9. Major Ligament
complex is called the
Deltoid Ligament.
It is the strongest of
the ankle ligaments
Navicular bone
› post. Tibial tendon
attaches
10. Provide proprioceptive information for
joint function
Provide static stability to the joint and
prevent excessive motion
Act as guides to direct motion
11. Peroneus brevis
Peroneus longus
› Both serve as the
major everters of
the ankle
› Also serve as plantar
flexors
14. History is always good!
› What happened?
› Which way did it bend?
› Could you walk?
› How much swelling/ecchymosis?
› When did it happen?
› What have you done for it?
› Have you sprained it before?
15. › Past history
› Mechanism of injury
› When does it hurt?
› Type of, quality of, duration of pain?
› Sounds or feelings?
› How long were you disabled?
› Swelling?
› Previous treatments?
16. › Postural deviations?
› Is there difficulty with walking?
› Deformities, asymmetries or swelling?
› Color and texture of skin, heat, redness?
› Patient in obvious pain?
› Is range of motion normal?
17. › Most helpful during the acute phase
› Remember your anatomy!
› Palpate the structures you know
Boney prominences
Ligaments
Tendon insertions
18. › Check Range of Motion
Plantar and Dorsi-flexion
Inversion and Eversion
› Neurovascular status
› Strength?
Not helpful in the acute setting
› Ligamentous testing
May be very difficult to do in the acute setting
22. Anterior Drawer Test tes utk
mengetahui integritas ligamen
talofibular anterior
23. Tes utk mengetahui integritas ligamen
calcaneofibular
25. › Xrays are indicated to r/o fx if:
Presents within 10 days of injury
Unable to bear weight at time of injury or in
office
Tenderness of distal 6cm of malleoli on the
post. Aspect.
Tenderness over the base of the 5th met or
navicular bone
26. Several Classifications Exist based on:
› Ligamentous injury and evidence of
instability
› Classification based on functional
impairment
› Number of ligaments involved
Combination of the above
27. Ligament status
› partial tear of the ligament
› mild tenderness and swelling
› no instability on exam when stressing
ligament
Functional status
› Slight or no functional loss
› able to bear weight and ambulate with
minimal pain
28. - The anterior talofibular ligament
affected
- stress: minimal change on inversion,
normal anterior drawer
- treatment by encouraging early active
movement:
a) stationary cycling
b) walking with protective taping or
semi-rigid brace ( Aircast splint )
29. c) NSAIDS (anti-inflammatory medication)
d) physiotherapy: electrotherapy,
strengthening exercises, proprioception.
e) functional progression to running,
jumping, hopping, swerving, recovery
into 6 weeks
30. • Ligament Status
– Incomplete tear of the ligament
– Moderate pain swelling and tenderness
– Mild to mod. ecchymosis
– Mild to moderate instability of the ligament
• Functional status
– Some loss of motion and function
– patient has pain with weight-bearing and
ambulation
31. - Complete tear of anterior talofibular
ligament with some damage of the
calcaneofibular ligament
- laxity when inversion, anterior drawer
present
- treatment: a) 1 week crutches, joint
taped or in aircast splint
b) follow grade 1 rehabilitation
32. • Ligament Status
– Complete tear and loss of integrity of a
ligament.
– Severe swelling (more than 4cm around the
fibula)
– Severe ecchymosis
– Significant mechanical instability with ligament
stressing
• Functional Status
– Significant loss of function and motion
– patient is unable to bear weight or ambulate.
33. - Uncommon severe injuries, associated
with fractures
- treatment: 10 days NWB in aircast
brace, then PWB with the brace up to 6
weeks. Aggressive rehabilitation follows
- surgical reconstruction must be
considered
36. – PRICEM
– Protection: (orthosis or brace)
– Rest: limit wt. Bearing until non-painful
– Ice, Compression, and Elevation
• Most important component acutely
• Limiting inflammation and swelling has been
shown to speed recovery
– Mobilize
• early range of motion has also been shown to
speed recovery
37. ACUTE
Major goals in the acute
phase are to reduce
swelling and pain
RICE
AROM as long as it is pain
free.
U/S, Laser, Acupuncture
A brace can be used to
prevent inversion of the
foot
Research shows that early
limited stress following the
inflammation phase might
promote faster, stronger
healing as it helps to align
the collagen fibers.
SUBACUTE
U/S, laser, Acupuncture
AROM without brace
starting with dorsiflexion
and plantarflexion
Progressive isometric
exercises
Cross fiber massage to the
ligament in late rehab
Taping or tensor bandage
Build up to functional skills
CHRONIC
Resisted exercise
strengthening
Balance and agility
Proprioception training
Functional training
43. Neuromuscular
Control Training
› Can be enhanced
by training in
controlled activities
› Uneven surfaces,
BAPS boards, rocker
boards, or
Dynadiscs can also
be utilized to
challenge athlete
51. Stretching of the Achilles tendon
Strengthening of the surrounding muscles
Proprioceptive training: balance
exercises and agility
Wearing proper footwear and or tape
when appropriate
52. Reviewed anatomy and clinical exam
Ankle injuries are extremely common
with high potential for long term sequele.
A through exam and early aggressive
treatment including a rehabilitation
program will lead to optimal results.