THE ANKLE

Chapter 15

ANKLE ANATOMYBONESTwo bones in the lower leg

Tibia – medial, larger, weight bearing Medial Malleolus

Fibula Lateral Malleolus

Two tarsal boneTalusCalcaneus

ANKLE ANATOMY

TRUE ANKLE JOINTTibia, fibula and talusMortise

Definition: where the talus fits into the tibia and the fibula

ANKLE JOINTS

Subtalar jointBetween the

Talus and the Calcaneus

LIGAMENTS – p. 317LATERAL SIDE– 3 ligaments named for bonesAnterior talofibular

(ATF)Calcaneofibular

(CF)Posterior talofibular

(PTF)

LIGAMENTS – p. 317

MEDIAL SIDEDeltoid

Strong ligament4 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

InversionMost common type of ankle sprain

Accounts for 80% of all sprainsAKA ‘a lateral ankle sprain’

First degree sprainOnly involves the anterior talofibular ligamentMild pain, tenderness, and swellingNo instability

TYPES OF ANKLE SPRAINS

InversionSecond degree sprain

Anterior talofibular ligament is torn and calcaneofibular ligament is injured as well

Most painfulModerate swellingMild Instability

MECHANISMS OF ANKLE SPRAINS

InversionThird degree sprain

Complete tear of all three lateral ligamentsUncommonLots of pain, but it can subsideVery unstableUsually requires surgery

TESTING ATF STABILITY

Drawer TestStablize lower leg with one handPull 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 footS/S: pain with external rotation of foot; tender over AITFLTreatment: 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 ankleCause: Too much motionS/S: immediate swelling, point tender over the bone, does not want to weight bearTreatment: splint, ice, x-ray Cast 6-8 weeks