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Ankle Sprains and Treatment

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Ottawa ankle rules Ankle ... Fracture Dislocation or subluxation Syndesmosis injury Tendon rupture Wound penetrating into the joint Uncertain diagnosis ... – PowerPoint PPT presentation

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Title: Ankle Sprains and Treatment


1
Ankle Sprains and Treatment
  • Baylor College of Medicine
  • Anoop Agrawal, M.D.

2
Quick Review
  • Name the ligaments on the lateral aspect of the
    ankle.
  • ant talofibular (ATFL), calcaneofibular (CFL),
    and post talofibular (PTFL)

3
Quick Review
  • Name the ligaments on the medial aspect of the
    ankle.
  • deltoid ligament

4
Quick Review
  • What is the most common mechanism of injury that
    results in an ankle sprain?
  • inversion with plantarflexion
  • What is the name of the guidelines designed to
    assess need for radiographs?
  • Ottawa ankle rules

5
Ankle Sprains
  • Classification based on location and grade
  • Location
  • Lateral
  • Medial
  • Syndesmostic (high ankle sprain)

6
Lateral Ankle Sprain
  • Most common type
  • Which ligament is always involved in this type of
    sprain?
  • ant talofibular ligament (ATFL)
  • Stronger forces of injury may also involve the
    CFL. The CFL rarely is injured in isolation.

7
Medial Ankle Sprain
  • Uncommon injury due to the strength of the
    deltoid ligament
  • Forced eversion can damage the deltoid, but more
    commonly results in an avulsion fracture of the
    medial malleolus because of the deltoids
    strength.

8
Syndesmotic Sprain(High Ankle Sprain)
  • One more ligament to KNOW...actually two more
  • ant and post tibiofibular ligaments (syndesmosis
    ligaments)
  • Occurs with dorsiflexsion and/or eversion, often
    times with concomitant lateral force to the knee
  • What exam maneuver is performed to assess for
    this sprain?

Squeeze Test
9
Syndesmotic Sprain
  • Anterior tibiofibular ligament
  • Posterior tibiofibular not pictured
  • Positive Squeeze test on exam

10
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11
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12
May see widened space between fibula and tibia.
Normally, less than 5 mm wide.
13
Ankle Sprains Grade
  • Three Classifications of Grades
  • Grade I partial tear of ligament, no functional
    impairment, not frequently seen in the office
  • Grade II incomplete tear of ligament with mild
    to moderate functional impairment, pain with
    weight bearing
  • Grade III complete tear and loss of integrity of
    ligament, usually unable to bear weight
  • Time for healing is not always proportional to
    grade.

14
Treatment
  • RICE - rest, ice, compression, elevation
  • NSAIDS
  • Functional Rehabilitation vs. Immobilization - In
    grade I and II, all studies have found rehab to
    be superior to immobilization in every aspect.
  • For grade III - controversial, but a few studies
    support early functional rehab
  • Splints and braces - semi-rigid device allowing
    for plantar and dorsiflexion with
    stabilization/prevention of inversion/eversion

15
Rehab Program
  • Functional Rehab begins on the day of the injury.
  • There are four progressive phases
  • Range of Motion - start immediately
  • Achilles Tendon stretch
  • Write upper case alphabet with great toe
  • Perform each three to five times a day

16
Rehab Program
  • Muscle Strengthening - phase two, begin as
    swelling and pain are controlled.
  • Isometric (using walls) and isotonic (using
    resistance bands/towels) exercises -
    dorsiflexion, plantarflexion, inversion, eversion
  • Toe curls - two sets of 10, twice a day
  • Toe raises - two sets of 10, twice a day
  • Emphasis on strengthening peroneal and anterior
    tibialis muscles (dorsiflexion, eversion)

17
Achilles Tendon stretch
18
Rehab Program
  • Proprioceptive training
  • Activity-specific training
  • Walk-jog
  • Jog-run

19
Orthopedics Referral
  • Reasons for referral
  • Fracture
  • Dislocation or subluxation
  • Syndesmosis injury
  • Tendon rupture
  • Wound penetrating into the joint
  • Uncertain diagnosis
  • Neurovascular compromise requires emergent care

20
References
  • Chorley, J, Powers, C. Clinical Features and
    Management of Ankle Pain in the Young Athlete.
    Up To Date, 2006
  • Maughan, KL. Ankle Sprain. Up To Date, 2006.
  • Pfeffer, GB. Foot and Ankle. Essentials of
    Musculoskeletal Care, Greene, WB (2nd Ed).
    American Academy of Orthopaedic Surgeons,
    Rosemont, IL, 2001.
  • Wolfe, MW, et al. Management of Ankle Sprains.
    American Family Physician 631 Jan 1, 2001.

21
Questions?
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