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- Chronic pain/disability
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- Recurrent Ankle instability
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- Osteochrondral defects of the talus
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- Peroneal tendon injuries
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- Neurovascular injuries
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- Tibiotalar OA
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- Pantalar OA
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- Grade I: Stretch with no macroscopic fibre disruption
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- Grade II: Partial Fibre disruption
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- Grade III: Rupture (Usually associated with another injury, usually f#) + syndesmotic structures + tendon rupture
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- Physically active people (basketball, football,soccer, soldiers)- most common
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- Males and females affected equally
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- Highest in 15-19 yo
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- Limited ankle dorsiflexion
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- Previous Hx of ankle sprain
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- Lateral ankle = inversion sprain
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- Medial ankle = eversion sprain (rare due to limited eversion of the ankle)
Usually occurs due to eversion/pronation and abduction/external rotation Foot planted in pronation, upper body falls laterally -unexpected misstep/landing on uneven surface |
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- Sudden onset of pain from "rolling the ankle"/landing from a jump/stepping into a hole
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- Pts may recall a pop at the time
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- Pain from mild aching to intense (worse at the end of the day
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- Aggravated by weight bearing
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- Swelling (worse at the end of the day)
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- Rapid bruising and swelling could indicate rupture
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- Bruising and discolouration gradually gravitates towards foot
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- Cold foot and or paraesthesia = neurovascular compromise/compartment syndrome
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- Tenderness over affected ligament
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- ROM may be painful on passive inversion/dorsiflexion (lateral) or passive eversion (medial)
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- +ve Talar tilt, +ve Anterior draw test, +ve ankle eversion stress test +ve external rot test
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- Syndesmotic sprains can be differentiated with the fibular squeeze test (rare in the general population, ankle in high forced ext rot and/ankle dorsiflexion)
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- Palpation dorsalis pedis and posterior tibia pulses + sensation over foot for neurovascular compromise
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- Suspect instability = recurrent sprains, difficulty running on uneven surfaces, cutting and jumping, giving way
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- Palpation of ATFL, CFL and PTFL and medial ankle and entire fibula to assess for f# (pain and crepitus)
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- Assess foot : especially navicular, midfoot and 5th metatarsal
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- Significant Instability
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- Significant Crepitus
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- Catching
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- No response to conservative care after 4-6 weeks
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- MRI/US considered
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- Syndesmotic sprain
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- F# (Lisfranc)
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- Dislocation
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- Intraaritcular meniscoid
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- Subtalar sprain
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- Achilles tendinopathy
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- CRPS
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- Inflammatory Arthropathy
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- Usually heal quickly, but some report pain, instability, crepitus, weakness, stiffness, swelling
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- PRICE for 72 hours after injury
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- Ice/ice massage for 15 minutes each hour
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- NSAID advice
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- All sprains may require complete immobilisation
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- Prevention = taping/using devices (air splint/velcro brace)
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- Then manual therapy
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- Joint mobilisation
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- Transverse friction massage of affected ligament
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- Myofascial release and stretching of gastrosoleus
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- Ankle Alphabet
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- When ROM, pain and swelling improves, move onto strengthening
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- Strengthening includes isometric contractions against immobile object then to dynamic resistance with weights, tubing, bands
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- Strenghtening of dorsiflexion, plantar flexion, inversion and eversion
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- Strengthening of Peroneals (resisted eversion)
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- If ankle is instable = hip abductor strengthening
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-Wobbleboard to gain proprioception
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- Return to activity starts with straight line then progress to forwards/backwards, side to side,pivoting cutting motions
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- Return to play = full pain free ROM and ankle strength >80-90%
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- Grade III/ syndesmosis involvement = surgical consult (younger patients with occupation/activities that places them at higher risk of re-injury)
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- If ligamentous laxity - immobilise and crutches should be given, refer to orthopaedic surgeon (could be osteochondral defects of the talus, peroneal tendon, intra-articular loose bodies and fractures)
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- Symptom's worse when standing
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- Symptoms worse in the evening
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- Navicular drop >5mm
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- Distal tibiofibular joint hypomobility
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- Mild- Moderate sprains usually recover within 7-15 days
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- Instability and defects occur in 25-40% of patients
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