Ankle Injuries. Ankle Sprain. Range of Motion. The most likely diagnosis is lateral ligament sprain. Dorsiflexion Plantarflexion Inversion

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Ankle Injuries Dr Peter Brukner, OAM Sports Physician Associate Professor Centre for Sports Medicine Research & Education The University of Melbourne Adjunct Professor School

1 Ankle Injuries Dr Peter Brukner, OAM Sports Physician Associate Professor Centre for Sports Medicine Research & Education The University of Melbourne Adjunct Professor School of Human Movement Studies The University of Queensland Ankle Sprain The most likely diagnosis is lateral ligament sprain Range of Motion Dorsiflexion Plantarflexion Inversion 1

2 Lunge Palpation Palpation (Medial) 2

3 Palpation Anterior Drawer Talar Tilt 3

4 Proprioception Ankle Sprain The majority of these injuries respond well to a standard treatment regime Ankle Sprains R.I.C.E NWB/PWB/FWB electrotherapeutic modalities strengthening proprioception tape/brace 4

5 Mobilization Strengthening Proprioception 5

6 Proprioception Protection Bracing / Taping 6

7 The Difficult Ankle A significant group do not progress The Difficult Ankle. and complain of persistent pain, swelling and impaired function after 3-6 weeks Principles of Diagnosis History 3. Examination 4. Investigation 7

8 1. Common 2. Less common 3. Not to be missed 1. Common chronic instability synovitis ankle joint sinus tarsi syndrome posterior impingement anterior impingement 1. Common talar dome base of 5th metatarsal chronic instability synovitis ankle joint sinus tarsi syndrome posterior impingement anterior impingement 8

9 Talar Dome Fractures Talar Dome Fractures CT Bone Scan Talar Dome Fractures (MRI) 9

10 1. Common talar dome base of 5th metatarsal chronic instability synovitis ankle joint sinus tarsi syndrome posterior impingement anterior impingement Base of 5th Metatarsal 1. Common Possible causes talar dome base of 5th metatarsal chronic instability synovitis ankle joint sinus tarsi syndrome posterior impingement anterior impingement 10

11 1. Common talar dome base of 5th metatarsal chronic instability synovitis ankle joint sinus tarsi syndrome posterior impingement anterior impingement 1. Common talar dome base of 5th metatarsal chronic instability synovitis ankle joint sinus tarsi syndrome posterior impingement anterior impingement 11

12 1. Common talar dome base of 5th metatarsal chronic instability synovitis ankle joint sinus tarsi syndrome posterior impingement anterior impingement 12

13 1. Common talar dome base of 5th metatarsal chronic instability synovitis ankle joint sinus tarsi syndrome posterior impingement anterior impingement 13

14 2. Less common lateral process talus anterior process calcaneus tibial plafond os trigonum / posterior process talus AITFL injury anterolateral impingement neural causes 2. Less common lateral process talus 2. Less common - anterior process calcaneus 14

15 2. Less common tibial plafond 2. Less common os trigonum posterior process talus 2. Less Common lateral process talus anterior process calcaneus tibial plafond os trigonum/posterior process talus AITFL injury anterolateral impingement neural causes 15

16 2. Less Common lateral process talus anterior process calcaneus tibial plafond os trigonum/posterior process talus AITFL injury anterolateral impingement neural causes Anterolateral Impingement 16

2. Less Common lateral process talus anterior process calcaneus tibial plafond os trigonum/posterior process talus AITFL injury anterolateral impingement

17 2. Less Common lateral process talus anterior process calcaneus tibial plafond os trigonum/posterior process talus AITFL injury anterolateral impingement neural causes Neural Tension 3. Not to be missed dislocation peroneal tendon rupture tibialias posterior tendon reflex sympathetic dystrophy (RSD) OCD 17

18 Principles of Diagnosits 1.Possible causes 2. History 3. Examination 4. Investigation 18

19 History mechanism of injury pain, swelling, bruising level of dysfunction early management? X-ray History subsequent progress current symptoms pain swelling impingement instability function history of previous injury Principles of Diagnosits 1.Possible causes 2. History 3. Examination 4. Investigation 19

20 Examination inspection range of motion palpation ligament testing functional testing Examination strength testing proprioception neural tension impingement tests anterior posterior Principles of Diagnosits 1.Possible causes 2. History 3. Examination 4. Investigation 20

$Plain X-ray 1. fracture 2. posterior impingement 3.$

21 Plain X-ray 1. fracture 2. posterior impingement 3. anterior impingement } Special views Triple Phase Bone Scan important screening testing three phases angiogram (immediate) blood pool (2 minutes) bone phase (2-3 hours) 21

22 Triple phase bone scan no uptake uptake uptake Uptake - talar dome fracture - other fracture Mild Uptake - impingement syndrome - synovitis - RSD (late) 22

23 No Uptake impingement syndrome AITFL injury synovitis sinus tarsi syndrome dislocating peroneal tendon RSD (early) CT scans If bone scan shows uptake CT performed to visualise fracture MRI alternative to CT more sensitive in osteochondral damage soft tissue imaging 23

24 The Difficult Ankle Investigation Conclusion consider possible causes good history thorough examination investigate bone scan/mri is the key 24

25 Avoiding Ankle Injuries?..Yet another basketballer 25

Outline. Ankle/Foot Anatomy Ankle Sprains Ottawa Ankle Rules DDx: The Sprain That Wasn t

Outline. Ankle/Foot Anatomy Ankle Sprains Ottawa Ankle Rules DDx: The Sprain That Wasn t Ankle Injuries Outline Ankle/Foot Anatomy Ankle Sprains Ottawa Ankle Rules DDx: The Sprain That Wasn t Anatomy: Ankle Mortise Bony Anatomy Lateral Ligament Complex Medial Ligament Complex Ankle Sprains