
- indications: high ankle sprains
- limits separation and anterior distal fibular glide
What should we use STM for with sprains?
lymphatic draining for swelling
What are JM with MET for sprains useful for?
- ROM, proprioception and tissue tolerances
- AP talar mobes
- Hypo analgesic effect and subsequent increased ROM
What is the ultimate purpose of MET for ankle sprains?
- tissue proliferation (acute) and stabilization (acute and chronic)
What other MET can we do for sprains?
- balance and neuromuscular training
What can balance training do for sprains?
- prevents reoccurrences
- improved balance and inversion joint position sense and greater motor neuron excitability (reaction time)
What is the prognosis for return to activity for a GRADE I sprain?
- 1-2 weeks
- avg 7.2 days with track and field athletes
What is the prognosis for return to activity for a GRADE II sprain?
- 2-6 weeks
- avg 15 days with track and field athletes
What is the prognosis for return to activity for a GRADE III sprain?
- > 6 weeks
- avg 30-55 days with track and field atheletes
What should we know about surgery for CAI?
- NO procedure is better than another
- Early functional rehab appears superior to 6 weeks immobilization in restoring early function
