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Are females or males more likely to sprain their ankle?
What is the most common predisposition to an ankle sprain?
Previosu ankle sprain
T or F: 30% of people who suffer LAS will develop chronic instability.
Repetitive strains are linked to?
Increased risk of OA and articulate degeneration
Lateral Ankle Sprains Risk Factors
- Previous ankle ligament injury
- Greater height and weight
- Limb dominance
- Pes Cavus
- Larger foot size
- Gen joint laxity
- Inappropriate footwear for sport
- Strength asymmetry
- Decreased eversion eccentric strength
- Decreased reaction time
What is the most common form of an ankle sprain?
MOI of inversion sprains?
Excess supination of rear-foot upon landing from jump
How to pts with inversion sprains present?
- point tenderness
- instability and functional limits
What is the order that ligaments tears?
ATF then CF then PTF
Which ligament is the most commonly torn with an inversion sprain?
Anterior Talofibular Ligament
Where is the anterior talofibular ligament tense?
Where does the ATF run?
Anteriorinferior border of fibula to neck of talus
Where does the CF run?
Obliquely from tip of fibulae to calcaneal tubercle
Where is the CF taut and on slack?
Eversion = Slack
Inversion and DF = taut
Where does the PTF run?
Posterior border of distal fibula and inserts on tubercle on lateral talus
Which lateral ligament is the strongest?
When is the PTF tense?
Only during hyper-DF
T or F: PTF injuries commonly are accompanied by fractures or dislocations.
T or F: all medial ligaments are fused together.
What is likely to occur instead of medial malleolus?
Avulsion of medial malleolus is more likely
Are males or females more likely to have an eversion sprain?
MOI of eversion sprain
**plants and then cuts in opposite direction
Grade 1 Ankle Sprain
- Usually only ATF
- Joint integrity maintained, little functional instability
- Swelling slight
- Mild, localized pain over ATF
- Negative (0) to 1+ on anterior drawer or talar tilt
Grade 2 Ankle Sprains
- Complete rupture of ATF and partial tear of CF
- Maybe felt or heard "pop"
- Moderate disability
- Mod swelling
- Restricted ROM
- Mod pain localized over ligs
- (+) anterior drawer for increased laxity but has end point
Grade 3 Ankle Sprain
- Complete tear of ATF and CF possible PTF
- Severe disability with lost of ROM and inability to bear weight
- Mod-Severe swelling
- Marked tenderness localized over ligaments
(+) anterior drawer and talar tilt
Describe the grading of ligament tears
Grade 1: stretching/small tears
Grade 2: larger, but incomplete tear
Grade 3: complete tear
What is the grading by which ligament is torn?
1st degree: ATF completely disrupted
2nd degree: ATF and CF ligs disrupted
3rd degree: Ankle dislocated and all three lateral ankle ligaments ruptured
What ligament does the anterior drawer test test?
What ligament does the talar tilt test test?
What is a positive anterior drawer test?
Result in dimple anterolateral joint line as talus subluxes
- Sinus tarsi syndrome
- Anterior calcaneal process fix
- Lateral or posterior talar process fx
- Os trigonum syndrome
- Talar OCD
- Synovial impingement
- Meniscoid lesion
- Anterior bony impingement
- Subluxing peroneal tendon
- Proximal 5th met fx
- Lisfranc joint injury
What do you use the Ottawa ankle rules for?
Indicates the need for radiographs of the ankle
What are the Ottawa ankle rules?
- If bone tenderness at distal posterior 6 cm of fibula or at base of 5th metatarsal (lateral side)
- If tenderness over distal posterior 6 cm of tibia or navicular bone
- Tenderness of previous locations
- Inability to bear weight immediately after injury and during exam
- Must be able to take 4 steps
- growth plates weaker than ligaments spanning joint
- not as much swelling
- pain over epiphysis not lig
Changes after ankle sprain?
- Pathological laxity
- Impaired arthrokinematics
- Synovial changes
- Development of degenerative joint disease
How long does it take from ligament to regain its normal histologic characteristics?
- RICE 48-72 hours
- Protective ROM after 48 hrs
- Protect ankle for first 6 weeks (neutral DF)
- Slowly begin to increase weight as patient able to tolerate
- Allow 4-6 weeks for recovery
- loss of ankle DF common
What is the normal degrees for walking and running?
20-30 degrees normal for walking and running
What is the sequence that they should be able to perform the following sequence before returning to rigorous activities?
- Normal walking
- Running straight ahead
- Running and cutting
- Lateral running
What is a syndesmotic ankle sprain?
High ankle sprain
What are the ligaments involved in a high ankle sprain?
- Anterior inferior tibiofibular ligament
- Posterior inferior tibiofibular ligament
- Transverse ligament
- Interosseous ligament
Which ligament is injured first in a SAI?
Anterior inferior tibiofibular lig
Which ligament is the last torn in a SAI?
Posterior inferior tibiofibular ligament
Where does the anterior inferior tibiofibular run?
Anterolateral distal tibia and runs distal and lateral to anteromedial distal fibula
Where does the posterior inferior tibiofibular ligament run?
Posterolateral distal tibia and runs horizontal to posteromedial distal fibula
Is the distal tib/TBI joint stable or unstable?
MOI of SAI
- ER maneuver with foot DF and in probated position
- Foot planted fixed to ground with IR of leg and body
Physical exam finding of SAI
- Pain (ant b/t distal tib and fib) (posterior at lvl of ankle joint)
- Pain with WB
- Note the distance from the ankle where the pain is (high = more severe)
What is the most sensitive test for SAI?
What is the most specific test for SAI?
Which test for SAI has the highest diagnostic accuracy?
- Protect the injured joint
- Minimize inflammatory response
- Decrease pain
Tx: Elevation, Compression, Cryotherapy, E stim, AROM
- Restore mobility
- Restore strength
- Restore function
Tx: towel stretch, bike, squats, joint mobs, strengthening, bal and proprioception
Advanced Training Phase
- Return to full activity
- Increasing strength
- Increasing NM control
Tx: hopping, bounding, lat shuffling, plyometrics
What is Sinus Tarsi Syndrome?
"Trash bag diagnosis"
Vague, proximal, anterolateral foot pain in area of sinus tarsi that hurts with jumping
Treatment for sinus tarsi syndrome
- Brace and injection
- PT modalities
- Address weakness, pain and motion deficits
- Phonophoesis or iontophoresis
What is a meniscoid lesion?
When ATF is torn and falls into the joint and then in DF talus impinges on this fragment and causes painful pinch
- Non-WB for 2-4 weeks
- WB in cast from 2-6 weeks
- Begin PT after 6th week
Post-op maximum protection phase
Post-op moderate protection phase
- Joint mob
- Gentle self stretch
- Gradually increase strength
- balance board
When will post-op patients return to full activity? And how much strength should they have?
90% strength of uninvolved side
Sets found in the same folder
Toe deformities & gait analysis-LQ
ankle and foot mobilizations
Foot/ankle special tests
Misc Foot Disorders
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