This document discusses ankle sprains, providing an overview of their prevalence, anatomy involved, examination techniques, treatment stages, and bracing options. Some key points include: ankle sprains account for 40% of sports injuries and 10% of ER visits; lateral ankle sprains make up 85% of cases; examination involves assessing for swelling, tenderness, and range of motion limitations; treatment follows the PRICE method initially and later incorporates exercises to improve range of motion, strength, proprioception, and mechanics; bracing can provide stability and proprioceptive feedback during rehabilitation.
This document outlines the modules of an orthopedic semiology textbook for medical assistants and medical experts. It lists 25 modules that cover topics like orthopedic terminology, musculoskeletal diseases, orthopedic exams, specific body parts and injuries, and includes references to online videos and textbooks about orthopedic physical exams, conditions, and treatments.
Dr Pooja Joshi presented on motor control in ankle instability. The ankle is a stable hinge joint made unstable by injury or repeated trauma. Assessment of ankle instability includes history, physical exam testing ranges of motion and ligaments, and evaluating proprioception and neuromotor control. Treatment focuses on reducing pain and swelling followed by motor control training using techniques like motor imagery, mirror therapy, and bracing to prevent further injury and give closed loop feedback to the central nervous system.
Chronic ankle instability and syndesmotic injuriesKent Heady
Chronic ankle instability and syndesmotic injuries are debilitating conditions that can result from untreated ankle sprains. Chronic ankle instability incorporates recurrent sprains, persistent pain, and repeated instances of the ankle giving way. It is caused by ligament damage and long-term alterations to proprioception and muscle function. Syndesmotic injuries specifically involve damage to ligaments connecting the fibula and tibia. Both conditions are typically treated first with rehabilitation, and surgery is indicated if instability symptoms persist. Surgical options aim to anatomically repair damaged ligaments or use screws or sutures to stabilize the syndesmosis. Postoperative rehabilitation focuses on immobilization and physical therapy to regain strength and function.
This document discusses chronic ankle instability (CAI) pathobiomechanics and manual therapy treatment approaches. It notes that individuals with CAI exhibit altered muscle activation patterns and eccentric weakness during gait compared to healthy individuals. Manual therapy techniques like joint mobilization and manipulation can improve ankle range of motion and landing kinematics in individuals with CAI. Combining manual therapy with exercises may provide better outcomes than exercises alone for treating acute ankle sprains.
This document provides an overview of common ligamentous and tendon injuries around the ankle. It describes the anatomy of the ankle joint and surrounding ligaments. It then discusses the evaluation and treatment of lateral and medial ankle sprains, syndesmotic injuries, ankle dislocations, Achilles tendon ruptures, and peroneal tendon dislocations. For each injury, the document outlines the typical mechanism, clinical findings, imaging evaluation, classification systems, and non-surgical and surgical management approaches.
Ankle and foot injuries can include ligament sprains, fractures, and tendon injuries. The most common ankle injury is a lateral ankle sprain caused by inversion of the foot. Ankle sprains are graded based on severity from grade 1 to 3. Fractures of the ankle include fractures of the medial and lateral malleoli. Other injuries discussed include fractures of the talus, calcaneus, metatarsals and phalanges. Injuries are treated initially with RICE and rehabilitation, while more severe injuries may require surgery. Complications can include malunion, nonunion, arthritis and tendonitis.
A grade 3 ankle sprain is a complete tear of one or more ankle ligaments. It causes significant swelling, tenderness, instability, and pain when the ankle is moved. The injured ligaments include the posterior talofibular, anterior talofibular, and calcaneofibular ligaments. Treatment may involve immobilization, physical therapy over a long period of time, and possible surgical reconstruction. Recovery from a grade 3 ankle sprain can take up to 9 months.
This document outlines the modules of an orthopedic semiology textbook for medical assistants and medical experts. It lists 25 modules that cover topics like orthopedic terminology, musculoskeletal diseases, orthopedic exams, specific body parts and injuries, and includes references to online videos and textbooks about orthopedic physical exams, conditions, and treatments.
Dr Pooja Joshi presented on motor control in ankle instability. The ankle is a stable hinge joint made unstable by injury or repeated trauma. Assessment of ankle instability includes history, physical exam testing ranges of motion and ligaments, and evaluating proprioception and neuromotor control. Treatment focuses on reducing pain and swelling followed by motor control training using techniques like motor imagery, mirror therapy, and bracing to prevent further injury and give closed loop feedback to the central nervous system.
Chronic ankle instability and syndesmotic injuriesKent Heady
Chronic ankle instability and syndesmotic injuries are debilitating conditions that can result from untreated ankle sprains. Chronic ankle instability incorporates recurrent sprains, persistent pain, and repeated instances of the ankle giving way. It is caused by ligament damage and long-term alterations to proprioception and muscle function. Syndesmotic injuries specifically involve damage to ligaments connecting the fibula and tibia. Both conditions are typically treated first with rehabilitation, and surgery is indicated if instability symptoms persist. Surgical options aim to anatomically repair damaged ligaments or use screws or sutures to stabilize the syndesmosis. Postoperative rehabilitation focuses on immobilization and physical therapy to regain strength and function.
This document discusses chronic ankle instability (CAI) pathobiomechanics and manual therapy treatment approaches. It notes that individuals with CAI exhibit altered muscle activation patterns and eccentric weakness during gait compared to healthy individuals. Manual therapy techniques like joint mobilization and manipulation can improve ankle range of motion and landing kinematics in individuals with CAI. Combining manual therapy with exercises may provide better outcomes than exercises alone for treating acute ankle sprains.
This document provides an overview of common ligamentous and tendon injuries around the ankle. It describes the anatomy of the ankle joint and surrounding ligaments. It then discusses the evaluation and treatment of lateral and medial ankle sprains, syndesmotic injuries, ankle dislocations, Achilles tendon ruptures, and peroneal tendon dislocations. For each injury, the document outlines the typical mechanism, clinical findings, imaging evaluation, classification systems, and non-surgical and surgical management approaches.
Ankle and foot injuries can include ligament sprains, fractures, and tendon injuries. The most common ankle injury is a lateral ankle sprain caused by inversion of the foot. Ankle sprains are graded based on severity from grade 1 to 3. Fractures of the ankle include fractures of the medial and lateral malleoli. Other injuries discussed include fractures of the talus, calcaneus, metatarsals and phalanges. Injuries are treated initially with RICE and rehabilitation, while more severe injuries may require surgery. Complications can include malunion, nonunion, arthritis and tendonitis.
A grade 3 ankle sprain is a complete tear of one or more ankle ligaments. It causes significant swelling, tenderness, instability, and pain when the ankle is moved. The injured ligaments include the posterior talofibular, anterior talofibular, and calcaneofibular ligaments. Treatment may involve immobilization, physical therapy over a long period of time, and possible surgical reconstruction. Recovery from a grade 3 ankle sprain can take up to 9 months.
This document discusses ankle arthritis, including its pathophysiology, clinical presentation, imaging, and treatment options. Primary ankle osteoarthritis is rare due to the ankle's high congruency and stability, but secondary osteoarthritis is more common following trauma. Imaging can include x-rays, CT, MRI, and injections to determine the location of pain. Conservative treatment includes NSAIDs, injections, and bracing, while surgical options include arthroscopic debridement, osteotomies, ankle replacement, and arthrodesis (fusion). Ankle fusion is a reliable treatment but limits mobility, while replacement shows improving results but higher short-term complication rates. Complications of treatment include nonunion, malunion, infection, and adjacent joint
The human foot and ankle are mechanically complex structures. The foot contains 26 bones, 33 joints, muscles, ligaments, and a network of arteries, veins and nerves. It withstands great pressure and provides flexibility. The ankle serves as a shock absorber and propels movement, composed of the fibula, tibia and talus bones and ligaments. Common foot and ankle problems affect 3 in 4 people in the US. Seek medical treatment for severe or persistent pain, swelling, inability to bear weight, or signs of infection.
This document discusses ankle sprains and ligament injuries, including the different types of ankle ligaments, grading of sprains, differential diagnosis, evaluation, treatment options, rehabilitation, and surgical indications and techniques. It notes that functional treatment for ankle sprains is generally better than casting. For chronic ankle instability, assessment includes stress views and MRI to plan potential surgical repair or reconstruction of the lateral ligaments. Anatomic repair of the ligaments is preferred over non-anatomic reconstruction when surgery is indicated.
This document provides a supplement and revision to the 2001 Clinical Practice Guideline on the diagnosis and treatment of heel pain published in the Journal of Foot & Ankle Surgery. It outlines a pathway for evaluating and managing plantar heel pain, which is the most common type of heel pain seen in clinical practice. A thorough history and physical exam can usually determine the cause is mechanical in nature and rule out other potential etiologies. Conservative treatment is recommended first and includes padding, strapping, orthotics, medications, stretching, and corticosteroid injections. For patients who do not improve with conservative care, further treatment options are outlined in a three-tier ladder approach including night splints, additional orthotics, immobilization, injections
This document discusses clinical prediction rules (CPRs), which are decision tools used by clinicians to predict outcomes. It covers the development, validation, and functions of CPRs. Specifically, it outlines 8 standards for developing a CPR, including clearly defining outcomes and predictors, ensuring reliability of predictors, having an adequate sample size, and accurately measuring a CPR's performance. An example CPR for ankle fractures is used to illustrate the development process. The document emphasizes the importance of prospectively validating CPRs in new populations before implementation, to assess their accuracy outside the initial study.
The document summarizes anatomy and common injuries of the foot, ankle, and lower leg. It describes the 26 bones, 38 joints, ligaments, muscles, and four arches of the foot. The most commonly injured joint is the ankle, with sprains being most frequent. Other common injuries include blisters, calluses, athlete's foot, turf toe, arch strains, fractures, plantar fasciitis, shin splints, stress fractures, heel spurs, compartment syndrome, and Achilles tendon injuries. Special tests are used to evaluate injuries and determine if referral is needed.
Discover the most common reasons why people everyday experience foot and ankle pain, and what can be done to prevent and treat the problem. This informative slideshow was created by Advanced Podiatry of Tampa, Florida.
A podiatrist specializes in diagnosing and treating conditions of the foot, ankle, and lower leg. They attend podiatric medical school for four years and complete a residency. Common conditions treated include dermatological issues like fungal nail infections, orthopedic problems like plantar fasciitis and bunions, neurological disorders, and diabetes-related foot complications. Treatment options may include debridement, medications, orthotics, surgery, and wound care depending on the specific condition. Regular foot care can help prevent complications in patients with diabetes.
The document discusses various types of ankle injuries and treatments. It focuses on ankle arthritis, cartilage defects, and ligament injuries. For cartilage defects, it recommends treating the worst lesion with cartilage grafting from the tibia. Rehabilitation for cartilage grafting involves initial non-weight bearing, continuous passive motion therapy, and a early emphasis on regaining full range of motion. Rehabilitation for ankle injuries generally should provide protection, improve joint mechanics and gait, enhance proprioception, and restore patient function.
This document describes the symptoms and treatment for a grade 2 ankle sprain. A grade 2 sprain involves a partial tearing of the ligaments in the lateral part of the ankle. Initial signs include moderate to severe pain, swelling, stiffness, bruising, decreased range of motion, and possible instability. Treatment involves RICE (rest, ice, compression, elevation) for two days followed by range of motion and strengthening exercises. Recovery takes 2-6 weeks with treatment and physical therapy.
This document provides an overview of common foot and ankle problems, including tendoachilles tendinopathy, plantar fasciitis, tibialis posterior tendinopathy, hallux valgus, MTPJ OA, and Morton's neuroma. For each condition, it describes typical presentation, recommended first-line treatments in primary care including physiotherapy, referral criteria if conservative treatment fails, and potential surgical interventions. Common investigations like ultrasound are also mentioned. The document aims to inform primary care providers on evaluating and managing some frequent foot and ankle issues.
Common foot and ankle injuries and diseasesCATHY WILLIAMS
The document discusses common foot and ankle injuries and diseases such as Achilles tendonitis, arthritis, bunions, diabetic foot issues, flat feet, hammertoes, and heel pain. It also covers foot fractures. The document then discusses treatment options for foot and ankle problems available at RNV Podiatry, including over 1300 surgical procedures performed by Dr. Rachel N. Verville at her clinics in Plano, Frisco, and Dallas, Texas. Contact information is provided at the end.
This document discusses the management of foot and ankle trauma. It begins with an overview of the anatomy of the ankle joint and examination of the foot and ankle. It then covers the assessment and management of ankle fractures, including distinguishing stable from unstable fractures. Weight bearing x-rays may better determine stability compared to stress views. Finally, it discusses the management of Achilles tendon ruptures, noting early loading and mobilization leads to better outcomes compared to immobilization.
Ankle sprains are common sports injuries, especially in basketball, soccer, football, and running. This document provides treatment guidelines for both acute and chronic ankle sprains. The rehabilitation process involves regaining range of motion, strengthening muscles through exercises of increasing difficulty, training proprioception and balance, and returning to activity-specific training. Preventing relapses is important and can be aided by sports-specific and injury prevention exercises.
This document discusses ankle arthritis, including its pathophysiology, clinical presentation, imaging, and treatment options. Primary ankle osteoarthritis is rare due to the ankle's high congruency and stability, but secondary osteoarthritis is more common following trauma. Imaging can include x-rays, CT, MRI, and injections to determine the location of pain. Conservative treatment includes NSAIDs, injections, and bracing, while surgical options include arthroscopic debridement, osteotomies, ankle replacement, and arthrodesis (fusion). Ankle fusion is a reliable treatment but limits mobility, while replacement shows improving results but higher short-term complication rates. Complications of treatment include nonunion, malunion, infection, and adjacent joint
The human foot and ankle are mechanically complex structures. The foot contains 26 bones, 33 joints, muscles, ligaments, and a network of arteries, veins and nerves. It withstands great pressure and provides flexibility. The ankle serves as a shock absorber and propels movement, composed of the fibula, tibia and talus bones and ligaments. Common foot and ankle problems affect 3 in 4 people in the US. Seek medical treatment for severe or persistent pain, swelling, inability to bear weight, or signs of infection.
This document discusses ankle sprains and ligament injuries, including the different types of ankle ligaments, grading of sprains, differential diagnosis, evaluation, treatment options, rehabilitation, and surgical indications and techniques. It notes that functional treatment for ankle sprains is generally better than casting. For chronic ankle instability, assessment includes stress views and MRI to plan potential surgical repair or reconstruction of the lateral ligaments. Anatomic repair of the ligaments is preferred over non-anatomic reconstruction when surgery is indicated.
This document provides a supplement and revision to the 2001 Clinical Practice Guideline on the diagnosis and treatment of heel pain published in the Journal of Foot & Ankle Surgery. It outlines a pathway for evaluating and managing plantar heel pain, which is the most common type of heel pain seen in clinical practice. A thorough history and physical exam can usually determine the cause is mechanical in nature and rule out other potential etiologies. Conservative treatment is recommended first and includes padding, strapping, orthotics, medications, stretching, and corticosteroid injections. For patients who do not improve with conservative care, further treatment options are outlined in a three-tier ladder approach including night splints, additional orthotics, immobilization, injections
This document discusses clinical prediction rules (CPRs), which are decision tools used by clinicians to predict outcomes. It covers the development, validation, and functions of CPRs. Specifically, it outlines 8 standards for developing a CPR, including clearly defining outcomes and predictors, ensuring reliability of predictors, having an adequate sample size, and accurately measuring a CPR's performance. An example CPR for ankle fractures is used to illustrate the development process. The document emphasizes the importance of prospectively validating CPRs in new populations before implementation, to assess their accuracy outside the initial study.
The document summarizes anatomy and common injuries of the foot, ankle, and lower leg. It describes the 26 bones, 38 joints, ligaments, muscles, and four arches of the foot. The most commonly injured joint is the ankle, with sprains being most frequent. Other common injuries include blisters, calluses, athlete's foot, turf toe, arch strains, fractures, plantar fasciitis, shin splints, stress fractures, heel spurs, compartment syndrome, and Achilles tendon injuries. Special tests are used to evaluate injuries and determine if referral is needed.
Discover the most common reasons why people everyday experience foot and ankle pain, and what can be done to prevent and treat the problem. This informative slideshow was created by Advanced Podiatry of Tampa, Florida.
A podiatrist specializes in diagnosing and treating conditions of the foot, ankle, and lower leg. They attend podiatric medical school for four years and complete a residency. Common conditions treated include dermatological issues like fungal nail infections, orthopedic problems like plantar fasciitis and bunions, neurological disorders, and diabetes-related foot complications. Treatment options may include debridement, medications, orthotics, surgery, and wound care depending on the specific condition. Regular foot care can help prevent complications in patients with diabetes.
The document discusses various types of ankle injuries and treatments. It focuses on ankle arthritis, cartilage defects, and ligament injuries. For cartilage defects, it recommends treating the worst lesion with cartilage grafting from the tibia. Rehabilitation for cartilage grafting involves initial non-weight bearing, continuous passive motion therapy, and a early emphasis on regaining full range of motion. Rehabilitation for ankle injuries generally should provide protection, improve joint mechanics and gait, enhance proprioception, and restore patient function.
This document describes the symptoms and treatment for a grade 2 ankle sprain. A grade 2 sprain involves a partial tearing of the ligaments in the lateral part of the ankle. Initial signs include moderate to severe pain, swelling, stiffness, bruising, decreased range of motion, and possible instability. Treatment involves RICE (rest, ice, compression, elevation) for two days followed by range of motion and strengthening exercises. Recovery takes 2-6 weeks with treatment and physical therapy.
This document provides an overview of common foot and ankle problems, including tendoachilles tendinopathy, plantar fasciitis, tibialis posterior tendinopathy, hallux valgus, MTPJ OA, and Morton's neuroma. For each condition, it describes typical presentation, recommended first-line treatments in primary care including physiotherapy, referral criteria if conservative treatment fails, and potential surgical interventions. Common investigations like ultrasound are also mentioned. The document aims to inform primary care providers on evaluating and managing some frequent foot and ankle issues.
Common foot and ankle injuries and diseasesCATHY WILLIAMS
The document discusses common foot and ankle injuries and diseases such as Achilles tendonitis, arthritis, bunions, diabetic foot issues, flat feet, hammertoes, and heel pain. It also covers foot fractures. The document then discusses treatment options for foot and ankle problems available at RNV Podiatry, including over 1300 surgical procedures performed by Dr. Rachel N. Verville at her clinics in Plano, Frisco, and Dallas, Texas. Contact information is provided at the end.
This document discusses the management of foot and ankle trauma. It begins with an overview of the anatomy of the ankle joint and examination of the foot and ankle. It then covers the assessment and management of ankle fractures, including distinguishing stable from unstable fractures. Weight bearing x-rays may better determine stability compared to stress views. Finally, it discusses the management of Achilles tendon ruptures, noting early loading and mobilization leads to better outcomes compared to immobilization.
Ankle sprains are common sports injuries, especially in basketball, soccer, football, and running. This document provides treatment guidelines for both acute and chronic ankle sprains. The rehabilitation process involves regaining range of motion, strengthening muscles through exercises of increasing difficulty, training proprioception and balance, and returning to activity-specific training. Preventing relapses is important and can be aided by sports-specific and injury prevention exercises.
1. Model Injuries
Classroom Look At
Ankle Sprains
Stephen M. Pribut, DPM
Clinical Assistant Professor of Surgery, GWUMC
Thursday, February 14, 13
2. Lateral Ankle Instability
and Injury
• Overview
• Evaluation
• Treatment
• Intersection of mechanics & biology
Thursday, February 14, 13
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
10. Examination &
Assessment
• Look
• Symmetry, Color, Swelling
• Touch
• Temperature, texture, tenderness
• Move
• Range of motion, limitations, pain on motion
Thursday, February 14, 13
11. Anterior Draw
Stress X-ray
Thursday, February 14, 13
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 navicular
Thursday, February 14, 13
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., DPM
Thursday, February 14, 13
17. Staged Recovery (2)
• Week 3+
• Exercise & Rehabilitation
• Improvement in collagen maturation
phase
• Graduated exercise program
Thursday, February 14, 13
18. Staged Exercises
• Range of motion
• ROM - all directions
• Alphabet painting with toes
• Theraband
• Wobble board
• Figure 8 running
Thursday, February 14, 13
19. Wobble Board Training
• Muscle strength
• Balance
• Joint position sense / proprioception
Thursday, February 14, 13
20. Problems:
Ankle Instability
• Mechanical
• Laxity
• Functional
• Subjective sensation of instability
Thursday, February 14, 13
21. Ankle Instability and Sensorimotor
Deficits
Cutaneous Alpha Motor
Receptors Neurons
Articular Extrafusal
CNS
Receptors Muscle Fibers
Tendon & Muscle Articular Gamma Motor
Receptors Receptors Neurons
Thursday, February 14, 13
22. Factors In Ankle Instability and
Sensorimotor Deficits
Reflex Reactions Walking Mechanics
Postural Control Muscle Strength Running Mechanics
Proprioception Jumping & Landing
Passive Active
Sensory Motor
Thursday, February 14, 13
23. Ankle Instability and Sensorimotor
Deficits
Postural Running
Reflex Reactions
Control Mechanics
Muscle Walking Jumping &
Proprioception
Strength Mechanics Landing
Passive Active
Sensory Motor
Thursday, February 14, 13
26. Early Stages
• AFO
• Cam walker
• Pneumatic walking boot
• Control of ankle and STJ
• Allows early ambulation with Grade II &
Grade III injury
Thursday, February 14, 13
27. Later Stage or
Mild Injury
• Gauntlet (lace-up) - Swede-O
• Stirrup - semirigid plastic slabs
• 3 in 1
• Airsplint sport - sleeve, stirrup, locking
wrap
Thursday, February 14, 13
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 boots
Thursday, February 14, 13
32. Other Lateral Injuries
• 5th metatarsal avulsion fracture
• Jones fracture
• Peroneus brevis tendon tear
• Peroneus longus tendinopathy
• Cuboid fracture
Thursday, February 14, 13