Anatomy of the ankle
The upper ankle joint (articulatio Talocruralis) is a compound between the lower tail end of the bone of the lower leg (tibia et fibula) and the large bone in the ankle – talus. The upper ankle joint perform the movements of flexibility (Flexio), in which the upper side of the foot moves towards the lover leg and stretching (extensio), and in which the upper side of the foot moves in the opposite direction, i.e. away from the front of the lower leg.
Ankle joint ligaments:
Inner talo-crural joint connection (lig. Deltoideum) consists of four parts:
- Pars tibionavicularis
- Pars tibiocalcanearis
- Pars tibiotalaris anterior
- Pars tibiotalaris posterior
External talo-crural connection joint consists of:
- talofibulare anterius
- talofibulare posterius
The cause of injury:
Inversion injuries are about 70-85% of all injuries to the ankle joint. The injury comes when the foot is in the plantar flexion (a position similar to that used by the foot when the foot pedal is pressed in the car) and supination (foot slightly rotated outwards). The mechanism of injury often includes landing or standing at the foot of another person. This type of injury leads to the extension of the outer linkage of the ankle, in the sense of partial or complete breakage of ligamentary structures. The injuries to the inner joint of the ankle (Deltoideum) occur at the forset of the joints of the ankle. Isolated injuries to this connection are very rare and there is always a need to consider the possible fracture of the fibula (external lover leg bone).
Diagnosis of injury, estimation of severity and degree of distortion
The size of the edema and hematoma is most often correlated with the degree of injury. By palpating painful places we can identify who of the ligaments was injured. Careful examination should exclude the possibility of fracturing the base of the five metatarsal bones, proximal fibula and medial and lateral maleolus. Stage III dissociation is associated with 80% incidence of damage to the nerve structure of the lover leg.
The stability of the ankle joint is examined with mechanical stress tests:
- Anterior drawer test and
- Talar tilt test
The division of ankle injuries by severity:
|I. little distortion||Minimal||Minimal||Almost normal||Normal|
|II. Partial interruption||Moderate||Moderate||Difficulty walking on your fingers||+ Anterior drawer test
– Talar tilt test
|III. Complete interruption||Significant||Significant||Significant loss||+ Anterior drawer test
+ Talar tilt test
When does an X-ray needed for the diagnosis?
X-ray often is not required for athletes with injured ankle. According to the Ottawa Ankle Rules, X-rays are necessary for those:
- Which have sensitivity along the last edge or at the distal end of the medial or lateral malleolus
- Who cannot carry their own weight for 4 steps
- Have pain in the base of five metatarsal bones
Treatment of injury and return to the field
In the acute phase of injury, the most important is to apply the RICE method:
- 1st. recovery phase (Rest, Ice, Compression and Elevation). Moderate resting with elevation of the leg is recommended, the use of ice for 5-7 minutes, 3-5 times during the day (especially in the first 24 hours).
- 2nd. phase of rehabilitation, the goal is to restore the normal range of movement and strengthen the ankle (physical therapy). An athlete can start limited (to the extent of pain) plantar flexion exercise and dorsal extensions.
- 3rd. phase of recovery (when movements are close physiologically, and the pain and the edema are gone) begins with exercise proprioception, conditioning training and endurance training.