THE ANKLE Chapter 15

ANKLE ANATOMY BONES Two bones in the lower leg Two tarsal bone Tibia – medial, larger, weight bearing Medial Malleolus Fibula Lateral Malleolus Two tarsal bone Talus Calcaneus

ANKLE ANATOMY TRUE ANKLE JOINT Tibia, fibula and talus Mortise Definition: where the talus fits into the tibia and the fibula

ANKLE JOINTS Subtalar joint Between the Talus and the Calcaneus

LIGAMENTS – p. 317 LATERAL SIDE– 3 ligaments named for bones Anterior talofibular (ATF) Calcaneofibular (CF) Posterior talofibular (PTF)

LIGAMENTS – p. 317 MEDIAL SIDE Deltoid Strong ligament 4 parts that form one ligament

LIGAMENTS TIBIOFIBULAR LIGAMENTS – holds tibia and fibula together Anterior tibiofibular Posterior tibiofibular

MUSCLES The muscles that move the ankle are found in the lower leg – not around the ankle joint (we will talk more about this in the lower leg injury section)

ANKLE MOTIONS Dorsiflexion Plantarflexion Inversion Eversion

Injuries

TYPES OF ANKLE SPRAINS Inversion Most common type of ankle sprain Accounts for 80% of all sprains AKA ‘a lateral ankle sprain’ First degree sprain Only involves the anterior talofibular ligament Mild pain, tenderness, and swelling No instability

TYPES OF ANKLE SPRAINS Inversion Second degree sprain Anterior talofibular ligament is torn and calcaneofibular ligament is injured as well Most painful Moderate swelling Mild Instability

MECHANISMS OF ANKLE SPRAINS Inversion Third degree sprain Complete tear of all three lateral ligaments Uncommon Lots of pain, but it can subside Very unstable Usually requires surgery

TESTING ATF STABILITY Drawer Test Stablize lower leg with one hand Pull heel forward (like opening a drawer) Should not move forward if ligament is intact

TYPES OF ANKLE SPRAINS Eversion Not as common Can occur more on tartan surfaces and artificial turf Everything is worse (pain, swelling, etc) when compared to an inversion injury If the deltoid tears, the tibiofibular ligaments may tear also

High Ankle Sprain Involves Anterior Inferior Tibiofibular (AITFL) Ligament Injury allows tibia and fibula to separate

High Ankle Sprain Cause: Inversion with rotation; rotation of foot S/S: pain with external rotation of foot; tender over AITFL Treatment: RICE, may need to be immobilized; possible surgery if severe enough

Treatment of Ankle Sprains Prevention – once you sprain an ankle it is easy to do again – tape and rehab Rest – No activity for 24-48 hours Ice – 20 minutes on, 40 minutes off Compression – ace wrap with horseshoe Elevation – ankle above the heart Support – crutches and aircast if needed

Ankle Rehab ABCs Circles Theraband exercises Single Leg Balance Balance Board Calf Raises And so much more….

Distal Tibia/Fibula Fractures Always need to suspect a fracture when evaluating a potential sprained ankle Cause: Too much motion S/S: immediate swelling, point tender over the bone, does not want to weight bear Treatment: splint, ice, x-ray Cast 6-8 weeks