Ankle Injuries in Sport

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In a systematic review of 227 studys, what is the prevelance of ankle injuries?
second highest prevelance at 11.2-20.8% (knee first with 16-27%)
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What % of all injuries were ankle injuries in the 41 football academies study between 1998-2006?
23% of all injuries were ankle injuries
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What is the different between the tibia and fibula?
The tibia is thicker, sharing 5/6 body weight, fibula is thinner with 1/6 bodyweight and extends to a lower position - to the lateral malleolus
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What 4 bones make up the rear-foot?
Tibia, fibula, talus and calcaneus
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What 3 bones make up the min-foot?
Navicular, cuboid and cuneiforms (3)
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What 2 bone types make up the fore-foot?
Metatarsals (5) and phalanges (5)
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what are the 5 joints of the foot? (in order from rear to fore-foot)
Talocrural joint, Subtalar joint, transverse-tarsal joint, tarsal-metatarsal joints, metatarsal-phalangeal joints
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What movement does the talocrural (also called tiliotalar joint) control?
Plantarflexion and dorsiflexion
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What movement does the subtalar joint allow?
Inversion and eversion
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What are the 2 phalanges of the 1st digit (Hallux) called?
Proximal and distal phalange (on the big toe)
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What are the 3 phalange of the 2-5th digits called?
Proximal, intermediate, and distal phalange
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What is the primary motion of the ankle joint?
Plantarflexion (point toes down) and dorsiflexion (lift toes to shin), for propulsion and locomotion
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what is the secondary motion of the ankle joint?
Inversion (sole of foot turned inward) and eversion (sole of foot turner outward), for adapting surface
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What is ankle supination?
plantarflexion and inversion
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What is ankle pronation?
dorsiflecion and eversion
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Describe the Gastrocnemius
largest and most superficial calk muscle, main propellent in walking, running and jumping.
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Describe the soleus
Large muscle which is deeper than gastrocnemius, used constantly in prolonged standing to mantain an upright position
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What are the gastrocnemius and soleus together called?
Triceps Surao
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What is the Triceps Surae (Gastrocnemius+soleus) main function?
To plantarflex the ankle joint
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What can happen is a contraction of the Triceps Surae is too furceful?
It could casue achilles tendon rupture, like jumping off during a smash of badminton shuttles
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Describe the Tibialis Posterior
Deepest calf muscle, supports arch of the foot, ankle plantarflexor, Insertion on medial aspect of foot. Helps towards invesdion and suppoting the arch
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Describe the Tibialis Anterior
Fleshy part of the anterior side of the shin. Insertion on medial aspect of foot so also contributed to invertion of ankle joint. Main movement is dorsiflexion.
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What is the 'origin' of a muscle?
The proximal edge of the muscle (the start)
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What is the 'insertion' of a muscle?
The distal edge of the muscle (the end)
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Describe the peroneus longus
Strongest ankle evertor, runs along the lateral aspect to bottom of foot and inserts at medial side of the foot on cuneiform of 1st metatarsal. Also called Fibularis Longus (origin on fibula head)
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Describe the peroneus Brevis
Less strong that peroneal longus, ankle evertor, also called fibularis brevis (origin on fibula head)
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Describe the Extensor Hallucis Longus
Function is to extend the big toe (hallax) by pulling it back (upward)
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Describe the extensor digitorum longus
Extends the other 4 toes
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Describe the flexor hallucis longus
Function is to flex the big toe (hallux) by bending it down. It also supports the arch of the foot
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Describe the Flexor Digitorum Longus
The tendons pass under the foot, performs toe grip to maintain balance
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What are the 2 parts called that are effected in a high ankle sprain?
Interosseous membrane and syndesmotic ligament (anterior inferior tibiofibular ligament)
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Which ligament is affected by a medial sprain?
Deltoid Ligament
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What 3 ligaments are effected by a lateral sprain?
Anterior Talofibular ligament (ATFL), Posterior Talofibular Ligament (PTFL) and Calcaneofibular Ligament (CFL)
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When do the Ottawa Rules say an ankle x-ray is required?
If there is pain in to malleola zone and any of: bone tenderness at posterior edge or tip of lateral malleolus or bone tenderness at posterior edge of tip of medial malleolus or inability to weightbare.
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When do the Ottawa Rules say a foot x-ray is required?
If there is pain in the mid-foot zone and any of: bone tenderness at base of 5th metatarsal, bone tenderness at navicular or inability to weightbear.
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Why was the 1994 Ottawa Ankle RUles useful?
reduced ankle x-ray by 28% and foot x-ray by 14%
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What is sensitivity on the disease/test scale?
Sensitivity is the true positive rate, the proportion of positives that are correctly identified as positives
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What is Specificity on the desease/test scale?
Specificity is the true negative rate, the proportion of negatives that are correctly identified as negatives
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What does 100% sensitivity mean?
There is no false negatives - because all positive cases have been identified as positive
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What does 100% specificity mean?
There is no false positives - because all negative cases are identified as negatives
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What diagnosis would be given to an injury mechanism of inversion/supination?
(lateral) ligamentous sprain, possibly of ATFL, PTFL, CFL
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What diagnosis would be given to an injury mechanism of Eversion/pronation?
(Medial) ligamentous sprain of deltoid ligament
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What diagnosis would be given to an injury mechanism of inversion and dorsiflexion?
high ankle (syndesmosis) sprain of syndesmosis ligament and interosseous membrane
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What diagnosis would be given to an injury mechanism of forceful plantarflexion?
Tendon rupture of the achilles tendon
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What are the signs/symptoms of an inversion ligamentous sprain?
'snap' or 'pop' sound, pain and swelling, pain on palpation,
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Why is an inversion sprain more common that an eversion sprain?
The fibula extends to a lower position and creates a block to eversion sprains. Lateral ankle sprains account for 75-85%.
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What is involved in acute management of an ankle ligamentous sprain?
RICE = Rest, Ice (also called cryotherapy - reduces 65% of bloodflow after 10 minutes), Compression (reduces 95% of bloodflow is suppressed immediately), elevation (reduced 65% bloodflow when foot raised 70cm above heart level)
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Describe the anatomical grading system?
Grade 1 (1 ligament)= ATFL, Grade 2 (2 ligaments) = ATFL + PTF, Grade 3 (3 ligaments) = ATFL, PTFL _ CFL.
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Describe the severity grading system?
Grade 1 = mild/stretched, grade 2 = partial tear, grade 3 = complete tear/rupture
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What are the 2 tests for a lateral ankle sprain?
Anterior drawer test and talar tilt test
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Describe the Anterior Drawer Test
Test for ATFL tear. Hold ankle 10-20 degrees plantarflextion, stabilise tibia with 1 hand, pull foot forward with other hand, anterior translation indicates instability
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Describe the Talat Tilt Test
Test for CFL tear, hold foot and ankle in neutral position. Invert the hind-foot, feel for separation of the articular surface of the tibia and talus
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What are the 3 tests for a high ankle/syndesmosis sprain?
External rotation test, squeeze test and crossed leg test
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Describe the External Rotation Test
Knee flexed to 90 degrees. Ankle neutral. Rotate the foot outward. Pain in distal lower leg indicates injury
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Describe the Squeeze Test?
COmpress the tibia and fibula together at mid-calk. Pain in distal lower leg indicates injury
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Describe the Crossed Leg Test
Patient sits in a chiar, crosses the affected leg over the opposite knee. Applies pressure to the medial knee. Pain in distal lower leg indicates injury
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What is the management process of a high ankle sprain?
Prescribe walker book. Walk with crutches to avoid weightbearing. Aim to avoid restretching the syndesmosis ligament and interosseous membrane further
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What is the management process for a mnor fracture?
Without limb deformity = prescribe walker boot, crutches to avoid weightbearing. With limb deformity or dislocation = hospitalised for orthopaedics management. Walkerboot after surgery.
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What is the aim when prescribing conservative functional exercises to Grade 1 and 2 injuries (mild/partial tears)
To improve joint flexibility, strength, balance, proprioception, range of motion, joint stability
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What Traditional Chinese Medicines are adopted in Asia?
Herbs, massage, acupuncture for pain relief, reduce swelling, and restore normal ankle function.
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What is the purpose of assisted prophylactic devices?
Provide defferent functions like mechanical support, proprioception enhancement, and vertical landing posture promotion
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Give examples of assisted prophylactic devices?
Orthosis, brace, brace, taping
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With Grade 3 ligamentous sprain, what is the benefit and limitations of surgical treatment?
Better to reduce the recurrent giving way and pain on activity, however could have complications in surgery
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With Grade 3 ligamentous sprain, what are the benefits and limitations of conservative treatment?
Free from conplications, no other symptoms unlike surgery,
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What is advised for treatment of grade 3 ligamentous sprain?
Conservative treatment first using functional exercises. If this fails to enhance ankle function after a considerable period of time, surgical treatment might be recommented
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What should be avoided post grade 3 ligamentous sprain?
immobilisation! This could result in joint stiffness, muscle atrophy and loss of proprioception.
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What is the achilles tendon?
Connects the gastrocnemius and soleus muscles to the calcaneus and function to plantarflex the ankle joint
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What are the signs and symptoms of an achilles tendon rupture?
Sudden onset of pain, 'pop' sound, heel area swollen and bruised, can't walk properly, palpate defect tendon, weak plantarflexion, cant lift toes.
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Name and describe the physical examination test for an Achilles tendon rupture?
Thompson test = patient lies face down on bed, examiner squeezes calf muscle, normal person foot would plantarflex, injured foot will not raise. Palpate to feel ruptured Achilles tendon.
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What is the management of an Achilles tendon rupture?
Surgical repair. If tendon breaks in middle they sew the two ends back. If the tendon detaches from the calcaneus, drill a tunned in calcaneus and fix the tendon.
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Explain rehab for an Achillies tendon rupture post-surgery
Wear a cast or walking boot for up to 12 weeks. Boot initially positions to keep foot plantarflexed slightly for tendon to heal. Then gradually adjusted to walking neutral boot. Begin weight bearing exercises. could be 6 months recovery time!
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What sports are inversion sprain injurys high in?
football, rugby, volleyball, handball, basketball
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Name some intrinsic risk factors for an inversion sprain injury
Previous sprain history, overwieght, inferior single leg balance
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Name some extrinsic risk factors for an inversion sprain injury
Use of shoes with air cells, not stretching before exercise, use of artificial turf for football, increased exercise intensity
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Describe the Aetiology of an incorrect landing in an ankle sprain injury
An increased supination moment at subtalar joint resulted from the medially deviated vertical ground reaction force. Force/torque does not pass through joint centre creating twisting torque. Ligament stretched
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Describe the Aetiology of the delayed peroneal reaction in an ankle sprain injury
Ankle sprain at peak force which is 40ms post ground strike. Peroneal muscle reaction time 57-69ms. Eversion torque generated at 135ms. Human reflex response not fast enough to prevent sudden inversion sprain injury
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What is an supination sprain injury?
Ankle inversion and plantarflexion plus an internal twisting of the foot. Sometimes with external rotation of the lower leg. Not when ankle fully loaded!
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What are the 2 major mechanisms of a supination sprain injury in football?
1) Impact by opponent on the medial aspect of the leg just before foot strike - laterally directed force so player lands with inverted ankle. 2) forced plantarflexion when injured player hits opponents foot or attempting to shoot/kick
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In the Honk Kong study, which form of treatment is most used?
Self-treatment (47.5%), general practitioner is 3rd at only 13.7%
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What is the major symptom of an ankle sprained 1-4 times compared to 5+ times?
Ankle sprained 1-4 times = major symptom is pain. Ankle sprained 5+ times = major symptom is ankle instability
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Chronic ankle instability can be divided into mechanical instability and functional ankle instability - what is the difference?
Mechanical = abnormal laxity of ligamentous restraints. Functional = normal ligamentous restraints but abnormal function with recurrent episodes of ankle giving-way
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What are the issues that arise from longer term chronic ankle instability?
delayed peroneal reaction time, inferior ankle proprioception, evertor strength, changes in gait, prolonged translational movement between tibia and talus cause cartilage wearing and ankle osteoarthritis. May need ankle replacement surgery
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What are the 5 categories of ankle sprain prevention?
1 - prophylactic devices, 2 - functional training, 3 - technique training, 4 - change of game rules, 5 - education
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What are prophylactic devices?
taping, bracing, orthosis = wrap ankle joint from foot to shank. Resist ankle inversion, improve proprioception and joint position sense and maintain vertical anatomical position during landing.
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What is functional training?
Aim to improve strength of deep muscles, stablity, postural control and proprioception with the use of wobble balance board, ankle disc, rubber band and other devices
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What is technique training?
Specific to sporting events, aims to correct landing. E.g. volleyball - teach players to move across the floor and then jump vertically instead of jumping across and forward. Land vertically.
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How does game rules help?
E.g. footballers used to tackle from behind when they were not quick enough which caused lots of injuries. Now a tackle from behind is a red card.
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How can education help?
Educate players on footwear - e.g. australian netball comp in 1995 all players advised on high-cut shoes. Advise on seeking immediate treatment as apose to playing on.
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How does the 'intelligent anti-sprain system' work?
A gyroscope at heel monitors ankle inversin. When it exceeds 300 degrees, electrodes deliver stimulation to peroneal muscle. Able to resist ankle sprain motion - gives mechanical support from own muscles
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Other cards in this set

Card 2

Front

What % of all injuries were ankle injuries in the 41 football academies study between 1998-2006?

Back

23% of all injuries were ankle injuries

Card 3

Front

What is the different between the tibia and fibula?

Back

Preview of the front of card 3

Card 4

Front

What 4 bones make up the rear-foot?

Back

Preview of the front of card 4

Card 5

Front

What 3 bones make up the min-foot?

Back

Preview of the front of card 5
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