Transcript THE ANKLE
THE ANKLE The Ankle and Lower Leg 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? Anatomy of the Ankle What bone make up the Ankle joint? Tibia Fibula Talus Calcaneus Anatomy of the Ankle What type of joint is the Ankle? The Ankle joint is a HINGE JOINT The TALOCRURAL Joint Major Ligaments of the Ankle LATERAL ASPECT Anterior Tibiofibular Anterior Talofibular- 3 Calcaneofibular- 6 Posterior Talofibular- 9 Major Ligaments of the Ankle MEDIAL ASPECT Posterior Talotibial Posterior Talocalcaneal Deltoid Muscles and Tendons around the Ankle Achilles Tendon Peroneal Tendinitis Anterior Tibialis Tendinitis Posterior Tibialis Tendinitis Common Ankle Injuries Inverted Ankle Sprain Everted Ankle Sprain Ankle Dislocation Muscle and Tendon Strains 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 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. Ankle Dislocation/Fracture Ankle Dislocation - Fracture Medical Emergency Usually the foot is inverted. Frequently both the Tibia and Fibula are fractured. Ankle Dislocation/Fracture - Medical Emergency Muscle and Tendon Strains Most common is the Achilles Tendon Strain. THOMPSON Test the Achilles. Peroneal tendon sometimes damaged with inversion ankle sprain. Compression Test Homan’s Test Percussion Test Thompson Test Anterior Drawer Test Talar Tilt Test 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 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 Grading Scales for Sprained Ankles GRADE I Most common ankle sprain. Mild pain, still weight baring. GRADE II More painful, report popping sound. Can not bear weight. Stretching of lateral ligaments of the ankle. GRADE III Extreme pain. Usually complete tear of one of the ankle ligaments. Sometimes fracture occurs also. 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 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 – 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 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 – 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 Rehab/Treatment Plan for Sprained Ankles RICE Modalities Exercises 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 Goals of RICE Limit Swelling Reduce pain Return to sport/activity quicker 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 Modalities Used HIGH VOLTAGE Assists in activating pain killing receptors. Assists in muscle stimulation around ankle joint to aid in edema removal. ULTRASOUNDAssists in edema removal. Assists in bringing digestive enzymes to clean debris cells of the injured ankle. Rehab Exercises Range of Motion ABC’s One leg Stands BAPS Board Towel Curls Toe Pickups Toe Rises Theraband 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 15-20 minutes of competition 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. 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. Ankle Braces Ankle Braces Ankle Braces Questions Over Ankle Notes: