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Leg Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
The ankle is supported by many ligaments; the lateral ligament complex is a key structure because most ankle sprains are located at the lateral side. The anterior talofibular ligament (ATFL) connects the talus with the fibula.The calcaneofibular ligament (CFL) connects the fibula with the calcaneus.24The posterior talofibular ligament (PTFL) originates from the malleolar fossa and inserts almost horizontally into the posterolateral talus.25
Biomechanics of the foot and ankle
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Sheraz S Malik, Shahbaz S Malik
The joint is stabilised by congruent articular surfaces, joint capsule and ligaments. The talus is 4.2 mm wider anteriorly than posteriorly, and in dorsiflexion the ankle is in a ‘closed packed’ position of maximum stability.5 The ligamentous support is critical in plantarflexion and when the ankle is unloaded. Lateral stability is provided by lateral ligament complex, which resists anterior draw of talus, inversion and internal rotation. The tensile strengths of anterior talofibular, calcaneofibular, and posterior talofibular ligaments are 139N, 346N and 261N, respectively. The anterior talofibular ligament is the weakest and most commonly injured ankle ligament. Medial stability is provided by superficial and deep deltoid ligaments, which resist eversion and external rotation stresses. The deep deltoid ligament has a tensile strength of 714N, and is the least frequently completely disrupted ankle ligament.6 The syndesmotic ligaments maintain stability between distal tibia and fibula and support distal fibula loading.
Sports medicine and sports injuries
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
In the acute phase it may be difficult to assess the ligament injury thoroughly. Once the acute injury has settled, any difference in laxity when comparing the two sides is diag-nostic. However, the laxity of ligaments varies dramatically between patients and with age so absolute measurements are not reliable. When the diagnosis remains in doubt, imaging can be useful, for example ultrasound or magnetic resonance imaging (MRI). Grade 1 and 2 ligament injuries can be treated with pain relief, splinting and gentle mobilisation to avoid stiffness. Grade 3 injuries may require surgical repair to bring together the torn ends of the ligament, or another reconstructive procedure. The treatment depends on the site of the ligament and joint stability. For example, in ankle inversion injuries, the patient will recover without anterior talofibular ligament reconstruction.
Finite element analysis of shank and ankle with different boot collar heights in parachuting landing on inversion ground surface
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Chenyu Luo, Tianyun Jiang, Shan Tian, Jie Yao, Yubo Fan
The peak stresses of tibia, fibula, as well as cartilage of ankle joint and subtalar joint were analyzed. The medium collar boots would induce lower peak stress at tibia than the other two cases, while the collar height would not obviously influence the peak stress of fibula. Besides, medium and high collar boots would protect cartilages better compared to low collar boots through reducing peak stress of both ankle joint cartilage and subtalar joint cartilage. Furthermore, the peak forces of lateral ankle ligaments were also analyzed. The lateral ankle ligaments included anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligament. When landing on inversion ground surface, the ankle performed inversion motion in this simulation, and lateral ankle ligaments would be under damage risk, especially anterior talofibular ligament (Yu et al. 2016). The lateral ankle ligaments were protected best with medium collar boots.
Plausible mechanisms of and techniques to assess ankle joint degeneration following lateral ankle sprains: a narrative review
Published in The Physician and Sportsmedicine, 2019
Kyeongtak Song, Erik A. Wikstrom
Previous data has observed that 89% of young patients (mean age of 19 years) with a severe acute ankle sprain had talar chondral lesions [19]. The talar chondral lesions are commonly found arthroscopically on the medial aspect of the talus in patients with acute LAS and CAI [17,19]. During a typical LAS, it is speculated that the medial talar dome impacts the inner surface of the medial malleolus or tibial plafond, which may result in a talar osteochondral lesion on the medial talus. Empirical data also indicates that a partial or complete tear of the anterior talofibular ligament (ATFL) results in early degenerative changes in the anteromedial and anterolateral regions of the talar dome compared to an uninjured ankle [21]. Similarly, research shows that articular cartilage damage at the time of an ankle fracture also increases the risk of PTOA [22]. Cumulatively, the evidence suggests that osteochondral lesions during a traumatic ankle injury is sufficient to cause degenerative changes.
Factors influencing return to play following conservatively treated ankle sprain: a systematic review
Published in The Physician and Sportsmedicine, 2019
Saed A. Al Bimani, Lucy S. Gates, Martin Warner, Catherine Bowen
Inclusion criteria were articles assessing factors that may influence RTP following conservatively treated acute ankle sprain; Any grade of ankle sprain; new and recurrent; athletes practicing any sport activity at any level; any age range; both male and female patients and full text articles published in English from inception until May 2018. Ankle sprain in this review is defined as a traumatic injury that occurred to one or more of lateral ankle ligaments: anterior talofibular ligament, posterior talofibular ligament and calcaneofibular ligament. All types of study designs were considered to be included in this review. Articles were excluded if they did not include time to return to play (TTRTP) as an outcome measure at follow-up assessment and if they included participants following ankle surgery. In this review TTRTP is defined as number of days from injury until an athlete is back to sport activity. Animal and cadaver studies were also excluded.