PT677- Ankle Sprains & Complications

Characteristics of CAI

- persistent pain - recurrent sprains (repeated episodes of ankle give- way)

MOI of most ankle sprains ___% syndes __% eversion

80% PF & INV 10% syndesmoses > 3% eversion Male=Female

what will radiographic imaging show with a high ankle sprain? gap should be less than ___mm -WB or non WB?

**increased tib-fib clearance (at front) ➔ should be less than 6mm!! -decreased tibiofibular overlap (at back) -increased medial clear space *DONE IN WB➔ see if mortise opens up

what is emphasized with rehab of functional chronic ankle instability? week 4 POST OPPERATION

-ROM -isometric peroneal strength -Bike/swim (cardio)

what are the dorsal-lateral ligaments of the cuboid? _____➔ connects? _____➔ connects?

-bifurcate -dorsal CC ligament

what are risks of an acute ankle sprain? -5 (4= things that are options that you cannnn do)

-history of previous lateral ankle sprain if you dont... -use an orthotic - properly warm up - have normal DF ROM -partake in balance training

functional impairments ➔ that can lead to chronic ankle instability -4 (things PTs can work to improve)

-impaired proprioception -impaired NM control -impaired postural control -strength deficits

what are risk factors for ankle instability? 3= intristic (things with foot/gait)

-increased talar curvature -inverted heel at heel strike (varus) -decreased foot clearance when walking -no use of orthotic -no balance training

what are the cuboid stress tests? -3

-midtarsal adduction -midtarsal supination -cuboid shear (JPA)

ankle sprain rehab phase 2 (subacute) -3

-minimize pain & inflammation -promote tissue healing start.... -restore ROM and flexibility -re-establish proprioception (NM control) -maintain overall Cardio fit

what is the return to sport criteria following an ankle sprain? -6 things met? -1 think MUST be doing?

-no swelling -full A/PROM -no limp -strength 90% uninvolved -single-leg hop 90% -max running/cutting speed -**balance retraining!

what are the plantar ligaments of the cuboid? -3 *run under it

-peroneus longus tendon -short plantar ligament -long plantar ligament

what is emphasized with rehab of functional chronic ankle instability? week 6 POST OPPERATION

-proprioceptive -balance start easy➔ harder!

Classic SIGNS/SX for ankle sprain *what pt says

-swelling -MOI -twisted ankle

sprain grades

1 = micro trauma 2 = partial tear 3 = complete tear

high ankle sprain rehab phase goals (4 phases)

1 = stabilization and protection 2= amb PWB without pain 3 = unilateral balance 4 = fast-pain free amb

Ankle sprain rehab schema

1. protect from further injury 2. decrease pain, swelling & spasm 3. re- establish ➔ ROM, flexibility & tissue mobility ➔ NM control, muscular strength, endurance, power ➔ proprioception, coordination & agility ➔ functional skills

ankle sprain rehab phase 1 (acute) -2 main things! -________ impedes progress

1. protect from further injury -encourage healing 2. limit swelling -maintain function of uninjured tissue **warning: dependency impedes progress NO LIMPING--> AD!!

high ankle sprain tests -4 main -2 extras!

1. squeeze test 2. ER stress test 3. fibula translation test 4. cotton test -tape stabilization test -crossed-leg test

ANKLE SPRAIN➔ Physical impairment measures -5 categories MUST test (and things in each)

1. swelling ROM 2. ankle ROM (DF/PF) 3. ankle/foot supination & pronation (inv/evr) 4. STJ ROM (RF inv/ evr in prone) Special 5. anterior drawer (ATFL) 6. talar tily strength 7. isokinetic inv/evr balance 8. single- leg balance 9. balance error scoring system 10. star excursion balance test

mechanical insufficencies that can cause chronic ankle instability -4

1.path laxity (hypermobile) 2. ROM ➔ arthrokinematic restriction (roll/slide) 3.synovial changes 4.degenerative changes (old)

How often does CAI occur after acute lateral ankle sprains? ___-___%

10-30% of indiv.

what percent of individuals have persistent symptoms following an ankle sprain? ankle sprains = _____% all sport injuries

5-33% =30% of all sports injuries ➔ COMMON

time to RTS after syndesmoses sprain?

=45 days *mean for opperative & nonop

phase 4 rehab -syndesmotic sprain @ rehab? can move on if...?

@ rehab -ALL WB exercises can RTS if... -can do MAX speed activites

phase 3 rehab -syndesmotic sprain @ rehab? can move on if...?

@ rehab -SL balance -treadmill walk move on -CAN perform unilat heel raise!!

phase 2 rehab-syndesmotic sprain @ rehab? can move on if...?

@ rehab -balance exercise -low level OCK strengthening to move on... -ambulate w/o pain

CAI: Mechanical vs functional? What 2 ligaments are often those "injured"?

ATF and calcaneal ligmanets common!

What are individuals with CAI at risk for ? -2

Articular cartilage degeneration & OA

What is CAI associated with? *aka what 3 things get CHALLANGED w mult inversion injuries

Extra- articular conditions - peroneal pain, -impingement -tarsal (cuboid syndrome) *becuase these areas are getting CHALLENGED due to poor ligament protection

how can cuboid get stuck out of place?

If rolling into INVERSION -&peroneus fire to PREVENT injury (everts) —> cuboid can get spun in place Can get stuck in everted position!!! PT reports -PAIN at midfoot when WB (@ midstance when advance tibia)

what is involved in an inversion ankle sprain exam? -examine? -special tests? -R/o?

Lateral ➔ palpation of ATFL and CFL (lateral) ➔ ligament tests (A/P drawer, talar tilt, inversion stress test) Medial ➔ palpation of deltoid ligament (medial) Strength/recrutiment -RMIN (posterior tib & peroneals)

what is emphasized with rehab of functional chronic ankle instability? week 1 POST OPPERATION

Neutral foot BOOT -elevate -ice -Crutches➔ WBAT

what is emphasized with rehab of functional chronic ankle instability? week 8-12 POST OPPERATION

PT can RTS as long as Peroneal strength is = to uninvolved!

suspect inversion ankle sprain MUST rule out....?

R/O ➔ palpate proximal fibula to R/O Maisonneuve fx ➔ syndesmosis injury ➔ Fx--Ottawa ankle rules (palpate bony landmarks)

what is emphasized with rehab of functional chronic ankle instability?

balance re-training *post-op if get surgery

what grades of syndesmotic injuries are surgery most common for?

grade 2 and 3

chronic ankle instabiltiy -surgery??➔ goal?

lateral ankle reconstruction methods GOAL= latearl stability uncommon

Functional anatomy - lateral foot bones? ➔ function? - medial foot bones? ➔ function?

lateral foot➔ Shock abs *calcan MEdial foot➔ propulsaion *talus

SIGNS/Sx of cuboid syndrome

lateral midfoot pain @CC joint ➔ due to sustained , disrupted, or subluxed congruency of CC joint

what is cuboid syndrome? -pain at _____area, ____joint -due to? -sx?

pain➔ lateral mid-foot pain @ CC joint due to sustained, disrupted or sublimed congruency of the CC joint Sx -pain, worse w WB (ESP. when shift weight to that foot!!) -pot. swelling

what is the cuboid manipulation? what to do AFTER it -3

perform=cuboid whip**manip or mobe to correct subluxation Protect 1. Taping or FO to protect lig Fix culprits 2. ➔ stretch Gastroc/soleus (incr DF) to prevent TTJ substitution, 3. ➔ get calcaneus to EVERT all the way

PT is thinking patient may have Chronic ankle instability.. -what imaging should PT order and for what concerns to R/o?

plain radiographs & MRI helpful to R/O - fx, - impingement, -osteochondral defects & -peroneal tendon injury & -assoicated tarsal conditioins

ankle sprain rehab phase 3 (maturation) -7 main

prevent re-injury restore (subacute) -ROM and flexibility improve (NOW!!!) 1.muscular strength, power and endurance 2.proprioception, agility, and coordination 3. maintain CV

what are ways to provide ankle specific perturbations? *once you get to balance retrain

seated ➔ partial WBing ➔ standing -tilt boards/BAPs board -foam -uneven surfaces

If a pt walks with a step to gait pattern (they avoid DF), what might be injured?

talar dome

how much longer is a high ankle sprain recovery?

up to 2x longer than a grade 3 lateral ankle sprain =45days about