Ankle Injuries:Sprains and More
Ankle Injuries:Sprains and More
John F. Meyers M.D.John F. Meyers M.D.
Bony AnatomyBony Anatomy
• Tibia
• Fibula
• Talus
• Tibia
• Fibula
• Talus
Mortice and Tenon JointMortice and Tenon Joint
Lateral LigamentsLateral Ligaments
• Anterior talofibular• Calcaneofibular• Posterior talofibular
• Anterior talofibular• Calcaneofibular• Posterior talofibular
Medial ligamentsMedial ligaments
• Deltoid• Deltoid
Mechanism of InjuryDefinitions
Mechanism of InjuryDefinitions
• Plantar flexion: toes down• Dorsiflexion: Toes up• Inversion: Heel in• Adduction: Heel in• Eversion: Heel out• Abduction: Heel out
• Plantar flexion: toes down• Dorsiflexion: Toes up• Inversion: Heel in• Adduction: Heel in• Eversion: Heel out• Abduction: Heel out
Inversion InjuryInversion Injury
Eversion InjuryEversion Injury
External Rotation InjuryExternal Rotation Injury
Ankle Sprain OccurrenceAnkle Sprain Occurrence
• 27,000 ankle ligament injuries per day in United States
• Ankle sprains are more than 25% of injuries in football, basketball, soccer and volleyball
• 27,000 ankle ligament injuries per day in United States
• Ankle sprains are more than 25% of injuries in football, basketball, soccer and volleyball
Making The DiagnosisHistory
Making The DiagnosisHistory
• Mechanism of injury– Plantar flexion and inversion– Uneven terrain-stepping in a hole– Landing on another player’s foot– Teammate on back of ankle while foot is externally
rotated
• Mechanism of injury– Plantar flexion and inversion– Uneven terrain-stepping in a hole– Landing on another player’s foot– Teammate on back of ankle while foot is externally
rotated
Making The DiagnosisHistory
Making The DiagnosisHistory
• Audible pop• Immediate swelling• Inability to bear weight• These are all signs of a more severe injury
• Audible pop• Immediate swelling• Inability to bear weight• These are all signs of a more severe injury
Physical ExaminationPhysical Examination
• Observe for:– Swelling– Deformiity
• Palpate for tenderness– Ligaments– Bones
• Observe for:– Swelling– Deformiity
• Palpate for tenderness– Ligaments– Bones
Physical ExamDrawer test
Physical ExamDrawer test
• ATFL
• >4mm difference
• ATFL
• >4mm difference
Physical ExamTalar Tilt TestPhysical ExamTalar Tilt Test
• CFL
• > 6° difference
• CFL
• > 6° difference
Physical ExamSqueeze TestPhysical ExamSqueeze Test
• Anterior tibiofibular ligament
• High ankle sprain
• Anterior tibiofibular ligament
• High ankle sprain
Physical ExamExternal Rotation Test
Physical ExamExternal Rotation Test
• Anterior tibiofibular ligament
• High ankle sprain
• Anterior tibiofibular ligament
• High ankle sprain
Physical ExamPalpation
Physical ExamPalpation
• Length of tenderness predicts severity
• One week for each cm above ankle joint
• Length of tenderness predicts severity
• One week for each cm above ankle joint
Classification and Return to SportClassification and Return to Sport
• Grade I 7-14 days
• Grade II 2-6 weeks
• Grade III 4-26 weeks
• High ankle sprain 1 week per cm
• Grade I 7-14 days
• Grade II 2-6 weeks
• Grade III 4-26 weeks
• High ankle sprain 1 week per cm
Differential DiagnosisPhyseal Fractures OCDDifferential Diagnosis
Physeal Fractures OCD
Differential DiagnosisDifferential Diagnosis
Jones FractureJones Fracture Peroneal Tendon SubluxationPeroneal Tendon Subluxation
Treatment RICETreatment RICE
• Rest
• Ice
• Compression
• Elevation
• Rest
• Ice
• Compression
• Elevation
Treatment Grade I and IIFunctional Bracing
Treatment Grade I and IIFunctional Bracing
Treatment Grade III and SyndesmosisTreatment Grade III and Syndesmosis
Surgery or cast – NO!Functional Bracing –YES!
Surgery or cast – NO!Functional Bracing –YES!
• Return to work 2 to 4 times sooner• No difference in long term stability• No surgical complications• 87% excellent and good results with bracing• 60% excellent and good results with surgery
• Return to work 2 to 4 times sooner• No difference in long term stability• No surgical complications• 87% excellent and good results with bracing• 60% excellent and good results with surgery
RehabilitationRehabilitation
• Decrease swelling• Regain range of motion• Strengthen muscles• Balance and proprioceptive training• Functional drills
• Decrease swelling• Regain range of motion• Strengthen muscles• Balance and proprioceptive training• Functional drills
Balance and ProprioceptionBalance and Proprioception
Return to PlayReturn to Play
• Run without pain or limitations
• Sport specific movements without pain or limitation
• 90% strength• Protective brace
• Run without pain or limitations
• Sport specific movements without pain or limitation
• 90% strength• Protective brace
Failure to RecoverGiving Way and Recurrent Sprains
Failure to RecoverGiving Way and Recurrent Sprains
Rehabilitation Bracing Surgical reconstruction
of ligaments
Rehabilitation Bracing Surgical reconstruction
of ligaments
Failure to RecoverIntra Articular Problems
Failure to RecoverIntra Articular Problems
• OCD• Loose bodies• Bone spurs• Arthritis• Soft tissue impingment
• OCD• Loose bodies• Bone spurs• Arthritis• Soft tissue impingment
PreventionPrevention
• High top shoes• Taping• Shoes and tape• Braces
• High top shoes• Taping• Shoes and tape• Braces
PreventionPrevention
• Conditioning– Agility– Flexability
• Proprioception• Strengthening• Stretching and warming up• Recognize effects of fatigue
• Conditioning– Agility– Flexability
• Proprioception• Strengthening• Stretching and warming up• Recognize effects of fatigue
Thank You
Orthopaedic Research of Virginia
Thank You
Orthopaedic Research of Virginia