" The following table illustrates the differentiation in ankle injuries that exists:
Table 1. Useful Tests for Various Ankle Injuries
Injury Location
Specific Injury
Useful Test
Lateral
Inversion sprain
Lateral malleolus fracture
Osteochondritis dissecans
Peroneal tendon subluxation
Bifurcate ligament avulsion
Anterior drawer, talar tilt
X-ray as per Ottawa ankle rules
Mortise view ankle x-rays
Resisted dorsiflexion and eversion
X-rays
Medial
Medial ankle sprain
Medial malleolus fracture
Posterior tibialis tendon injury
Flexor hallucis longus tendinitis
Eversion stress
X-ray as per Ottawa ankle rules
Single heel-rise test
Resisted first-toe flexion
Posterior
Achilles tendon rupture
Os trigonum fracture
Thompson's
Weight-bearing lateral x-ray, tenderness on passive plantar flexion
Anterior
Syndesmosis sprain
Dorsiflexion injuries
Anterior tibialis tendon injury
Squeeze," external rotation
Side-to-side
Resisted dorsiflexion
Avulsion fracture, 5th metatarsal
Maisonneuve fracture
Palpation tenderness, foot x-rays
Palpation tenderness, fibula x-rays
Source: Trojan & Mckeag (1998)
Lateral Inversion Sprain
The lateral inversion sprain is sated to be "the most common ankle injury" accounting for approximately 85% of ankle sprains. The inversion injury will result in lateral ligaments being stretched and/or torn (generally from anterior to posterior)" (Trojan & McKeag, 1998. The following table illustrates how the physician grades the injury and reveals the prognosis as well:
Table 2. Grading of Lateral Ankle Sprains and Return to Play (11)
Grade
Anterior
Drawer Test
Talar Tilt
Test
Return to Play
Negative
1-10 dy
Increased laxity
Negative
2-4 wk
Positive
5-8 wk with optimal rehab
Source: Trojan & Mckeag (1998)
Treatment for lateral sprains are stated as being inclusive of "rest, ice, compression and elevation" along with assistance of crutches and pain and swelling medication as illustrated in the PRICEMMM Table below:
Protection with ankle bracing to prevent reinjury while ligament heals;
Rest for injured ankle until normal heel-toe gait is restored;
Ice on ankle to decrease swelling and relieve pain;
Compression as soon as possible to decrease swelling;
Elevation: the initial step for reducing swelling;
Medication: NSAIDs or acetominophen for pain relief;
Mobilization early on when pain free to expedite return to play; and Modalities: exercise and proprioception training to prevent reinjury.
Source: Trojan & McKeag (1998)
Medial Eversion Sprain
The medial eversion sprain is the type of sprains that wrestlers commonly deal with in. These types of sprains are not as common as lateral sprains with lateral sprains accounting for 85% of ankle sprains and eversion sprains accounting for 10% of ankle sprains. But, when a fracture does occur, 75% of the time it occurs on the medial side.
Syndesmosis Sprain
The Syndesmosis sprain is "postulated to be external rotation and hyperdorsiflexion" in nature as to the causal mechanism. Syndesmosis sprains account for between 1% and 11% of all ankle sprains and occurs more in contact sports. These sprains typically take longer to heal and recovery is 55 days instead of the 35 days allotted for a lateral sprain with a rating of grade 3. The bifurcate ligament injury usually happens due to "violent dorsiflexion, forceful plantar flexion, or direct trauma"(Trojan & McKeag, 1998) This type of sprain accounts for 19% of ankle inversion sprains.
Achilles Tendon Rupture
Achilles tendon rupture usually occurs in older athletes who are not conditions and in younger athletes that have been inactive due to another injury. The sensation is reported to be sharp pain in the Achilles and say it sounded like they were shot. Trojan & McKeag (1998) state of treatment in this injury that it is "controversial."..and that... "Casting is a reasonable option, especially if the tear is more than 2 cm from the calcaneal attachment. Surgery should be considered for the elite athlete to minimize the chance of rerupture."(Trojan & McKeag,1998)
Other Ankle Injury Classifications
Achilles tendon rupture usually occurs in older athletes who are not conditions and in younger athletes that have been inactive due to another injury. The sensation is reported to be sharp pain in the Achilles and say it sounded like they were shot. Trojan & McKeag (1998) state of treatment in this injury that it is "controversial."..and that... "Casting is a reasonable option, especially if the tear is more than 2 cm from the calcaneal attachment. Surgery should be considered for the elite athlete to minimize the chance of rerupture."(Trojan & McKeag,1998) Other sprains are the: (1) Peroneal Tendon Subluxation or Dislocation; (2) The Flexor Hallucis longus injury; (3) The Lateral Periostitis or 'Jumpers Ankle"; (4) Os trigonum injury; (5) Anterior tibialis tendon injury; and (6) Fractures which account for 15% of all ankle injuries among athletes. (Trojan & McKeag, 1998) The following table illustrates the diagnosis and care for varying types of ankle sprain and strain:
Table 4. Diagnosing and Managing Ankle Fractures
Site or Type
Characteristics and Findings
Treatment
Comments
Malleolus
Injuries that extend across an imaginary line drawn through the top of talar dome on AP x-ray considered unstable
Referral for unstable...
Our semester plans gives you unlimited, unrestricted access to our entire library of resources —writing tools, guides, example essays, tutorials, class notes, and more.
Get Started Now