Quick and Simple Look At Lateral Ankle Injuries
Upcoming SlideShare
Loading in...5
×
 

Quick and Simple Look At Lateral Ankle Injuries

on

  • 1,151 views

An overview for non-specialists

An overview for non-specialists

Statistics

Views

Total Views
1,151
Views on SlideShare
1,151
Embed Views
0

Actions

Likes
0
Downloads
6
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Quick and Simple Look At Lateral Ankle Injuries Quick and Simple Look At Lateral Ankle Injuries Presentation Transcript

  • Model Injuries Classroom Look At Ankle Sprains Stephen M. Pribut, DPM Clinical Assistant Professor of Surgery, GWUMCThursday, February 14, 13
  • Lateral Ankle Instability and Injury • Overview • Evaluation • Treatment • Intersection of mechanics & biologyThursday, February 14, 13
  • Overview • 40% of all sport injuries • Account for 25% of time lost in athletics • 23,000 sprains per/day in the U.S. • 10% of all ER visits in U.S. • Lateral ankle injuries = 85% • Medial ankle injury = 5% • Syndesmosis = 10% • Long term problems in up to 50%Thursday, February 14, 13
  • AnatomyThursday, February 14, 13
  • Sagittal Plane Axis of MotionThursday, February 14, 13
  • Peroneal Tendons • Assist lateral stability • Pulleys aid functioning • Behind malleolus • Around CuboidThursday, February 14, 13
  • Lateral Ankle Structures Affected • Anterior Talo-Fibular ligament • Calcaneo-fibular ligament • Posterior talo-fibular ligament • Anterior-inferior tibio-fibular ligamentThursday, February 14, 13
  • Lateral Ankle Structures Affected (2) • Peroneus brevis tendon • Peroneus longus tendon • Os peroneum • 5th metatarsal base - fracture • variant: Jone’s fracture • Interosseus ligament tear • Fibular fracture • Osteochondral fracture of TalusThursday, February 14, 13
  • Peroneal TendonsThursday, February 14, 13
  • Examination & Assessment • Look • Symmetry, Color, Swelling • Touch • Temperature, texture, tenderness • Move • Range of motion, limitations, pain on motionThursday, February 14, 13
  • Anterior Draw Stress X-rayThursday, February 14, 13
  • Ottawa Ankle Rules • Less than 15% of ankle injuries presenting to the ER have a fracture. Rules were set up for ankle and foot x-rays following ankle sprain • Tenderness at distal 6 cm of the posterior aspect of medial or lateral malleolus • Tenderness at tip of malleolus • Inability to walk 4 steps • Tenderness of base of 5th metatarsal or navicularThursday, February 14, 13
  • Thursday, February 14, 13
  • Long Term Prognosis • Residual instability, pain and swelling can occur in 20% to 40% of patients after a Grade II lateral ankle sprain. Review articles & Lectures: Doug Richie, Jr., DPMThursday, February 14, 13
  • Immediate Treatment • PRICE • Protection • Rest • Ice (24h - 48h) (long term - adverse impact to nerves, skin, blood flow) • Compression • ElevationThursday, February 14, 13
  • Staged Recovery • Immediate: PRICE • minimize swelling, hemorrhage, inflammation, pain • Week 1 - 3: Protection • collagen - proliferative phase (initially Type 3 collagen)Thursday, February 14, 13
  • Staged Recovery (2) • Week 3+ • Exercise & Rehabilitation • Improvement in collagen maturation phase • Graduated exercise programThursday, February 14, 13
  • Staged Exercises • Range of motion • ROM - all directions • Alphabet painting with toes • Theraband • Wobble board • Figure 8 runningThursday, February 14, 13
  • Wobble Board Training • Muscle strength • Balance • Joint position sense / proprioceptionThursday, February 14, 13
  • Problems: Ankle Instability • Mechanical • Laxity • Functional • Subjective sensation of instabilityThursday, February 14, 13
  • Ankle Instability and Sensorimotor Deficits Cutaneous Alpha Motor Receptors Neurons Articular Extrafusal CNS Receptors Muscle Fibers Tendon & Muscle Articular Gamma Motor Receptors Receptors NeuronsThursday, February 14, 13
  • Factors In Ankle Instability and Sensorimotor Deficits Reflex Reactions Walking Mechanics Postural Control Muscle Strength Running Mechanics Proprioception Jumping & Landing Passive Active Sensory MotorThursday, February 14, 13
  • Ankle Instability and Sensorimotor Deficits Postural Running Reflex Reactions Control Mechanics Muscle Walking Jumping & Proprioception Strength Mechanics Landing Passive Active Sensory MotorThursday, February 14, 13
  • Deficits • Proprioception = Primary Deficit • Improve balance • Improve strength • Peroneal tendon reflex & responsivenessThursday, February 14, 13
  • Bracing • Stability • Proprioceptive feedbackThursday, February 14, 13
  • Early Stages • AFO • Cam walker • Pneumatic walking boot • Control of ankle and STJ • Allows early ambulation with Grade II & Grade III injuryThursday, February 14, 13
  • Later Stage or Mild Injury • Gauntlet (lace-up) - Swede-O • Stirrup - semirigid plastic slabs • 3 in 1 • Airsplint sport - sleeve, stirrup, locking wrapThursday, February 14, 13
  • BracingThursday, February 14, 13
  • Brace SelectionThursday, February 14, 13
  • Smaller BracesThursday, February 14, 13
  • Brace Limitations • Age considerations • Balance in elderly • Leg length differences • Creation of new pains • Smaller braces - don’t fit in all shoes • Joint axis interactions • Weight of braces and bootsThursday, February 14, 13
  • Other Lateral Injuries • 5th metatarsal avulsion fracture • Jones fracture • Peroneus brevis tendon tear • Peroneus longus tendinopathy • Cuboid fractureThursday, February 14, 13