Acute Ankle Injuries

normal DF ROM

20 degrees

normal PF ROM

50 degrees

amount of DF needed for walking

10 degrees

normal eversion ROM

5-10 degrees

normal inversion ROM

20-30 degrees

common acute ankle injuries

lateral ligament sprain (ATFL, CFL, PTFL)

less common acute ankle injuries

osteochonral lesion of talus, medial ligament sprain, anteroinferior tibiofibular ligament injury, fractures, dislocation, tendon rupture

acute ankle injury that should not be missed

sprained syndesmosis

cause of lateral ankle sprain

landing on foot in PF and inversion

grade I lateral ankle sprain

ATFL, slight/local edema, able to WB, ligament stretched

grade II lateral ankle sprain

ATFL and CFL, moderate/local edema, difficult to WB, partial tear of ligament, slight instability

grade III lateral ankle sprain

all ligaments involved, significant/diffuse edema, impossible to WB without pain, complete tear of the ligaments

directions that stress the ATFL

PF, inversion

directions that stress the CFL

DF, inversion

initial management of acute ankle injuries

PRICE and POLICE

why is a pad put under the wrap of a lateral ankle sprain

applies more compression to keep the swelling out of the area

ligaments involved in a high ankle sprain

anterior tibiofibular ligament, interosseous ligament

types of ligament tests

anterior drawer, talar tilt

tests for syndesmosis

distal tibiofibular compression, DF compression, ER test, heel thump, kleiger, squeeze test

clinical prediction rules for ankle sprain

symptoms worse with standing, symptoms worse in evening, navicular drop more than 5 mm, distal tibiofibular hypomobility

cause of persistent pain after ankle sprain

osteochondral lesions of the talar dome (bruising of cartilage into bone), avulsion fracture of base of fifth metatarsal

why can an avulsion fracture of the base of the fifth metatarsal occur after an ankle sprain

the peroneals are trying to prevent a sprain and pull on it

cause of longitudinal tear of peroneals

rubbing against the bone because they are dislocated

causes of persistent ankle pain

dislocation of peroneal tendons, AITF ligament injury, syndesmosis injury, synovitis, sinus tarsi syndrome

lisfranc midfoot injury

can feel like an ankle sprain that results in bruising on plantar foot