Ankle Injuries and Related Conditions

Rotational Point and Ankle Movement

• Extensor digitorum longus: Located on top, neither everts nor inverts (maybe a weak inverter).

• Peroneal muscles: Located behind the lateral malleolus, they are evertors of the ankle.

• Axis of rotation: Tendon location relative to the axis determines movement.

Sideline Assessment Case

• Initial Observation: Profuse swelling along the medial malleolus of the left leg.

• Movements: Varus, valgus, and rotational movements limited due to pain.

• Ligament injury: Most likely the tibial calcaneal ligament because Inversion ankle sprain occurred. It was not the anterior talofibular ligament since it's an anterior view, and posterior is on the posterior side.

• Grade 3 ankle sprain: complete tearing of the anterior talofibular ligament, sometimes a calcaneofibular ligament involved with joint instability and inability to weight bear.

• Grade 2 ankle sprain: difficulty walking, but able to still walk.

Practical Exam Information

• Order reversal: The order of the practical and theory exams will be reversed this time.

• Location: Computer labs are booked, but bring laptops as a backup.

Lateral Ankle Sprain

• Typical presentation: Rolling the ankle with a combination of plantar flexion and inversion.

• Ligament Damage: Anterior talofibular ligament (ATF) is most likely damaged.

• Diagnosis: History of event causing pain and diagnostic tests.

• Radiographs: Recommended to rule out fibular fractures; fibula is not a weight-bearing bone.

• Special tests: Anterior drawer test to check for instability.

Plantar Fasciitis Case

• Symptoms: Heel pain, stiffness along the plantar surface, most intense in the morning and end of the day.

• Physical Exam: Point tenderness along the calcaneal tuberosity, exacerbated by passive dorsiflexion.

• Radiographs: Normal results.

• Cause: Plantar fascia inflammation.

• Pain Mechanism: Plantar fascia tightens during rest/sleep (plantar flexion), causing pain upon initial movement (first step in the morning), which then subsides. Pain worsens at the end of the day due to continuous tearing of focal adhesions.

• Treatment: Night splints to keep the foot in dorsiflexion, reducing overnight tightening.

Ankle Injury Case: Milo Lucic

• Symptoms: Diffuse swelling around the ankle, point tenderness, pain with ankle rotation and dorsiflexion.

• Diagnosis: Distal tibiofibular joint ligament tear (high ankle sprain).

• Mechanism: Twisting motion causing separation between tibia and fibula.
  Radiograph interpretation. Usually to rule out fractures.

Syndesmotic Sprain Details

• Ligaments Affected: Distal anterior tibiofibular ligament (ATFL), possibly with anterior or posterior distal tibial talar involvement.

• Diagnosis: Pain upon ankle rotation and positive squeeze test.

• Treatment: Bracing for support; may allow weight bearing.

Ankle Fractures and Dislocations

• Mechanism: Rotational motion leading to bone fractures instead of ligament tears.

• Common Fractures: Tibia and fibula fractures, often requiring plates and screws for stabilization.

• Ski Boot Fracture: Tib-fib fracture mid-shaft due to boot support directing force upwards.

Bone vs. Ligament Healing

• Bone: Heals completely without scar tissue, one of two tissues in the body that will heal without forming scar tissue (the liver being the other one).

• Ligaments: Form scar tissue, are less vascular, and do not heal as well; may result in long-term weakness around the joint.