There are three primary ligaments that make up the lateral ankle ligament complex. Their attachment points are easy to identify, as the ligament names designate the two bones they connect. These three key ligaments are the anterior talofibular connecting the talus and fibula , posterior talofibular also connecting talus and fibula , and the calcaneal fibular connecting the calacaneus and fibula.
Of these, the anterior talofibular and calcaneofibular are the most commonly injured with the inversion ankle sprain Figure 1. Excessive inversion is the most likely foot movement that sprains these ligaments.
However extreme plantar flexion, especially if combined with inversion, is also a likely contributor to inversion ankle sprain. A common example of lateral ankle sprain is stepping off an elevated surface like a curb, or stepping down into a hole where the foot is both plantar flexed and inverted.
Alignment of the foot and ankle complex is essential to transmit body weight and ground reaction force through the foot and ankle region. Once the foot turns inward, it is no longer a stable base of support and the entire body weight magnifies the force these ligaments have to resist. When a person has sustained an inversion ankle sprain, the primary goal is to prevent any excessive movement during the ligament's healing so scar tissue can knit the torn fibers back together and maintain as much stability as possible.
Deep friction techniques are often advocated to treat an ankle sprain, with the theory being that it can help reduce fibrous scar tissue that might adhere the healing ligament to adjacent soft-tissue. There has also been some speculation that friction massage may aid in fibroblast proliferation to help repair damaged tissue.
On the opposite side of the ankle is the deltoid ligament complex. It is sometimes just call the deltoid ligament, but it is actually a group of four separate ligaments.
Sports medicine is one of his areas of special interest: he has worked both on the touchline and in sports injuries clinics, and now lectures on the Sports Therapy programme at Bournemouth University. Having spent several years managing physiotherapy and health assessment teams in two key Nuffield Health hospitals, Paul also has an extensive understanding of orthopaedic surgery.
BH23 1EB. Let's talk! Facebook Twitter Instagram Linkedin Youtube. Facebook Twitter Instagram Linkedin. Ankle Sprains. The ankle Ankle sprains are one of the most common injuries we see.
Autosuggest Results. Severe and prolonged pain Limited range of motion Mild swelling Difficulty with weight bearing. Table Graphic Jump Location Table 41—8. Injuries associated with ankle sprains. View Table Download. A syndesmotic injury or "high ankle" sprain involves the anterior tibio fibular ligament in the anterolateral aspect of the ankle, superior to the anterior talo fibular ligament The injury mechanism often involves the foot being turned out or externally rotated and everted eg, when being tackled This injury is commonly missed or misdiagnosed as an anterior talofibular ligament sprain on initial visit.
Localized pain, swelling, and bruising over the lateral aspect of the ankle Difficulty weight bearing Limping The patient's ankle may feel unstable The anterior, inferior aspect below the lateral malleolus is most often the point of maximal tenderness consistent with anterior talofibular and calcaneofibular ligament injuries. Severe and prolonged pain over the anterior ankle at the anterior tibiofibular ligament, worse with weight bearing The point of maximal tenderness involves the anterior tibiofibular ligament, which is higher than the anterior talofibular ligament It is also important to palpate the proximal fibula to Subscribe: Institutional or Individual.
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Please Wait. Biomechanics of the unstable ankle joint and clinical implications. Biomechanical evaluation of the anterior drawer test: the contribution of the lateral ankle ligaments. Foot Ankle. Bone bruises detected by magnetic resonance imaging following lateral ankle sprains.
Knee Surg Sports Traumatol Arthrosc. Syndesmotic ankle sprains. Am J Sports Med. Occult osseous injuries after ankle sprains: incidence, location, pattern, and age. Foot Ankle Int. Lazarus ML. Imaging of the foot and ankle in the injured athlete. Hopkinson WJ, St. Syndesmosis sprains of the ankle. A radiographic evaluation of the tibiofibular syndesmosis.
Wheeless CR. Wheeless' Textbook of orthopaedics. Knight KL. In: Cryotherapy in sport injury management. Champaign, Ill. Wexler RK. The injured ankle. Am Fam Physician. Weinstein ML. An ankle protocol for second-degree ankle sprains. Mil Med. Early mobilization versus immobilization after ankle ligament stabilization. Scand J Med Sci Sports. Early ankle mobilization. Part I: the immediate effect on acute, lateral ankle sprains a randomized clinical trial. The prevention of ankle sprains in sports.
A systematic review of the literature. Br J Sports Med. A twofold reduction in the incidence of acute ankle sprains in volleyball after the introduction of an injury prevention program: a prospective cohort study. Effects of a 6-week strength and proprioception training program on measures of dynamic balance: a single-case design. J Athl Train. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
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Normal anatomy of the medial ankle. Maintain extremity in a nongravity position with compression. Achilles tendon stretch, weight-bearing Stand with heel on floor and bend at knees. Alphabet exercises performed Move ankle in multiple planes of motion by drawing letters of alphabet lower case and upper case. Repeat four to five times a day. Exercises can be in conjunction with cold therapy. Muscle strengthening Isometric exercises Resistance can be provided by immovable object wall or floor or contralateral foot.
Plantar flexion Push foot downward away from head. Dorsiflexion Pull foot upward toward head. Inversion Push foot inward toward midline of body. Eversion Push foot outward away from midline of body. Isotonic exercises Resistance can be provided by contralateral foot, rubber tubing or weights. Toe curls and marble pickups Place foot on a towel; then curl toes, moving the towel toward body. Two sets of 10 repetitions; repeat two times a day. Toe curls can be done throughout the day, at work or at home.
Use toes to pick up marbles or other small object. Toe raises, heel walks and toe walks Lift body by rising up on toes. Achilles tendon stretching using a towel. Use of elastic tubing in strengthening exercises for eversion. Single-leg toe raises done on a step. Do five to 10 repetitions; repeat set two times a day. Walking on different surfaces Walk in normal or heel-to-toe fashion over various surfaces; progress from hard, flat floor to uneven surface. Walk 50 feet two times a day.
Training for return to activity Walk-jog Do 50 percent walking and 50 percent jogging in forward direction and backward direction; progress to jogging; jog in a pattern e. Increase distance in increments of one-eighth mile.
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