Ankle instability
Maneesh Bhatia in Essentials of Foot and Ankle Surgery, 2021
Clinical examination of an acute ankle injury should initially follow the Ottawa ankle rules to rule out a fracture. There is often tenderness over the lateral ligaments. The optimal time to assess a LAS is on day 5 after the injury when the pain has diminished, with 96% sensitivity and 85% specificity to detect ligament rupture (11). An anterior drawer test is performed with the ankle in slight plantarflexion (Figure 12.8) and considered positive when there is laxity, a soft end point and a dimple is seen just anterior to the tip of the fibula (when compared to the un-injured side) (11). The absence of visible discolouration and a negative anterior drawer sign at this stage reliably indicates that the ATFL is intact (11). To assess CFL, a talar tilt test is performed with the ankle in neutral (Figure 12.9).
Environmental Design for Health
Maria A. Fiatarone Singh, John Sutton Chair in Exercise, Nutrition, and the Older Woman, 2000
It is good to remember that stairs represent both a safety challenge as noted above, and an opportunity for increased strength, power, endurance, and balance. With a few tips, the stairs can be transformed into safe yet challenging pieces of exercise equipment which are always at hand. For example, the bottom step can be used as a way to train for balance by hanging your heels off it, and slowly rising up on your toes as high as possible and then slowly lowering your body weight again (see also Chapter 2 for more tips). Repeat this move five to ten times whenever you start to climb the stairs. Initially this should be done while holding onto the handrail, but as you improve. you can graduate to one fingertip support and even closed eyes. Once even this is too easy, you can do it on one foot instead of two, which will give twice the stimulation to the muscles around the ankle, improving both strength and coordination. This is particularly important for the prevention of falls and as a way of rehabilitating after an ankle injury such as a sprain or fracture. Because balance is so often a problem in older women, these exercises form an important addition to any exercise routine. Initially, they should always be done with a relative or neighbor standing behind you in case you lose your balance.
Osteoporotic ankle fractures
Peter V. Giannoudis, Thomas A. Einhorn in Surgical and Medical Treatment of Osteoporosis, 2020
In the past, high complication rates after operative management of these injuries have been documented and have led many surgeons to follow a more “conservative” approach to these injuries (9,10). Variation to the management according the geographic location of the treating surgeon has been observed (1), with surgeons of the west coast of the United States advocating more for surgical management compared to their colleagues from the east coast. Increased rates of nonunion and malunion have been documented with nonoperative management (11), while other studies have shown better functional outcomes with operative management (12). Nevertheless, the literature is still unclear as to which management provides the better outcomes. The first report of the ongoing Ankle Injury Management (AIM) trial (13,14), which is a pragmatic, multicenter, equivalence, randomized controlled trial (RCT) that has included 620 patients over 60 years of age and compared the close contact casting technique to the open reduction and internal fixation (ORIF) of unstable ankle fractures, concluded that both of these treatment options provide clinically equivalent outcome to ORIF at reduced cost to the UK National Health Service (NHS) and to society at 6 months.
Range of motion and ankle injury history association with sex in pediatric and adolescent athletes
Published in The Physician and Sportsmedicine, 2018
Dai Sugimoto, Ronald E. McCartney, Robert L. Parisien, Jesse Dashe, Dennis R. Borg, William P. Meehan
While previous investigations mainly focused on the adult population [5–7,9,13,14], the ankle injury of pediatric and adolescent population has been understudied, especially its risk factors. Identification of risk factors is essential in determining appropriate and effective prevention strategies [15]. Past investigations showed strong effect of sex on ankle joint instability [12]. Furthermore, a history of previous injury itself is one of the strongest risk factors for future ankle injury [16]. Although sex and a history of injury are not modifiable, they may be useful for identifying athletes at the highest risk of sustaining future ankle sprains, a population on whom prevention interventions might be particularly targeted. While both sex and a history of previous ankle injury represent potential risk factors for ankle sprain, the mechanism by which these risk factors resulted in increased risk of ankle sprain remains unknown. A key measurement to fill the mechanism gap may be ankle ROM. It may be that sex and a history of prior ankle sprain influence ankle ROMs, and that the change in ROM is associated with the increased risk of injury. Thus, we sought to determine the associations between sex, a history of ankle sprain, and ankle ROM in pediatric and adolescent athletes.
Neurodynamic mobilization in a collegiate long jumper with exercise-induced lateral leg and ankle pain: A case report
Published in Physiotherapy Theory and Practice, 2018
Terry Cox, Tom Sneed, Herb Hamann
In this case report, the patient was found to have persistent symptoms that remained following traditional ankle injury management. Physical therapy examination that included neurodynamic testing allowed the therapist to appropriately match interventions to the persistent symptoms. This patient was found to be motivated and very reliable in administering the nerve mobilization intervention, mostly at home. Following seven weeks of neural mobilization, this patient demonstrated improvements in all outcome measures. It is the authors’ hope that this case report encourages other therapists to examine and treat the nervous system locally and more centrally, considering nerve tissue along with other tissue types in patient examinations.
Neuromuscular training for the prevention of ankle sprains in female athletes: a systematic review
Published in The Physician and Sportsmedicine, 2020
Lauren E. Caldemeyer, Symone M. Brown, Mary K. Mulcahey
Given recent evidence that favors the effectiveness of NMT programs in ankle injury prevention, the value of NMT prevention programs warrants further investigation given that several studies have demonstrated improvements in balance and stability measurements after NMT programs in female athletes specifically [7,8,10,12,39]. These studies were not included in this systematic review because they relied on postural sway and balance measurements to assess the effectiveness of NMT, rather than directly examining the rates or risks of ankle injuries subsequent to NMT programs. Several of these studies have established that NMT programs significantly improve Star Excursion Balance Test (SEBT) scores in the intervention groups relative to their control groups [7,10,12]. Furthermore, previous studies have determined that postural sway may be a predictive measure of ankle injury risk [40], and SEBT is a valuable tool for evaluating the effectiveness of NMT interventions focused on improving postural control [11]. In the context of these determinants, the results of these studies are relevant, despite lacking direct measurements of ankle injuries subsequent to NMT, since chronic ankle instability is associated with subsequent ankle sprains and ongoing balance impairments [2–6]. These findings are especially important in the context of non-contact ankle injuries, when instability and balance impairments are likely to play a role in ankle injury. Additionally, 2 studies in our systematic review demonstrated that the greatest effects of NMT programs were observed for non-contact ankle sprains [31,33]. However, the value of SEBT and postural sway tests in predicting the risk of contact ankle sprains, such as landing on an opposing player’s foot, has not been evaluated. Future studies should combine evaluations of balance and postural control with epidemiological reports of ankle injuries after the implementation of NMT to begin to bridge this gap.
Related Knowledge Centers
- Differential Diagnosis
- Hematoma
- Ottawa Ankle Rules
- Proprioception
- White Blood Cell
- Bruise
- Ligament
- Radiography
- Sprain
- Medical History