ANkle

1. T
F
Ta
BONY ANKLE JOINT

2. P. Longus
P. Brevis
P. Tertius
Ext. Digitorum
Longus
Ext. Hallucis
Longus
Tib. Anterior
Tib. Posterior
Flex. Digitorum
Longus
Flex. Hallucis
Longus
Achilles
Tendon

3. SYNOVIAL JOINTS

5. LATERAL LIGAMENTS

7. Calcaneus Sustentaculum Tali
Navicular
Talus
Tibia
Deltoid
Ligament
MEDIAL ANKLE

8. ANKLE MOVEMENT AND
THE EFFECTS ON
LIGAMENTS
Plantar Neutral Dorsi

9. INVERSION
SPRAIN

11. A B
BOTH INVERSIONS?

12. INVERSION SPRAIN
85% of all sprains
Happens during
loading and unloading
of the ankle.

13. What ligament is the
first line of defence?
Depends on ankle position

14. Peroneus Brevis
Base 5th

15. Anterior Inf. Tib-fib.
Ant. Talofibular.
Post.
Talofib.
Calcaneofibular
P. Brevis
Base 5
Lateral Structures Ankle

16. MANDATE ON
PLAYING SURFACE
HOW SEVERE IS THE
INJURY.
HOW DO WE REMOVE
THEM FROM THE FIELD

17. ASSESSMENT
S.
O.
A.
P.
Subjective
Objective
Analysis
Plan

18. Subjective: Information
that is gathered from
the athlete.
Objective: Observable
or measurable findings.

19. WEIGHT BEARING
OR
NON-WEIGHT
BEARING

20. PAIN RESPONSE OF
DAMAGED TISSUE
1. Damaged muscle and
ligaments are painful
when stretched.
2. Damaged muscle is
painful to contract.

21. PAIN RESPONSE .. Con’t
3. Both structures are
painful if palpated at
the site of tear.

22. FIELD ASSESSMENT
Ankle Sprains - General
Mechanism of Injury
Pain …… where?
Hear/feel anything?
Injured before?
Continue with activity?

23. 1
2
3
4
PALPATION
Anterior Inferior
Tibiofibular Ligament
Anterior Talofibular
Base of 5th
Metatarsal
Calcaneofibular Lig.

24. INVERSION SPRAINS
One area of tenderness.
No sensation of tearing
or feeling unstable.
Full ROM with discomfort
on active plantar
flexion and inversion.
.. 2

25. .. 2
Stand athlete to check
for pain in ankle or
leg.
Walk to the sideline if
athlete can walk
without a limp.

26. INVERSION SPRAIN
At least two areas of pain.
Hear/feel of tearing.
Painful ankle.
Limitation of pl. flexion
and inversion.
2..

27. …2
Check to see if the
athlete can stand.
Determine where the pain
is located (leg pain
N.W.B.).
If they can walk, but limp,
remove N.W.B.

28. EVERSION SPRAIN
• Least common sprain.
• Most fractures happen in
eversion.
• Stability of the medial
ankle depends upon the
Deltoid Ligament and
the lateral malleolus.

29. EVERSION
• Slight medial tenderness.
• Pain and slight limitation
on active eversion.
• Stand to determine if
there is leg pain.
• Walk off playing surface if
not antalgic.

30. ANKLE SPRAIN
SEVERE
Rigid, high footwear.
Unable to continue on
with the activity.
Leg pain on standing.

33. Eversion and
External Rotation
of the ankle
without Deltoid
Ligament tear.

35. 2. Ant. Inf.
Tib-fib.
3. Fracture 1. Deltoid

37. Hockey Player
Inversion
Minimal Pain
Mild swelling
Mild bruising
Return in five
days

38. Day 6

40. THE MINOR SPRAIN
Can this athlete return to
play during this contest?
Definition… Discomfort
versus pain?
Pain changes the way you
do things!

41. Dissect the sport into its’
components starting from
the most simple on the
ankle and progress to the
most difficult. If they can
perform the test without
pain… then return.
(Following taping?)

42. NON-RETURNING
ATHLETE
C.I.C.E.R.
Crutches for proper gait.
Referral for physio.
Prepare for return.

46. PREPARE FOR RETURN
Aside from the ‘formal’
rehabilitation, the athlete
must work on maintaining
conditioning and doing
whatever sport skills they
can.

48. WHEN DO I KNOW
THAT I AM READY
TO RETURN?????

49. WALK
JOG
FIGURE 8
SHUTTLE RUN
Pain

50. Figure 8 and Shuttle Run
25 m
½ Speed
R
L
¾ Speed
FIGURE 8
SHUTTLE

51. ???