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Questions and Answers
What is the most common mechanism of an ankle lateral sprain?
Which of the following is NOT a typical symptom of an ankle lateral sprain?
Which test is specifically used to assess for ankle lateral sprains?
What ligament is primarily damaged in a high ankle sprain?
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Which symptom is associated with a Lisfranc ligament complex injury?
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What finding is NOT a criterion according to the Ankle Ottawa Rules for deciding if an ankle x-ray is necessary?
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What is a common cause of a high ankle sprain?
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What is a key assessment finding for all types of ankle sprains?
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What is a common sign of medial deltoid ligament injuries?
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What distinguishes Achilles tendinopathy from acute injury?
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What is a common assessment finding in Achilles tendon rupture?
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Who is most likely to suffer from posterior impingement syndrome?
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What symptom characterizes Achilles tendinopathy?
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What can cause an Achilles tendon rupture?
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What assessment method is used to identify Achilles tendinopathy?
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What is a common initial symptom of medial deltoid ligament injuries?
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Study Notes
Ankle Lateral Sprain
- Most common ankle injury.
- Typical mechanism: excessive plantarflexion and inversion.
- Can be caused by contact or non-contact.
- Etiology: previous injury, poor proprioception, weakness in surrounding area.
- Typical symptoms: pain, swelling, bruising, possible "pop" sound, antalgic gait, difficulty weight bearing.
- Pathophysiology: damage to one or more of the lateral ligaments (ATFL, CFL, PTFL).
- Pain may be on the inside due to bone bruising (compression).
- Pins and needles and burning sensation may occur.
- Assessment:
- Swelling and bruising over lateral malleolus.
- Heat.
- Reduced and painful active range of motion (AROM) in dorsiflexion, plantarflexion, and inversion.
- Reduced and painful passive range of motion (PROM) in dorsiflexion, plantarflexion, and inversion.
- Special tests: anterior drawer and talar tilt tests.
- Use balance exercises to build proprioception and decrease the risk of lateral sprain.
High Ankle Ligament Sprain
- Less common than lateral ankle sprain.
- Typical mechanism: excessive dorsiflexion, eversion, or external rotation.
- Can be caused by contact or non-contact injuries.
- Etiology: previous injury, poor balance, weakness in surrounding areas.
- Symptoms: pain, swelling, bruising (lateral lower leg), possible "pop" sound, abnormal gait.
- Pathophysiology: damage to one or more of the syndesmotic complex ligaments (AITFL, PITFL, and interosseous membrane).
- Be aware of Maisonneuve fracture; syndesmosis, AITFL, and deltoid ligament injury.
- Must check the medial ligament.
- Assessment:
- Reduced and painful AROM in dorsiflexion, plantarflexion, and eversion.
- Reduced and painful PROM in dorsiflexion, plantarflexion, and eversion.
- Tests: squeeze test and external rotation test.
Lisfranc Ligament Complex Injury
- Lisfranc ligament supports the tarsometarsal joints.
- Main joint: base of the 2nd metatarsal, medial, and middle cuneiform.
- Mechanisms: landing from height onto the toes or hyper plantarflexion of the foot.
- 20% of cases remain undiagnosed.
- Common in RTA athletes.
- More frequent in males than females.
- Assessment:
- Swelling and bruising.
- Difficulty bearing weight.
- Reduced and painful ROM in plantarflexion, inversion (midfoot), and eversion (dorsal).
- Tests: piano test, toe walk test, repetitive heel raise.
- Requires immediate referral.
Medial Ligament Complex Injury
- Includes the medial deltoid ligaments: ATTL, TNL, TCL, PTTL.
- Uncommon isolated injury.
- Often occurs with syndesmosis injuries.
- Assessment:
- Swelling and bruising around the medial malleolus.
- Pain when walking but may be able to bear weight.
- Pain and reduced ROM in dorsiflexion, plantarflexion, and eversion.
- Palpation: tenderness on damaged ligaments.
- Pain during anterior drawer and external rotation test (sitting).
- May require x-ray depending on Ottawa Rules.
Achilles Tendinopathy
- Often asymptomatic at the beginning.
- Plantaris muscle (medial to Achilles): medial pain.
- Gradual onset.
- Related to changes in load, biomechanics, calf weakness, footwear, or genetics.
- Common in individuals aged 30-40 but can occur in younger athletes.
- Stages of injury: reactive, disrepair, degeneration.
- Can present as acute, subacute, or chronic.
- Assessment:
- Swelling and thickening in Achilles tendon.
- Pain-free when walking, but limps.
- May experience pain in plantarflexion but may require heel raises, running, or jumping tests.
- Pain may occur during calf stretches.
- Tender Achilles tendon.
- May feel crepitus on palpation.
- Special tests: London test for Achilles tendon, toe walking.
Achilles Tendon Rupture
- Achilles tendon combines with gastrocnemius and soleus muscles.
- Plantaris muscle is also involved.
- "Pop" sound and feeling of being kicked in the back of the heel.
- Occurs often in middle-aged and older adults.
- More common in men than women.
- 60-90% of cases occur in sports.
- Non-surgical treatments are three times more likely to lead to re-rupture.
- May be able to walk.
- Assessment:
- Swelling and bruising over Achilles area.
- Often pain-free, with a heavy limp, unable to push off.
- Weakness or inability to actively plantarflex.
- Be aware of a "false negative" due to the Plantaris muscle.
- Passive: may have pain with external rotation, plantarflexion, and dorsiflexion due to inflammation.
- Resisted: weakness or inability to plantarflex; be aware of false negatives from the flexor hallucis longus, extensor hallucis longus, and tibialis posterior.
- Palpation: tender Achilles tendon, possible gap.
- Positive Thompson's test, weak calf endurance tests.
- Requires urgent referral.
Posterior Impingement Syndrome
- Pain during sprinting and kicking.
- Talus impinges against the calcaneus.
- Possible involvement of capsule, tendon, bone, or extra bone.
- Common in ballet dancers, footballers, gymnasts, and fast bowlers in cricket.
- Most common in dancers (61%).
- Can be secondary to inversion sprains.
- Assessment:
- Swelling and thickening in the posterior heel area.
- Pain-free when walking, but pain with forced plantarflexion.
- Pain with external rotation, active, and passive plantarflexion.
- Resistance: usually normal.
- May be tender over the posterior heel.
- May feel crepitus on palpation.
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Description
Test your knowledge on ankle lateral sprains, the most common type of ankle injury. This quiz covers mechanics, etiology, symptoms, assessment, and prevention strategies. Enhance your understanding of how to manage and mitigate the risks associated with lateral sprains.
