Model Injuries                                Classroom Look At                                   Ankle Sprains           ...
Lateral Ankle Instability                          and Injury                     • Overview                     • Evaluat...
Overview                     •      40% of all sport injuries                     •      Account for 25% of time lost in a...
AnatomyThursday, February 14, 13
Sagittal             Plane                            Axis of MotionThursday, February 14, 13
Peroneal Tendons                     • Assist lateral stability                     • Pulleys aid functioning             ...
Lateral Ankle                            Structures Affected           • Anterior Talo-Fibular ligament           • Calcan...
Lateral Ankle                    Structures Affected (2)                     •      Peroneus brevis tendon                ...
Peroneal TendonsThursday, February 14, 13
Examination &                             Assessment              • Look               • Symmetry, Color, Swelling        ...
Anterior Draw                             Stress X-rayThursday, February 14, 13
Ottawa Ankle Rules                     •      Less than 15% of ankle injuries presenting to the                           ...
Thursday, February 14, 13
Long Term Prognosis                     • Residual instability, pain and swelling can                            occur in ...
Immediate Treatment                     • PRICE                      • Protection                      • Rest             ...
Staged Recovery                     • Immediate: PRICE                      • minimize swelling, hemorrhage,              ...
Staged Recovery (2)                     • Week 3+                     • Exercise & Rehabilitation                      • I...
Staged Exercises                     • Range of motion                      • ROM - all directions                      • ...
Wobble Board Training                     • Muscle strength                     • Balance                     • Joint posi...
Problems:                            Ankle Instability                     • Mechanical                      • Laxity     ...
Ankle Instability and Sensorimotor                                          Deficits                        Cutaneous      ...
Factors In Ankle Instability and                                Sensorimotor Deficits                 Reflex Reactions      ...
Ankle Instability and Sensorimotor                                           Deficits                                      ...
Deficits                     • Proprioception = Primary Deficit                     • Improve balance                     • ...
Bracing                     • Stability                     • Proprioceptive feedbackThursday, February 14, 13
Early Stages                     • AFO                      • Cam walker                      • Pneumatic walking boot    ...
Later Stage or                                Mild Injury                     • Gauntlet (lace-up) - Swede-O              ...
BracingThursday, February 14, 13
Brace SelectionThursday, February 14, 13
Smaller BracesThursday, February 14, 13
Brace Limitations                     • Age considerations                      • Balance in elderly                     •...
Other Lateral Injuries                     • 5th metatarsal avulsion fracture                     • Jones fracture        ...
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Quick and Simple Look At Lateral Ankle Injuries

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An overview for non-specialists

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Quick and Simple Look At Lateral Ankle Injuries

  1. 1. Model Injuries Classroom Look At Ankle Sprains Stephen M. Pribut, DPM Clinical Assistant Professor of Surgery, GWUMCThursday, February 14, 13
  2. 2. Lateral Ankle Instability and Injury • Overview • Evaluation • Treatment • Intersection of mechanics & biologyThursday, February 14, 13
  3. 3. 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
  4. 4. AnatomyThursday, February 14, 13
  5. 5. Sagittal Plane Axis of MotionThursday, February 14, 13
  6. 6. Peroneal Tendons • Assist lateral stability • Pulleys aid functioning • Behind malleolus • Around CuboidThursday, February 14, 13
  7. 7. Lateral Ankle Structures Affected • Anterior Talo-Fibular ligament • Calcaneo-fibular ligament • Posterior talo-fibular ligament • Anterior-inferior tibio-fibular ligamentThursday, February 14, 13
  8. 8. 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
  9. 9. Peroneal TendonsThursday, February 14, 13
  10. 10. Examination & Assessment • Look • Symmetry, Color, Swelling • Touch • Temperature, texture, tenderness • Move • Range of motion, limitations, pain on motionThursday, February 14, 13
  11. 11. Anterior Draw Stress X-rayThursday, February 14, 13
  12. 12. 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
  13. 13. Thursday, February 14, 13
  14. 14. 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
  15. 15. Immediate Treatment • PRICE • Protection • Rest • Ice (24h - 48h) (long term - adverse impact to nerves, skin, blood flow) • Compression • ElevationThursday, February 14, 13
  16. 16. Staged Recovery • Immediate: PRICE • minimize swelling, hemorrhage, inflammation, pain • Week 1 - 3: Protection • collagen - proliferative phase (initially Type 3 collagen)Thursday, February 14, 13
  17. 17. Staged Recovery (2) • Week 3+ • Exercise & Rehabilitation • Improvement in collagen maturation phase • Graduated exercise programThursday, February 14, 13
  18. 18. Staged Exercises • Range of motion • ROM - all directions • Alphabet painting with toes • Theraband • Wobble board • Figure 8 runningThursday, February 14, 13
  19. 19. Wobble Board Training • Muscle strength • Balance • Joint position sense / proprioceptionThursday, February 14, 13
  20. 20. Problems: Ankle Instability • Mechanical • Laxity • Functional • Subjective sensation of instabilityThursday, February 14, 13
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. Deficits • Proprioception = Primary Deficit • Improve balance • Improve strength • Peroneal tendon reflex & responsivenessThursday, February 14, 13
  25. 25. Bracing • Stability • Proprioceptive feedbackThursday, February 14, 13
  26. 26. 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
  27. 27. 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
  28. 28. BracingThursday, February 14, 13
  29. 29. Brace SelectionThursday, February 14, 13
  30. 30. Smaller BracesThursday, February 14, 13
  31. 31. 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
  32. 32. Other Lateral Injuries • 5th metatarsal avulsion fracture • Jones fracture • Peroneus brevis tendon tear • Peroneus longus tendinopathy • Cuboid fractureThursday, February 14, 13

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