Proprioception is the ability of the brain to sense the position of a joint ex. Note that nerves within the ligament mediate proprioception and therefore this sense can be out of kilter following a ligament injury.
As the acuity of the injury resolves, patients with seemingly normal ankles on examination no swelling, no tenderness, no laxity may still feel unstable if proprioception has not returned to normal. It is important that the motion follow a deliberate pattern — and not random waving of the foot — as deliberate motion helps improve proprioception as well.
Proprioception can also be improved by having the patient stand on one foot with eyes closed. Once this is mastered, standing on one foot on a soft surface such as a pillow or bed with eyes closed and head moving side to side can further improve proprioception. Rehabilitation after an ankle sprain can often be completed with a home program, though trained physical therapists may be beneficial in providing initial instruction defining the program. Surgery is rarely indicated for the treatment of acute ankle sprains.
However, patients who have recurrent ankle sprains may be candidates for an ankle ligament stabilization procedure to treat their anatomic instability and restore functional stability. Most people with sprained ankles fully recover.
Even if the ligaments are permanently deformed, the muscles crossing the ankle joint can provide sufficient dynamic stability. However, because ankle sprains are such a common injuries, even a low rate of complications coupled with a high incidence may produce a significant number of people with poor outcomes.
Ankle injuries associated with chronic anatomic instability may lead to the development of traumatic arthritis. Risk factors for ankle sprains include a high arched foot cavus foot , ligamentous laxity leading to increased inversion, participating in high risk activities ex. Rovere et al PMID: studied the effectiveness of taping, wearing a laced stabilizer and high-top or low-top shoes among collegiate football for 6 seasons. They reported that the combination associated with the fewest injuries overall was low-top shoes and laced ankle stabilizers.
Football and soccer are the next most implicated sports causing ankle sprains during athletics. Ankle sprain, syndesmosis, mortise, talo-fibular ligament, calcaneo-fibular ligament, deltoid ligament, proprioception. Recognize an ankle sprain and differentiate between it and other ankle and hindfoot injuries.
Apply the Ottawa ankle rules to recognize need for x-rays. Table of Contents. Toggle navigation. Ankle Sprains Description Ankle sprains are among the most common musculoskeletal injuries.
Figure 1: Ankle Inversion, the typical mechanism of injury of an ankle sprain. Figure 2: The Ankle Mortise. The talus T sits in an inverted U known as the mortise.
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Previous Chapter. Next Chapter. Papadakis M. Maxine A. Papadakis, et al. Most occur to the ligaments on the lateral side of the ankle and are generally referred to as inversion ankle sprains because it is excessive inversion that causes the sprain.
There are two other ankle regions that are also susceptible to ligamentous sprain: the deltoid ligament complex on the medial side of the ankle and the distal tibiofibular syndesmosis above the ankle joint. Let's examine some key factors associated with each of these injuries. Inversion ankle sprains affecting the lateral ligaments are often considered the most common lower extremity soft-tissue injury.
The architecture of the leg and foot bones as well as the smaller size of these ligaments make them more vulnerable to injury. The primary function of the lateral ankle ligaments is to resist excessive inversion of the ankle. Yet for this important role, these ligaments aren't as strong and resilient as those on the opposite side of the ankle. That is one of the reasons that inversion sprains are much more frequent than eversion sprains. There are three primary ligaments that make up the lateral ankle ligament complex.
Their attachment points are easy to identify, as the ligament names designate the two bones they connect. These three key ligaments are the anterior talofibular connecting the talus and fibula , posterior talofibular also connecting talus and fibula , and the calcaneal fibular connecting the calacaneus and fibula. Of these, the anterior talofibular and calcaneofibular are the most commonly injured with the inversion ankle sprain Figure 1.
Excessive inversion is the most likely foot movement that sprains these ligaments. However extreme plantar flexion, especially if combined with inversion, is also a likely contributor to inversion ankle sprain.
This puts you at risk of twisting your ankle or even falling. Placing unusual stress to the ligament. This could be from walking or running on an uneven surface, jamming your foot, or twisting your ankle in an odd way.
Ankle sprain complications Without proper diagnosis, treatment, and care, an ankle sprain can impede your ability to walk and do other routine activities. Learn more about ankle sprains The links below will open a new browser window. Twisted ankle symptoms include bruising. The ankle may also feel warm to the touch. Talking to your doctor about your pain and its location will help with your diagnosis. Make an appointment for ankle sprain symptoms and diagnosis A UPMC Sports Medicine expert can help diagnose and manage the symptoms of an ankle sprain.
Learn more about ankle sprain symptoms and tests The links below will open a new browser window. Other ankle sprain treatments for athletes and non-athletes may include: Over-the-counter pain relievers, such as NSAIDs non-steroidal anti-inflammatory or acetaminophen.
Strengthening, stretching, and balancing exercises.
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