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