Cedera Pergelangan kaki

2.  Ankle injuries fall into the same basic
categories as do all athletic injuries:
• Contusions
• Sprains
• Strains
• Fractures

3.  Lateral ankle sprains (85%)
› Plantar flexion and inversion
 Syndesmotic sprains (10%)
› Dorsi-flexion and/or eversion
 Medial ankle sprains (5%)
› Eversion

4. Ankle
Ecchymosis

7.  Lateral complex
› Ant. talofibular
› calcaneofibular
› Post. talofibular
 Syndesmosis
› Ant. Inf. tibiofibular
› Post.Inf. tibiofibular

8.  Syndesmosis:
› Ant. Inf. Tibiofibular
ligament
› Post. Inf. Tibiofibular
ligament
› Transverse
tibiofibular ligament
› Interosseous
membrane

9.  Major Ligament
complex is called the
Deltoid Ligament.
 It is the strongest of
the ankle ligaments
 Navicular bone
› post. Tibial tendon
attaches

10.  Provide proprioceptive information for
joint function
 Provide static stability to the joint and
prevent excessive motion
 Act as guides to direct motion

11.  Peroneus brevis
 Peroneus longus
› Both serve as the
major everters of
the ankle
› Also serve as plantar
flexors

12.  Major tendons
› Anterior tibialis
(dorsi-flexor)
› Achilles tendon
(plantar flexor)
› Medial tendons
 Posterior tibialis
(inverter and plantar
flexor)
 Flexor digitorum
longus
 Flexor hallucis longus

13.  Osseous Structures (bones)
› Tibia, fibula, talus
 Ligaments (static stabilizers)
› Lateral, medial, syndesmotic
 Muscles/Tendons (dynamic stabilizers)
› Plantar & Dorsi-flexors
› Everters (peroneals)
› Inverters (post & ant tibialis)

14.  History is always good!
› What happened?
› Which way did it bend?
› Could you walk?
› How much swelling/ecchymosis?
› When did it happen?
› What have you done for it?
› Have you sprained it before?

15. › Past history
› Mechanism of injury
› When does it hurt?
› Type of, quality of, duration of pain?
› Sounds or feelings?
› How long were you disabled?
› Swelling?
› Previous treatments?

16. › Postural deviations?
› Is there difficulty with walking?
› Deformities, asymmetries or swelling?
› Color and texture of skin, heat, redness?
› Patient in obvious pain?
› Is range of motion normal?

17. › Most helpful during the acute phase
› Remember your anatomy!
› Palpate the structures you know
 Boney prominences
 Ligaments
 Tendon insertions

18. › Check Range of Motion
 Plantar and Dorsi-flexion
 Inversion and Eversion
› Neurovascular status
› Strength?
 Not helpful in the acute setting
› Ligamentous testing
 May be very difficult to do in the acute setting

22.  Anterior Drawer Test tes utk
mengetahui integritas ligamen
talofibular anterior

23.  Tes utk mengetahui integritas ligamen
calcaneofibular

24.  Untuk mengetahui adanya cedera
syndesmotic

25. › Xrays are indicated to r/o fx if:
 Presents within 10 days of injury
 Unable to bear weight at time of injury or in
office
 Tenderness of distal 6cm of malleoli on the
post. Aspect.
 Tenderness over the base of the 5th met or
navicular bone

26.  Several Classifications Exist based on:
› Ligamentous injury and evidence of
instability
› Classification based on functional
impairment
› Number of ligaments involved
 Combination of the above

27.  Ligament status
› partial tear of the ligament
› mild tenderness and swelling
› no instability on exam when stressing
ligament
 Functional status
› Slight or no functional loss
› able to bear weight and ambulate with
minimal pain

28.  - The anterior talofibular ligament
affected
 - stress: minimal change on inversion,
normal anterior drawer
 - treatment by encouraging early active
movement:
 a) stationary cycling
 b) walking with protective taping or
semi-rigid brace ( Aircast splint )

29.  c) NSAIDS (anti-inflammatory medication)
 d) physiotherapy: electrotherapy,
strengthening exercises, proprioception.
 e) functional progression to running,
jumping, hopping, swerving, recovery
into 6 weeks

30. • Ligament Status
– Incomplete tear of the ligament
– Moderate pain swelling and tenderness
– Mild to mod. ecchymosis
– Mild to moderate instability of the ligament
• Functional status
– Some loss of motion and function
– patient has pain with weight-bearing and
ambulation

31.  - Complete tear of anterior talofibular
ligament with some damage of the
calcaneofibular ligament
 - laxity when inversion, anterior drawer
present
 - treatment: a) 1 week crutches, joint
taped or in aircast splint
 b) follow grade 1 rehabilitation

32. • Ligament Status
– Complete tear and loss of integrity of a
ligament.
– Severe swelling (more than 4cm around the
fibula)
– Severe ecchymosis
– Significant mechanical instability with ligament
stressing
• Functional Status
– Significant loss of function and motion
– patient is unable to bear weight or ambulate.

33.  - Uncommon severe injuries, associated
with fractures
 - treatment: 10 days NWB in aircast
brace, then PWB with the brace up to 6
weeks. Aggressive rehabilitation follows
 - surgical reconstruction must be
considered

36. – PRICEM
– Protection: (orthosis or brace)
– Rest: limit wt. Bearing until non-painful
– Ice, Compression, and Elevation
• Most important component acutely
• Limiting inflammation and swelling has been
shown to speed recovery
– Mobilize
• early range of motion has also been shown to
speed recovery

37. ACUTE
 Major goals in the acute
phase are to reduce
swelling and pain
 RICE
 AROM as long as it is pain
free.
 U/S, Laser, Acupuncture
 A brace can be used to
prevent inversion of the
foot
 Research shows that early
limited stress following the
inflammation phase might
promote faster, stronger
healing as it helps to align
the collagen fibers.
SUBACUTE
 U/S, laser, Acupuncture
 AROM without brace
starting with dorsiflexion
and plantarflexion
 Progressive isometric
exercises
 Cross fiber massage to the
ligament in late rehab
 Taping or tensor bandage
 Build up to functional skills
CHRONIC
 Resisted exercise
strengthening
 Balance and agility
 Proprioception training
 Functional training

38. - Ice
- Ultrasound
- Rest/Activity Modification
- Fix training errors
- Fix biomechanical problems
- Stretching
- Strengthening
- Taping

39. • PPhhaassee oonnee——IImmmmoobbiilliizzaattiioonn
• PPhhaassee ttwwoo--EEaarrllyy mmoottiioonn
• PPhhaassee tthhrreeee--SSttrreennggtthheenniinngg
• PPhhaassee ffoouurr--FFuunnccttiioonnaall aaccttiivviittyy
• PPhhaassee ffiivvee--RReettuurrnn ttoo ffuullll aaccttiivviittyy

43.  Neuromuscular
Control Training
› Can be enhanced
by training in
controlled activities
› Uneven surfaces,
BAPS boards, rocker
boards, or
Dynadiscs can also
be utilized to
challenge athlete

51.  Stretching of the Achilles tendon
 Strengthening of the surrounding muscles
 Proprioceptive training: balance
exercises and agility
 Wearing proper footwear and or tape
when appropriate

52.  Reviewed anatomy and clinical exam
 Ankle injuries are extremely common
with high potential for long term sequele.
 A through exam and early aggressive
treatment including a rehabilitation
program will lead to optimal results.