1. THE ANKLE
Chapter 15

2. 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

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

4. ANKLE JOINTS
Subtalar joint
Between the Talus and the Calcaneus

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

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

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

10. 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)

11. ANKLE MOTIONS
Dorsiflexion
Plantarflexion
Inversion
Eversion

12. Injuries

13. 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

14. 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

15. 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

16. 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

17. 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

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

19. 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

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

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

22. 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