Ankle Sprain                Presented By:-               Kunal Vashist,PT                Back 2 Fitness
Background• Ankle Sprain is an injury to the ligaments around   the ankle.• Typically caused by sudden, strong contraction...
• Predisposing factors : • H/o Prev. Ankle Sprain• Chronic Ankle Instability• Rigid Supinated Foot• Reccurence may lead to...
• Longstanding Symptoms diagnosed as    “sprained ankle syndrome.”• 55% patients don’t visit health care   proffessionals....
Anatomy
Lateral Ligaments
Medial Ligaments
Muscles around Medial Malleolus
Muscles around lateral Malleolus
Functional Anatomy• Ankle Complex – 3 Articulations Talocrural Joint Subtalar Joint Distal Tibiofibular Syndesmosis
Movements occurs in 3 Cardinal Planes:• Sagittal Plane Motion – Plantar Flexion – Dorsi   Flexion• Frontal Plane Motion – ...
Coupled Rearfoot Motion Pronation – Dorsi flexion+ Eversion+ External   Rotation. Supination – Plantar flexion + Inversi...
Ankle Stability• Congruity of the articular surfaces when the   joints are loaded• Static ligamentous restraints• Musculo-...
Patho-Physiology
TABLE 1Grades of Ankle SprainSign/symptom         Grade I       Grade II   Grade IIILigament tear        None          Par...
Patho-Mechanics• Lateral Ankle Sprain – • Excessive supination of rear foot on externally   rotated leg during gait or lan...
• First Ligament to be damaged – Anterior Talo-  Fibular Ligament followed most often by   Calcaneo-Fibular Ligament.• Rup...
• Increased Supination moment at Subtalar   joint leads to excessive inversion and internal   rotation of rear foot in clo...
• Further, Predisposition to first time ankle   sprain includes:• Structural – Tibial Varum• Functional –           »   po...
• Acute Ankle Sprain – Tender & swollen ankle –   Painfull Movements but full weight bearing.   WHY most individuals who s...
Ankle sprain by Back 2 Fitness
Ankle sprain by Back 2 Fitness
Ankle sprain by Back 2 Fitness
Ankle sprain by Back 2 Fitness
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Ankle sprain by Back 2 Fitness

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Ankle Sprain discussed in plain language for therapists.

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  • When contracted, musculotendinous units generate stiffness, which leads to dynamic protection of joints. The muscles that cross the ankle complex are often described based on their concentric actions; however, when considering their role in providing dynamic stability to joints, it may be helpful to think about eccentric functions. The peroneal longus and brevis muscles are integral to the control of supination of the rearfoot and protection against lateral ankle sprains. 46 In addition to the peroneals, the muscles of the anterior compartment of the lower leg (anterior tibialis, extensor digitorum longus, extensor digitorum brevis, and peroneus tertius) may also contribute to the dynamic stability of the lateral ankle complex by contracting eccentrically during forced supination of the rearfoot. Specifically, these muscles may be able to slow the plantar-flexion component of supination and thus prevent injury to the lateral ligaments. 47
  • The anterior and posterior subtalar joints have separate ligamentous joint capsules and are separated from each other by the sinus tarsi and canalis tarsi. 37 throughout the entire ankle complex. 44 The joint is stabilized by a thick interosseous membrane and the anterior and posterior inferior tibiofibular ligaments. The structural integrity of the sydesmosis is necessary to form the stable roof for the mortise of the talocrural joint. The anterior inferior tibiofibular ligament is often injured in conjunction with eversion injuries, and damage results in the so-called high ankle sprain rather than the more common lateral ankle sprain. 45
  • ATFL demonstrates lower maximal load and energy to failure values under tensile stress as compared with the PTFL, CFL, anterior inferior tibiofibular ligament, and deltoid ligament. This may explain why the ATFL is the most frequently injured of the lateral ligaments.
  • Innervation The motor and sensory supplies to the ankle complex stem from the lumbar and sacral plexes. The motor supply to the muscles comes from the tibial, deep peroneal, and superficial peroneal nerves. The sensory supply comes from these 3 mixed nerves and 2 sensory nerves: the sural and saphenous nerves. The lateral ligaments and joint capsule of the talocruraland subtalar joints have been shown to be extensively innervated by mechanoreceptors that contribute to proprioception. 37,48,49 The major importance of muscle spindles, especially of those in the peroneal muscles, to proprioception about the ankle complex has been described. 50
  • Pathologic Laxity – Ligament Damage Arthrokinematics – Limited Dorsiflexion / Antero-inferior positional fault of lateral malleolus Synovial and Degenerative Changes – Synuvitis / osteophytes and loose bodies Proprioception – Impaired muscle activity in peroneals more imp. Than mechanoreceptors in ankle NMS Control – in peroneals / Glutes Medius activity / slow ncv / Proprioception Postural control – Balance and coordination
  • Ankle sprain by Back 2 Fitness

    1. 1. Ankle Sprain Presented By:- Kunal Vashist,PT Back 2 Fitness
    2. 2. Background• Ankle Sprain is an injury to the ligaments around  the ankle.• Typically caused by sudden, strong contraction  ,direct impact, or by a sudden, forceful twist.• Presenting with pain and swelling but ability to  walk on foot with discomfort usually excludes a  fracture.• The typical ankle sprain is an inversion injury that  occurs in the plantar-flexed position. (85%) – aka Inversion Sprain or supination Sprain.
    3. 3. • Predisposing factors : • H/o Prev. Ankle Sprain• Chronic Ankle Instability• Rigid Supinated Foot• Reccurence may lead to osteoarthritis and  articular degeneration.• Residual symptoms affect 72% of patients  (6wks to 18 months)
    4. 4. • Longstanding Symptoms diagnosed as   “sprained ankle syndrome.”• 55% patients don’t visit health care  proffessionals.• Underestimating severity of ankle sprain may  lead to reccurent injuries / residual symptoms.
    5. 5. Anatomy
    6. 6. Lateral Ligaments
    7. 7. Medial Ligaments
    8. 8. Muscles around Medial Malleolus
    9. 9. Muscles around lateral Malleolus
    10. 10. Functional Anatomy• Ankle Complex – 3 Articulations Talocrural Joint Subtalar Joint Distal Tibiofibular Syndesmosis
    11. 11. Movements occurs in 3 Cardinal Planes:• Sagittal Plane Motion – Plantar Flexion – Dorsi  Flexion• Frontal Plane Motion – Inversion – Eversion• Transverse Plane Motion – Internal / External  Rotation.
    12. 12. Coupled Rearfoot Motion Pronation – Dorsi flexion+ Eversion+ External  Rotation. Supination – Plantar flexion + Inversion +  Internal Rotation
    13. 13. Ankle Stability• Congruity of the articular surfaces when the  joints are loaded• Static ligamentous restraints• Musculo-tendinous units, which allow for  dynamic stabilization of the joints
    14. 14. Patho-Physiology
    15. 15. TABLE 1Grades of Ankle SprainSign/symptom Grade I Grade II Grade IIILigament tear None Partial CompleteLoss of functional Minimal Some GreatabilityPain Minimal Moderate SevereSwelling Minimal Moderate SevereEcchymosis Usually not Common YesDifficulty bearing None Usual Almost alwaysweight
    16. 16. Patho-Mechanics• Lateral Ankle Sprain – • Excessive supination of rear foot on externally  rotated leg during gait or landing from a jump.• Excessive inversion and internal rotation of  the rearfoot, coupled with external rotation of  the lower leg, results in strain to the lateral  ankle ligaments. 
    17. 17. • First Ligament to be damaged – Anterior Talo- Fibular Ligament followed most often by  Calcaneo-Fibular Ligament.• Ruptured ATFL increases Transverse plane  motion stressing the ligament further.  (Rotational Instability)• Damage to Talocrural Joint Capsule with  ligamentous stabilizers of subtalar joint.
    18. 18. • Increased Supination moment at Subtalar  joint leads to excessive inversion and internal  rotation of rear foot in closed kinetic chain.• May happen with rigid supinated foot or with  more laterally deviated subtalar joint axis.• Then if supination moment > compensatory  Pronation (Peroneals), Leads to Excessive  inversion and internal rotation.
    19. 19. • Further, Predisposition to first time ankle  sprain includes:• Structural – Tibial Varum• Functional – » poor postural control performance  » Impaired Propriocepton » Eversion > Inversion » Plantarflexion strength > Dorsiflexion Strength
    20. 20. • Acute Ankle Sprain – Tender & swollen ankle –  Painfull Movements but full weight bearing.   WHY most individuals who suffer an  initial ankle sprain are prone to recurrent  sprains ???
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