This PowerPoint is the epidemiology of ankle injuries in several sports-medical topics, including: kinesiology, anatomy, ankle pathology.

1. EPIDEMIOLOGY OF ANKLE INJURY
Nima Mehrabian & Fatemeh Allipoor
Supervisors: Dr.Latifi & Dr.Alizadeh
Department of Physical Education
Campus Alborz of Tehran University
Jan, 2022
1

2. Table of content
❖ Introduction……………………………………….……3
❖ Anatomy of Ankle……………………………….…..4
❖ Kinesiology of Ankle……………………….……….9
❖ Injury of Ankle……………………….……………...10
❖ Epidemiology………………………………….……...18
❖ Descriptive…………………………………….…….….21
❖ Analytic……………………………………………………28
❖ Conclusion……………………………………………….49
❖ Prevention…………………………………………….…50
❖ Usage or Application……………………………….51
❖ Summary…………………………………….…………..52
❖ References……………………………………...……...53
2

3. Introduction
• The ankles and feet contribute
significantly and effectively to
the production of lower limb
strength and consist of the
connection of the tibia and
fibula with the humerus.
Joseph Danley .B.2008
• The ankle is a stable joint that
is located at the junction of the
leg and foot and a lot of forces
are applied to it.
Dr. Mehrdad Mansory.A.2020
3

4. Anatomy of Ankle
 The ankle is made up of four basic bones:
➢ Talus
➢ Calcaneus
➢ Navicular
➢ Cuboid
Dr Mehrdad mansory.A .2020 4

5. Anatomy of Ankle
 The most important ankle joints are:
➢ Inferior tibiofibular joint
➢ Talocrural joint
➢ Subtalar joint
Dr.Mehrdad mansory.A.2020 5

6. Anatomy of Ankle
Internal and external
ligaments of the ankle
Internal ligament Deltoid ligament
External ligament
Anterior talofibular
ligament
Posterior talofibular
ligament
Calcaneofibular
ligament
Dr. Mehrdad Mansory.A.2020 6

7. Anatomy of Ankle
 Important ligaments of the tibia and fibula:
➢ Lower anterior tibiofibular ligament
➢ Inferior posterior tibiofibular ligament
➢ Posterior fibula ligament
➢ Transverse ligament
➢ Intraosseous ligament
Dr. Mehrdad mansory.A.2020 /https://www.physio-pedia.com/ 7

8. Anatomy of Ankle
Ankle
tendons
Achille
tendon
Flexor
tendons
Flexor
hallucis
longus
Flexor
digitorum
longus
Posterior
tibialis
Extensor
tendons
Extensor
hallucis
longus
Extensor
digitorum
longus
Anterior
tibialis
peroneus
tendons
Peroneus
brevis
Peroneus
longus
Dr. Mehrdad mansory.A.2020 8

9. Kinesiology of Ankle
 The most important ankle movements are:
➢ Dorsey Flexion
➢ Plantar flexion
➢ Inversion
➢ Eversion
Carol.A.Otis /https://www.researchgate.net/ 9

10. Ankle Injuries
➢ Peroneal tendonitis
➢ Anterior talofibular ligament rupture
➢ Calcaneofibular ligament rupture
➢ Rupture of the deltoid ligament
➢ Syndesmosis injury
➢ Leg sprains
➢ Tarsal Tunnel Syndrome
Dr.Mohamad hossieni.A.2020 /dr.forogh.com 10

11. Peroneal Tendonitis
➢ Peroneal tendonitis is a disease caused by
overexertion of the peroneal tendon.
➢ The most common causes of peroneal tendonitis
are:
➢ Running on uneven surfaces
➢ Decreased flexibility of the muscles in the back of
the leg
➢ Excessive physical activity
➢ Excessive rotation of the foot outwards
Dr. Mehrdad mansory.A.2020 /iranorthoped.com 11

12. Anterior Talofibular Ligament Rupture
• About 70% of ligament injuries are related to this
ligament alone.
• The most common symptoms of this injury are:
➢ Pain
➢ Swelling and tenderness
➢ Bruising
➢ Instability
Dr. Mohamad hossieni.B.2020 /https://orlandparkorthopedics.com 12

13. Calcaneofibular Ligament Rupture
• Ligament damage between the calcaneus bone and
the tibia can occur when the foot rotates inward.
• The most common symptoms of this injury are:
➢ Swelling and tenderness
➢ Pain
➢ Bruising
➢ Increased range of motion in rotation inward
Dr. Mohamad hossieni.B.2020 /http://scpt.ir/ 13

14. Rupture of the Deltoid Ligament
➢ Less than 10% of ankle ligament injuries are
deltoid ligament injuries, usually minor and
occur when the heel rotates outward.
➢ The most important symptoms of this injury are:
➢ pain
➢ Swelling and tenderness
➢ Increase the range of motion of the ankle
pronation and external rotation
Dr. Mohamad hossieni.B.2020 //http://scpt.ir 14

15. Syndesmosis Injury
➢ The most common mechanism of syndromic
injury is when the ankle is tilted up and out.
➢ The most important symptoms of this injury
are:
➢ Pain and swelling
➢ Long treatment period
➢ Acute sensitivity in the tibia and fibula
➢ Instability in the ankle joint
Dr. Mehrdad mansory.A.2020 / iranorthped.com 15

16. Tarsal Tunnel Syndrome
➢ Tarsal tunnel syndrome is a painful foot problem
that usually affects people who stand for a long
time.
➢ The most important cause of this injury are:
➢ Flat feet
➢ Osteoarthritis
➢ Overweight
➢ Diabetes
➢ Jobs that require long standing or walking
https://drheidarian.ir/ /dr.mohamadhossieni.B.2020 16

17. Leg Sprains
➢ If the amount of rotation in or out of the
foot is more than the ankle, the pressure
will cause the ligaments to stretch more
than normal.
➢ Ankle sprain is in three stages; Mild torsion,
moderate torsion, acute torsion.
➢ The most important cause of this injury are:
➢ Swelling
➢ Bruising
➢ Inability to bear weight
Dr.bijan forogh.A.2020 /drforogh.com 17

18. 18
Keywords
➢ Ankle injuries
➢ Ankle anatomy
➢ Ankle Kinesiology
➢ Epidemiology of ankle
➢ Ankle sprain and injury in sports Epidemiology
Analytic
Why
How
Descriptive
What is out
come
When
Where
Who
How many

19. Research Methods
19
Daniel Tik-Pui FONG
,et al 2019
A retrospective analysis of injury
prevalence data, injury incidence rates
and also examine demographic
information in athletes over five years
Sailesh V. Tummala et
al2020
A futuristic analysis was performed
based on student samples for basketball
ankle injuries based on descriptive
statistics studies.
Carlos Vicente
Andreoli et al .2020
A futuristic analysis was performed
based on student samples for basketball
ankle injuries based on descriptive
statistics studies.

20. Research Methods
20
Thomas W. Kaminski et
al 2013
Dr. Farzaneh Saki et al. Presented a
retrospective analysis of the prevalence of
injury and the type and area of injury in
handball.
Dr. Najmeh Rezaian et
al2020
Dr. Najmeh Rezaian has performed
futuristic analysis using descriptive data
and statistics in volleyball
Kurdi Ashkazari et
al.2020
Kurdi Ashkazari et al. A retrospective
analysis in the form of a review article on
descriptive statistics in the sports of
basketball, volleyball and handball

21. How many
 Prevalence of ankle injuries among
sports
Daniel Tik-Pui FONG ,et al 2019
21

22. How many
 Location of football injuries
34%
26%
19%
14%
7%
ankle knee thigh leg hip
Daniel Tik-Pui FONG ,et al 2019
22

23. How many
 Location of volleyball injuries
56%
14%
19%
6%
5%
ankle knee arm shoulder hand
Daniel Tik-Pui FONG ,et al 2019
23

24. How many
 Injury area in futsal athletes
23.7
22
13.2
7.4
6.3
0
0
0
0
0
0
0
0
0 5 10 15 20 25
ankle
knee
head
leg
foot
Series 3 Series 2 Series 1
Daniel Tik-Pui FONG ,et al 2019
24

25. How many
 Ankle injury incidence rate per 1000 in different sports
Daniel Tik-Pui FONG ,et al 2019
25

26. How many
 Rate of ankle injury in women and men
Carlos Vicente Andreoli et al .2020 26

27. Conclusion
➢ ankle ranked first in the most popular injured body site in most studies (24 sports,
➢ 34.3%), followed by knee (14 sports, 20.0%), head (8 sports, 11.4%), trunk (6 sports,
➢ 8.6%) and hand (6 sports, 8.6%). Figure 1 showed the weighted percentage of ankle
➢ injury in all 70 included sports. Ankle injury was most common in aero ball (80.0%),
➢ wall climbing (60.0%), indoor volleyball (45.6%), mountaineering (40.0%), netball
➢ (39.8%) and field events in track and field (39.2%). The prevalence of ankle injuries
➢ was over 20% in 25 sports
27

28. Who
 Comparison of Collegiate basketball game position during ankle injury between sexes.
Sailesh V. Tummala,et al 2020 28

29. Who
 Comparison of Collegiate basketball activity during ankle injury between sexes.
Sailesh V. Tummala et al2020 29

30. Conclusion
➢ Most ankle injuries in post-guard basketball athletes are more common in women
than men.
➢ In the center posts and the attack of men and women basketball athletes, according
to the prepared researches, the rate of injury of men is more than women.
➢ During the basketball game, the highest rate of ankle injury, rebounding in men and
the highest ankle injury in women occurred during the game.
30

31. Where
 Frequency and Rate of Common Ankle Injuries by Professional female Greek basketball
player Position
Nikolaos Kofotolis,et al 2007 31

32. Where
 Injury site in professional collegiate basketball athletes
Sailesh V. Tummala,et al2020 32

33. Conclusion
➢ Most injuries to the guard post occur in basketball athletes.
➢ The most common injury to American college basketball athletes in the
lateral ligament occurs in women.
33

34. When
 Injury rate of ankle injury in three sports during training and competition in Iran
Kurdi Ashkazari et al2020 34

35. When
 Men’s and Women’s Collegiate Basketball of time loss ankle injury
Sailesh V. Tummala et al.2020 35

36. when
 Practice type during ankle injury between Collegiate American basketball players
Sailesh V. Tummala et al2020 36

37. Conclusion
➢ According to research, the rate of basketball and handball injuries during the
match is more than during training.
➢ Basketball athletes with weak tears are three days away from the field.
➢ The rate of injury in conflict situations is higher in men than in women in
basketball.
37

38. What is out come
 Ankle Injury Rate by Mechanism and Severity in female Greek Professional
Basketball Players
Nikolaos Kofotolis,et al2007 38

39. What is out come
 Rates of Specific Ankle Injuries in
American Football League in
2009_2015
Mary K. Mulcahey2015 39

40. What is out come
 Most common ankle injury types in
different sports
Fong, Daniel Tik-Pui et al 2019 40

41. What is out come
 Expenses of Belgian athletes
according to the data of the
insurance company
E Cumps et al.2003 41

42. Conclusion
➢ The most common ankle injuries in professional Greek women basketball
players have been reported in dealing with an opponent.
➢ The highest rate of ankle injury in American League football is related to
sprain.
➢ According to the insurance company's report for injured Belgian athletes, the
highest costs are related to the ACL ligament and the ankle has low costs.
42

43. Why
 Investigating the causes of ankle
injury risk in football, basketball
and volleyball athletes in Iran
Kurdi Ashkazari et al2020
43

44. Why
44
Tummala et al 2018
The rate of ankle injuries in the National
Student Basketball League was lower for
women with 1.21 injuries per 1,000 athletes
than for men with 1.45 ankle injuries per
1,000.
Meeuwisse et al2003
Knee and ankle injuries have been reported
more in center basketball players than in
forward and guard players.

45. Why
45
Kucera et al2005
Extensive risk of ankle injury in young
football players who have previously
experienced a previous injury in the same
area. Who reported 61 to 69 percent of the
injuries being re-injured.
Arnason et al2004
In a study of 438 soccer players, poor
flexibility in the ankle and hamstring
muscle was a predictor of poor hamstring
muscle injury.

46. Conclusion
➢ Iranian handball players, the most common causes of injuries to the player's
collision with the opponent has been reported.
➢ The most important causes of injury in Iranian basketball players, collision
with the opponent has been reported as the first cause of injury.
➢ In Iranian volleyball players, the most important cause of ankle injury was
reported to be not warming the ankle properly.
46

47. How
47
Kurdi Ashkazari et al2020
Landing from a jump with collisions and shear
and torsional movement sIn basketball, landing
from jumping in defense on the net and Diving
in volleyball as well as fast movements
,Sudden stops, cuts and quick rerouting As the
most common mechanisms of handball The
damage is known.
Mckay et al 2001
About 45% of ankle injuries in basketball occur
during landing, and 30% of ankle injuries occur
in shear and torsion maneuvers.

48. How
48
Siyamaki et al 2020
The most common ankle injury in wrestling is
the ligaments on the outside of the ankle due
to an inward rotation.
Rezayian et al 2020
Ankle injuries in volleyball occur as a result of
collisions with other players (50%) and indirect
blows are secondary.

49. Conclusion
➢ Landing from a jump with collisions and shear and torsional movement sIn
basketball, landing from jumping in defense on the net and Diving in
volleyball as well as fast movements ,Sudden stops, cuts and quick rerouting
As the most common mechanisms of handball The damage is known.
49

50. Prevention
➢ Association Position Statement: Conservative Management and Prevention of
Ankle Sprains in Athletes:
➢ Syndesmotic ankle sprains should be treated more conservatively than lateral
ankle sprains. Acute management requires immobilization (non weight
bearing, walking boot, casting, or bracing) for a time period sufficient to
allow healing and functional return.
➢ Rest, ice, compression, and elevation (RICE) is almost universally accepted as
best practice by athletic trainers and other health care professionals
immediately after acute ankle sprains.
➢ in these studies included single-legged–stance balance training, balance
training with additional perturbation, balance training with upper extremity
movements or tasks, and dynamic jumping activities with a balance
component.
Thomas W. Kaminski et al 2013 50

51. Usage or application
51
McKeon et al 2008
reported a relative risk reduction
of 20% to 60% based on these
controlled trials.

52. summary
52
Title
Introduction The ankle is made up of a total of four bones and a set of ligaments
and tendons
type of study Retrospective / futuristic
How many On average, for every 2,000 people, 21.9% between men and women
who Women have more ankle injuries than men
Injury area Most injuries are sprain type
Injury time Most injuries during the race are more than during training
Types of damage Fracture, Sprint, Strain
Severity of injury The maximum distance from exercise in men is more than 3 days
Cause of injury Frequent jumps، Sudden stop، Jumping and shearing movements
How to damage Compression and rotational forces enter the ligaments and lead to
injury
prevention Strengthen muscles and stretching movements and muscle nerve
exercises

53. References
1.Dr.Mehrdad mansory.A.2020 from www.iranortoped.com
2.Dr.Mehrdad mansory.A.2020 from www.physio-pedia.com
3.Carol.A.B.Otis www.researchgate.net
4.Dr.Mohamad hossieni.B.2020 www.orlandparkorthopedics.com
5.Dr.Mohamad hossieni.B.2020 www.scpt.ir
6.Dr.Mehrdad mansory.A.2020 www.iranorthped.com
7.dr.mohamadhossieni.B.2020 https://drheidarian.ir/
8.Dr.bijan forogh.A.2020 www.drforogh.com
9.Daniel Tik-Pui FONG, Youlian HONG, Lap-Ki CHAN, Patrick Shu-Hang YUNG, Kai-Ming CHAN ,Department
of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University
of Hong Kong, Hong Kong, China.Department of Sports Science and Physical Education, Faculty of
Education, The Chinese University of Hong Kong, Hong Kong, China
10.Carlos Vicente Andreoli et al .2020
11.Sailesh V. Tummala, BS, David E. Hartigan, MD, Justin L. Makovicka, MD, Karan A. Patel, MD, and
Anikar Chhabra, MD, MS
12.Nikolaos Kofotolis, PhD and Eleftherios Kellis, PhD, Ankle Sprain Injuries: A 2-Year Prospective Cohort
Study in Female Greek Professional Basketball Players
53

54. 54
13. Mary K. Mulcahey, MD, Andrew S. Bernhardson, MD, Colin P. Murphy, BA, Angela Chang,§ BS, Tyler
Zajac, ATC, George Sanchez, BS, Anthony Sanchez, BS, James M. Whalen,|| MSEd, ATC, Mark D. Price,
MD, Thomas O. Clanton, MD, and Matthew T. Provencher, MD, CAPT, MC, USNR
14.E Cumps, E Verhagen, L Annemans, R Meeusen ,Injury rate and socioeconomic costs resulting from
sports injuries in Flanders: data derived from sports insurance statistics 2003
15.Mohammad Hasan Kordi Ashkezari, Abuzar Saadatian, Hamid Reza Falah Yakhdani, Saeid Abedinzadeh,
Epidemiology of Sports Injuries in Basketball, Volleyball, and Handball in Iran: A Systematic Review
16.Tummala et al, epidemiology of ankle injuries in men’s and women’s collegiate basketball,2018
17.Meeuwisse et al, Rates and risks of injury during intergollegiate basketball,2003
18.Kucera et al, Injury history as a risk factor for incident injury in youth soccer,2005
19.Arnason et al,The American journal of sports medicine,2004
20.Mckay et al, Ankle injuries in basketball :injury rate and risk factors, Biritish journal of sport
medicine,2001
21. Siyamaki et al 2020, Member of the faculty of the pathology department of the Institute of Asrar
22. Rezayian et al 2020, Assistant Professor of Physical Education, Islamic Azad University of Bojnourd
23. Thomas W. Kaminski et al,2013,National Athletic Trainers' Association Position Statement:
Conservative Management and Prevention of Ankle Sprains in Athletes
24. McKeon PO, Hertel J,J Athl Train. 2008

55. Thank You for Your Attention
55