Ankle Injuries
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Ankle Sprains
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Single most common injury in athletics caused
by sudden inversion or eversion moments
Tibia
Fibula
Lateral Malleolus
Medial Malleolus
Bones
of
Foot & Ankle
Medial Aspect
Medial Malleolus
Head of Talus
Foot & Ankle Bones
Tarsal
sinus
Calcaneous
Cuboid
Lateral View
3rd - 5th
Metatarsals
Talus
Lateral Ligaments
Anterior Tibiofibular Ligament
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Palpation
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External Rotation Test
Locate area where tibia and
fibula meet
Spring Test
Anterior Talofibular Ligament
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Palpation
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Superior to sinus tarsi
Anterior Drawer Test
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Anterior translation of talus under tibia
May cause a clunking at end point
Indicates laxity
Posterior Talofibular Ligament
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Posterior Drawer Test
Stabilize Tibia
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Apply a posterior stress to the foot and ankle
Posterior translation indicates ligament laxity
Talar Tilt Test (Varus Stress)
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Assessment
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Calcaneofibular ligament
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Apply a varus stress to calcaneous
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Grade 1-3+
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Feel for cluck
Deltoid Ligaments
Valgus Stress Test
Inversion Sprains
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Injury to the lateral ligaments
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Anterior talofibular ligament
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Inversion
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Plantar flexion
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Internal rotation
Calcaneofibular ligament
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Inversion
Inversion Sprain
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Symptoms
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Pain
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Active motion
Resistive motion
Loss of function
Signs
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Tenderness
Swelling
Ecchymosis
1º Inversion Sprain
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Symptoms
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Pain: mild
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Active motion
Resistive motion
Loss of function
Weight bearing minimally impaired
Signs
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Point Tenderness
Swelling
Ecchymosis
No laxity
Management
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RICE
Weight bearing to tolerance
Tape or brace
Modalities as needed
Strengthening
Return to activity when functional
Average return 7-10 days
2º Inversion Sprain
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Etiology
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Moderate inversion force
Pathology
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Partial tearing of ligaments
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Anterior Talofibular
Calcaneofibular
Signs and Symptoms
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Pop or snap heard or felt
Moderate pain
Moderate disability
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Management
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RICE up to 72 hours
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X-ray if unable to weight bear
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Crutches 5-10 days
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Progress to weight bearing
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Protective immobilization
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Tape or brace
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Modalities as needed
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Early ROM exercises
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Strength & proprioception
exercises
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Return to activity when
functional
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Average return 7-10 days
Difficulty bearing weight
Tenderness
Edema
3º Inversion Sprain
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Etiology
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Signs and Symptoms
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Relatively uncommon
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Significant inversion force
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Subluxation and relocation
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Pathology
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Anterior talofibular ligament
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Calcaneofibular ligament
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Anterior tibiofibular ligament
Severe pain
Edema
Hemarthrosis (blood in joint)
Ecchymosis
Inability to bear weight
Positive Tests
Anterior drawer
Talar Tilt
Management
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
RICE
Refer to MD
Eversion Sprain
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Etiology
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Indirect
Direct force
Eversion of ankle
Inversion of ankle
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Signs
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Crush injury
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Symptoms
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Pain
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Tenderness
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Active motion
Resistive motion
Loss of function
Weight bearing
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Collapse of arch
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Special Tests
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Deltoid ligaments
Swelling
Ecchymosis
Valgus stress
External rotation test
Management
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
Arch and ankle taping
Orthotics
Ankle
Dislocation

Assess neurovascular status