1. THE ANKLE
The Ankle and Lower Leg

2. Introduction
“Have you ever sprained your ankle, or do you know anyone who has?”
What did you do for it?
How long did the pain last?
Do you have any problems with that ankle?

3. Anatomy of the Ankle What bone make up the Ankle joint? Tibia Fibula
Talus
Calcaneus

4. Anatomy of the Ankle What type of joint is the Ankle?
The Ankle joint is a HINGE JOINT
The TALOCRURAL Joint

5. Major Ligaments of the Ankle
LATERAL ASPECT
Anterior Tibiofibular
Anterior Talofibular- 3
Calcaneofibular- 6
Posterior Talofibular- 9

6. Major Ligaments of the Ankle
MEDIAL ASPECT
Posterior Talotibial
Posterior Talocalcaneal
Deltoid

7. Muscles and Tendons around the Ankle
Achilles Tendon
Peroneal Tendinitis
Anterior Tibialis Tendinitis
Posterior Tibialis Tendinitis

8. Common Ankle Injuries Inverted Ankle Sprain Everted Ankle Sprain
Ankle Dislocation
Muscle and Tendon Strains

9. Inverted Ankle Sprain
Inversion Ankle Sprain- the foot turns inward rolling over the lateral aspect of the ankle.
Most common ankle sprain- about 85% of all ankle sprains

10. Everted Ankle Sprain
Eversion Ankle Sprain- the turns inward. The ankle rolls in medially.
Uncommon sprain due to bone support.
Occurs in about 10-15% of ankle sprains.

11. Ankle Dislocation/Fracture
Medical Emergency
Usually the foot is inverted.
Frequently both the Tibia and Fibula are fractured.

12. Ankle Dislocation/Fracture - Medical Emergency

13. Muscle and Tendon Strains
Most common is the Achilles Tendon Strain.
THOMPSON Test the Achilles.
Peroneal tendon sometimes damaged with inversion ankle sprain.

14. Compression Test
Percussion Test
Homan’s Test
Thompson Test

15. Anterior Drawer Test
Talar Tilt Test

16. Functional Tests
While weight bearing the following should be performed
Walk on toes (plantar flexion)
Walk on heels (dorsiflexion)
Walk on lateral borders of feet (inversion)
Walk on medial borders of feet (eversion)
Hops on injured ankle
Passive, active and resistive movements should be manually applied to determine joint integrity and muscle function
If any of these are painful they should be avoided

17. Prevention of Injury to the Ankle
Stretching of the Achilles tendon
Strengthening of the surrounding muscles
Proprioceptive training: balance exercises and agility
Wearing proper footwear and or tape when appropriate

18. Grading Scales for Sprained Ankles
Most common ankle sprain.
Mild pain, still weight baring.
More painful, report popping sound.
Can not bear weight.
Stretching of lateral ligaments of the ankle.
Extreme pain. Usually complete tear of one of the ankle ligaments.
Sometimes fracture occurs also.
GRADE I
GRADE II
GRADE III

19. Grade 1 Inversion Ankle Sprain
Etiology
Occurs with inversion plantar flexion and adduction
Causes stretching of the anterior talofibular ligament
Signs and Symptoms
Mild pain and disability; weight bearing is minimally impaired; point tenderness over ligaments and no laxity
Management
RICE for 1-2 days; limited weight bearing initially and then aggressive rehab
Tape may provide some additional support
Return to activity in 7-10 days

20. Grade 2 Inversion Ankle Sprain
Etiology
Moderate inversion force causing great deal of disability with many days of lost time
Signs and Symptoms
Feel or hear pop or snap; moderate pain w/ difficulty bearing weight; tenderness and edema
Positive talar tilt and anterior drawer tests
Possible tearing of the anterior talofibular and calcaneofibular ligaments
Management
RICE for at least first 72 hours; X-ray exam to rule out fx; crutches 5-10 days, progressing to weight bearing

21. Management (continued)
Will require protective immobilization but begin ROM exercises early to aid in maintenance of motion and proprioception
Taping will provide support during early stages of walking and running
Long term disability will include chronic instability with injury recurrence potentially leading to joint degeneration
Must continue to engage in rehab to prevent against re-injury

22. Grade 3 Inversion Ankle Sprain
Etiology
Relatively uncommon but is extremely disabling
Caused by significant force (inversion) resulting in spontaneous subluxation and reduction
Causes damage to the anterior/posterior talofibular and calcaneofibular ligaments as well as the capsule
Signs and Symptoms
Severe pain, swelling, hemarthrosis, discoloration
Unable to bear weight
Positive talar tilt and anterior drawer

23. Management
RICE, X-ray (physician may apply dorsiflexion splint for 3-6 weeks)
Crutches are provided after cast removal
Isometrics in cast; ROM, PRE and balance exercise once out
Surgery may be warranted to stabilize ankle due to increased laxity and instability

24. Rehab/Treatment Plan for Sprained Ankles
RICE
Modalities
Exercises

25. RICE Rest- stay off the Ankle, crutches may be needed
Ice- 15 minutes a 4 to 5 times a day
Compression- ace wrap with horseshoe keeps the swelling down
Elevation- keep ankle above heart level when possible, allows gravity to pump out swelling

26. Goals of RICE Limit Swelling Reduce pain
Return to sport/activity quicker

27. Modalities Used COLD WHIRLPOOL- 15 minutes a couple times a day
Vasoconstrictors vessels around ankle
Stimulates pain killing receptors
Slows cell metabolism
Aids in reducing swelling

28. Modalities Used HIGH VOLTAGE-
Assists in activating pain killing receptors.
Assists in muscle stimulation around ankle joint to aid in edema removal.
ULTRASOUND-
Assists in edema removal.
Assists in bringing digestive enzymes to clean debris cells of the injured ankle.

29. Rehab Exercises Range of Motion ABC’s One leg Stands BAPS Board
Towel Curls
Toe Pickups
Toe Rises
Theraband

30. Taping Vs. Wrapping TAPING-
Psychologically better feeling to the athlete
Tight fitting at first
Tape looses a large percentage of its support within the first minutes of competition

31. Taping Vs. Wrapping WRAPPING-
Purpose in wrapping is injury prevention.
Wrapping will not eliminate sprained ankle, but it does minimize the severity of the sprain.

32. Ankle Braces ANKLE BRACES- Many varieties and types. Lace Up Hinged
Air Casts
All offer different levels of support.
Large and competitive business market for ankle braces.

33. Ankle Braces

34. Ankle Braces

35. Ankle Braces

36. Questions Over Ankle
Notes: