The Ankle Flashcards
what ligaments make up the lateral ankle ligaments/lateral collateral ligaments (3)
Posterior talofibular ligament (PTFL)
calcaneofibular ligament (CF)
anterior talofibular ligament (ATFL)
what are the ligaments of the medial ankle
deltoid ligaments (4)
what 2 places can you take a pulse on the ankle/foot?
- dorsal pedis
- posterior tibial
what is the ‘true ankle joint’
talocrural joint
what does the talocrural joint
1. allow movement for
2. limit movement for
3. which ligaments is it supported by (medial & lateral side)
- dorsiflexion & plantar flexion
- inversion & eversion
- medial- deltoid, lateral- all 3 lateral collateral ligaments
what 3 bones form the talocrural joint and what else is it called?
talus, fibula & tibia
also called the mortis
what movement/displacement is prevented by the malleoli
medial & lateral displacement
what movement(s) is the ankle most and least stable in?
most- dorsiflexion
least-plantar flexion (most suseptible position for ankle sprain)
why are inversion ankle sprains more common than eversion?
because the lateral malleoli sits lower on the ankle than the medial malleoli. So this allows the foot to turn in easier than to turn out
what are normal active ROM for ankles & what does normal gait require?
dorsiflexion 20 degrees
plantarflexion 30-50 degrees
normal gait- 10 degrees dorsiflexion & 20 degrees plantarflexion
define stance phase
time spent in weight bearing or in contact with the ground
define step
sequence of events from a specific point in the gait on one extremity to the same point in the opposite extremity
define step length
distance traveled between the initial contacts of the right and left foot
define stride
2 sequential steps
define stride time
time required to complete a singlr stride
causes of over use injuries to the lower limb (10)
-prolonged training season
-impact force of activity
-training or competing on hard surfaces
-change of training surfaces
-downhill running
-muscle weakness
-high milage or sudden change in milage
-overtraining
-wrong type of footwear
-uneven surfaces
soft tissue function: anterior tibiofibular ligament
helps prevent splaying of the tibia and fibula
soft tissue function: posterior tibiofibular ligament
helps prevent splaying of tibia & fibula
soft tissue function: deltoid ligament
resits eversion
soft tissue function:anterior talofibular ligament
resist inversion
soft tissue function: calcaneofibular ligament
resist inversion
soft tissue function: posterior talofibular ligament
resist inversion
what are the 3 main functional demands of the ankle
-absorption
-propulsion
-stability
functional tests of the ankle (6)
-walk on toes
-walk on heels
-walk on lateral boarder of feet
-walk on medial boarders of the feet
-hop on injured ankle
-passive, active & resistive movements manually applied to the ankle
inversion ankle strain
1. caused by what type of ankle movement (etiology) 2. MOI
- caused by excessive inversion & plantar flexion
- MOI: from transfer of weight, running, jumping, landing
what (and list) the ottawa ankle rules
-Used to determine need for radiograph (x-rays)
1. if there is pain in malleolar or midfoot area
2. inability to bear weight for 4 steps at the time of examination
3. tenderness over inferior or posterior pole of either malleoli
4. tenderness along base of 5th metatarsal or navicular
what does the Buffalo modification focus on?
tenderness along fibula
how can a fibula fracture happen in an inversion ankle sprain?
talus overcompensates and jams into the fibula and breaks the distal end of the fibula
etiology & S/S of grade 1 inversion ligament sprain
etiology: occurs with mild inversion & plantar flexion
-stretches the anterior talofibular ligament (ATFL)
-minimal/slight tearing of the fibers
S/S: pain/swelling on the anterolateral aspect of the malleolus
-point tenderness over AFTL
-no laxity with stress testing
etiology & S/S of grade 2 inversion ligament sprain
etiology: moderate inversion force (with or without plantar flexion)
-moderate tearing of fibers
S/S: tearing or popping sensation felt on the lateral aspect
-pain/swelling on anyterolateral and inferior aspect of lateral malleolus
-Ecchymosis
-painful palpation of ATFL + CFL
- tender over deltoid and PTFL
-positive anterior drawer test
-antaglic (painful) gait
-functional instability
why is there tenderness in the deltiods on a grade 2 ligament inversion sprain
the deltoid ligaments get compressed and pinched by the medial malleolus
etiology & S/S of grade 3 inversion ligament sprain
etiology: complete rupture of one or more lateral ligaments
-caused by significant force of inversion + plantar felxion
- can cause damage to the capsule
S/S:
-severe pain, swelling, hemarthrosis, discoloration
-unable to bear weight
-positive tatlar tilt and anterior drawer test
-functional & clinical instability
define hemarthrosis
bleeding into a joint
eversion (medial) ankle sprain etiology
- injury to medial deltoid ligaments
- resulting from forceful eversion movement
- from excessive plantar flexion, sometime dorsiflexion
-takes longer to heal and can involve fibular fracture
S/S of eversion ligament sprain
-severe pain
-unable to bear weight
-point tenderness over deltiod ligament
-tenderness over anterior tibiofibular ligament
-pain to mortis if there is a fracture
why is eversion ligament sprains less common than inversion ligament sprains?
fibula sits lower & makes it harder to evert your foot
general rules for ankle sprain management
- immediate treatment:
- protection
-modified loading
-pain
-edema control
-restoration of ROM as soon as possible - when using ice:
- ice packs should not be applied directly on the skin
-ice can be applied directly on the skin. Secured with tensor bandage - apply horseshoe for additional compression
- crutches if limping
- incorporate rehab as soon as weight bearing is possible
- rule out fractures (ottawa ankle rules)
order of operations (NICE/RICE/PIER)
can do any just include:
rest
ice
compress
elevate
pressure
NSAIDS (if wanted)
