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PubMed1992

Ankle injuries in athletes.

Ankle injuries are the most frequent cause of physician evaluation in a sports-oriented environment. The lateral ligaments are most commonly injured. With a detailed history, physical and radiographic examination to avoid missing underlying pathology, the primary care physician can diagnose and treat the majority of ankle injuries. Occasionally, stress radiographs, arthograms, or magnetic resonance imaging (MRI) is needed. The vast majority of ankle sprains can be treated with adhesive tape strapping or semirigid orthotics and nonsteroidal anti-inflammatory medication followed by rehabilitation. Key points of rehabilitation are control of pain and swelling acutely with nonsteroidal anti-inflammatories and RICE (rest, ice, compression, and elevation), then restoring normal range of motion, strengthening muscle groups, and retraining proprioception of the ankle joint.

Ankle↗
PubMed2005

Athletes' ankle injuries: diagnosis and management.

Ankle injuries are common in the general and athletic populations. These injuries constitute 21% of all sports-related injuries. The wide spectrum of sports-related ankle injuries includes ligamentous injuries, soft-tissue and osseous impingement, osteochondral lesions of the talus, tendon injuries, and fractures. Occult lesions (eg, fractures of the lateral process of the talus, fractures of the anterior process of the calcaneus, fractures of the base of the fifth metatarsal, os trigonum, stress fractures) may be missed on initial physical examination, and patients with such injuries often present to a sports clinic with persistent pain around the ankle. Because of increasing participation in sporting events, health care professionals involved in the care of athletes at all levels must have a thorough understanding of the anatomy, pathophysiology, and initial management of ankle injuries. In this review, we describe the pertinent anatomy, pathology, diagnosis, and treatment of sports-related injuries of the ankle.

Ankle Injuries↗
PubMed1996

Practical methods of preventing ankle injuries.

Each year ankle sprains account for a significant degree of disability and expense. Thus, it is important that family physicians become familiar with methods of preventing ankle sprains. Both internal and external methods prevent ankle injuries. Internal methods include improving flexibility, strength and proprioception; effective external methods of ankle protection include using athletic tape, lace-up stabilizers and semirigid orthoses.

Ankle Injuries↗
PubMed1979

Rationalising requests for x-ray examination of acute ankle injuries.

Radiographs of injured ankles represent about 1 in 50 of all radiological examinations. The notes and radiographs of 100 patients with ankle injuries were reviewed, and the films of a further 93 patients who had ankle fractures treated by immobilisation were also scrutinised to assess the presence of absence of soft tissue swelling over the malleoli. Any accompanying radiographs of the foot requested at the same time were also studied. In 65 of the 100 cases of ankle injury there was no soft tissue swelling, and none of the patients had a major fracture, while 92 of the 93 patients with a major fracture had soft tissue swelling at the level of the malleoli. In 32 of the 100 cases of ankle injury foot radiographs had also been requested, but only three foot injuries were found. If the simple maxim of "No swelling adjacent to a malleolus, no radiographs" were applied radiography of twisted ankles could be reduced by as much as two-thirds. Moreover, if this maxim included the rider "and no routine foot films" the total casualty radiographic work load could be reduced by 8%.

Acute Disease↗
PubMed2006

Risk-factor analysis of high school basketball-player ankle injuries: a prospective controlled cohort study evaluating postural sway, ankle strength, and flexibility.

OBJECTIVE: To analyze risk factors, including postural sway, ankle strength, and flexibility, for the prediction of ankle injuries in men's high school basketball players. DESIGN: A cohort study with follow-up duration of 1 basketball season. SETTING: Biomechanics laboratory. PARTICIPANTS: Forty-two (age, 16.5+/-1.1y) players competing in first league of the High School Basketball Association without history of injury in the lower extremities within 6 months before recruitment and without significant malalignment in the lower extremities were included. None of these players met exclusion criteria such as using ankle braces or taping or failed in wearing low-top sports shoes during the follow-up season. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Biomechanic measurements including isokinetic ankle strength, 1-leg standing postural sway, and ankle joint dorsiflexion flexibility were performed before the basketball season by 1 physical therapist. The subsequent monthly follow-up questionnaires were sent and returned by mail to prospectively record the incidence of ankle injury occurring in the season. Results of these preseason measurements were analyzed to correlate if any of these measured variables could predict future ankle injuries. RESULTS: Eighteen ankle sport injuries were recorded for 42 players during the follow-up season. High variation of postural sway in both anteroposterior and mediolateral directions corresponded to occurrences of ankle injuries (P=.01, odds ratio [OR]=1.220; P< .001, OR=1.216, respectively). All other variables were not associated with injury. CONCLUSIONS: High variations of postural sway in 1-leg standing test could explain partly the increased prevalence of ankle injury in basketball players. It may be used as a screening tool to recommend balance training before basketball season.

Adolescent↗
PubMed2001

Ankle injuries in basketball: injury rate and risk factors.

OBJECTIVES: To determine the rate of ankle injury and examine risk factors of ankle injuries in mainly recreational basketball players. METHODS: Injury observers sat courtside to determine the occurrence of ankle injuries in basketball. Ankle injured players and a group of non-injured basketball players completed a questionnaire. RESULTS: A total of 10 393 basketball participations were observed and 40 ankle injuries documented. A group of non-injured players formed the control group (n = 360). The rate of ankle injury was 3.85 per 1000 participations, with almost half (45.9%) missing one week or more of competition and the most common mechanism being landing (45%). Over half (56.8%) of the ankle injured basketball players did not seek professional treatment. Three risk factors for ankle injury were identified: (1) players with a history of ankle injury were almost five times more likely to sustain an ankle injury (odds ratio (OR) 4.94, 95% confidence interval (CI) 1.95 to 12.48); (2) players wearing shoes with air cells in the heel were 4.3 times more likely to injure an ankle than those wearing shoes without air cells (OR 4.34, 95% CI 1.51 to 12.40); (3) players who did not stretch before the game were 2.6 times more likely to injure an ankle than players who did (OR 2.62, 95% CI 1.01 to 6.34). There was also a trend toward ankle tape decreasing the risk of ankle injury in players with a history of ankle injury (p = 0.06). CONCLUSIONS: Ankle injuries occurred at a rate of 3.85 per 1000 participations. The three identified risk factors, and landing, should all be considered when preventive strategies for ankle injuries in basketball are being formulated.

Adult↗
PubMed1999

Validation of the Ottawa Ankle Rules in children with ankle injuries.

OBJECTIVES: The Ottawa Ankle Rules (OAR) have been found to be 100% sensitive in adult patients with ankle injuries, and application of the OAR has resulted in a 28% reduction in the number of x-rays ordered. The objectives of this study were to determine the sensitivity and specificity of the OAR in children and to determine the potential change in x-ray utilization. METHODS: Children, aged 2-16 years, presenting to the EDs of two children's hospitals, with an ankle injury in the previous 48 hours, were enrolled. All patients were assessed by either staff physicians or fellows. X-rays were ordered according to standard clinical practice. Prior to reviewing x-rays, the physical examination was recorded on a standardized form. Positive outcomes (clinically significant) were defined as fractures with fragments > or =3 mm. Patients not x-rayed and asymptomatic at five to seven days postinjury were considered to have no significant fracture. RESULTS: Six hundred seventy patients were enrolled. The OAR were 100% sensitive (95% CI = 95% to 100%) for significant ankle fractures, with a specificity of 24% (95% CI = 20% to 28%). The OAR were 100% sensitive (95% CI = 82% to 100%) for the midfoot, with a specificity of 36% (95% CI = 29% to 43%). If the OAR had been followed, there would have been a reduction of ankle x-rays by 16% and foot x-rays by 29% without missing any clinically significant fracture. However, analysis of the two hospitals showed that if the rules had been applied, one would have a reduction in x-rays, while the other center would have an increase. CONCLUSIONS: This study demonstrates the OAR to be sensitive for detecting clinically significant (> or =3 mm) ankle and midfoot fractures in children. The application of these rules may reduce the number of x-rays ordered. A further study is required to determine the effect of using the OAR in clinical practice.

Adolescent↗
PubMed1983

Limiting the use of routine radiography for acute ankle injuries.

In the diagnosis of ankle injuries routine radiography is often productive. An international survey of the average number of radiographs made of injured ankles suggested that two projections are adequate to detect fractures. This was confirmed in a prospective study of 242 patients coming to a hospital emergency department with recent ankle injuries. All the fractures could be identified on an anteroposterior or a lateral projection, although some were more obvious on an oblique view. As well, all the fractures were associated with malleolar soft-tissue swelling. Thus, radiography for acute ankle injuries could safely be restricted to patients with soft-tissue swelling, and fractures could be diagnosed using only two routine projections, though for management purposes additional projections might be needed. With a policy of limiting the use of radiography substantial cost reductions are possible.

Acute Disease↗
PubMed2005

Sonographic detection of radiographically occult fractures in paediatric ankle injuries.

BACKGROUND: In some paediatric ankle injuries, the clinical picture is suggestive of a fracture despite negative three-view radiographs. OBJECTIVE: To determine the effectiveness of high-resolution US to differentiate radiographically occult fractures from sprains. MATERIALS AND METHODS: During a 12-month period, children aged 5-13 years who had sustained an acute ankle injury suspicious of a fracture on clinical examination, but with negative radiography, were referred for high-resolution US. Follow-up radiographs were obtained after 2-3 weeks. RESULTS: A total of 20 children were examined. In 13, US did not reveal a fracture; small fractures were detected in 7. All patients with negative US studies had negative follow-up radiographs. In six patients with positive US the follow-up radiographs demonstrated a periosteal reaction. In one child in whom a fracture line identified by US was in the depth of the lateral malleolus, the follow-up radiograph demonstrated an area of increased bone density. CONCLUSIONS: US is effective for the detection of radiographically silent fractures of the paediatric ankle. It may be used as an adjunct to radiography in clinically suspicious, but radiographically negative ankle injuries.

Adolescent↗
PubMed1988

Ankle injuries in the young athlete.

Ankle injuries in the young athlete are quite different from those of an adult. Because the epiphyseal plates of the distal tibia and fibula are significantly weaker than surrounding ligaments, failure on stress occurs through the growth plates rather than through soft tissue. Growth-plate injuries can assume a distinct pattern based on the maturity of the physis. Leg length inequality and angular deformity are potential sequelae from significant injury to the ankle in the skeletally immature but, fortunately, occur infrequently. Soft-tissue injuries about the ankle are rare, but with advanced, rigorous training techniques a new pattern of overuse injuries appears to be emerging.

Adolescent↗
PubMed1996

Evaluation and diagnosis of ankle injuries.

The evaluation of ankle injuries is a common challenge for family physicians. Diagnosis is made by using knowledge of the anatomy and function of the ankle joint to aid in taking an adequate history and performing an appropriate physical examination. The patient should be questioned about the mechanism of injury, previous injury, disability, treatment and pain. The ankle should be evaluated for ecchymosis, swelling, areas of tenderness and laxity. These measures help to determine what, if any, additional diagnostic procedures may be needed. Most ankle sprains are lateral, affecting the anterior talofibular, calcaneofibular and posterior talofibular ligaments. Other injuries include medial ankle sprains affecting the deltoid ligament, trauma to the Achilles and peroneal tendons, tarsal tunnel syndrome, fractures, syndesmotic sprains, synovial impingement and chronic instability. Criteria for radiographic evaluation include inability to bear weight initially or when examined, and tenderness over the medial or lateral malleolus. Accurate diagnosis is critical for appropriate treatment and minimizing functional disability.

Achilles Tendon↗
PubMed1990

The incidence of recurrent soft tissue ankle injuries.

A prospective study was carried out to assess the incidence of recurrent soft tissue injuries to the ankle joint. Out of 310 patients with acute ankle injuries seen in the accident and emergency department at the Royal Victoria Infirmary, Newcastle upon Tyne, 101 (32.5%) had injuries which were severe enough to necessitate review in the follow-up clinic. Twenty-seven of these patients (26.7%) had sustained one or more previous injuries to the same ankle within the past 24 months. This rather high incidence of recurrence highlights the need to evaluate our current diagnostic and treatment policies in dealing with this common injury.

Acute Disease↗
PubMed1996

Foot-ankle injuries: influence of crash location, seating position and age.

Foot-ankle injuries have increased in relative importance in recent years. As a basis for future countermeasures, an epidemiology study has been undertaken using Swedish accident data from Folksam Insurance. The database consists of 805 foot-ankle injuries out of 57,949 car occupant injuries reported from 1985 to 1991. The influence of crash location, seating position and occupant age is determined for the frequency, incidence and rate of foot-ankle injury in car crashes. Frontal car crashes produce 76% of the AIS 2-3 foot-ankle injuries with 13% in side impacts and 8% in roll-overs. The rate of AIS 2-3 foot-ankle injury is 24.7 per 1000 occupants injured in all crash locations and is similar irrespective of seating positions. Ankle fractures and sprains both occur at an incidence of 3.7 per 1000 injuries, followed by malleolus fractures at 2.7 and midtarsal fractures at 2.4. The foot-ankle injury incidence and rate are significantly greater (p < 0.01) in near oblique-frontal crashes than for 12 o'clock frontals. For drivers in 11 o'clock and front passengers in 12 o'clock, the incidence is 27.8 per 1000 injuries as compared to 17.5 for drivers and front passengers in 12 o'clock crashes. Occupant age is not as significant as seating position and crash location; however, there are higher incidences for rear occupants > or = 60 years old in oblique frontal crashes. Using the new AAAM Impairment Injury Scale (IIS), 48% of the foot-ankle injuries are rated with residual impairment IIS 1-2. The incidence in near-seated occupants is 1.5 times greater in oblique frontal crashes than in frontals. The incidence for IIS 1-2 impairment in near oblique-frontal crashes is 12.8 per 1000 occupant injuries as compared to 8.3 in frontal crashes.

Abbreviated Injury Scale↗
PubMed1999

Evaluation and management of lateral ankle injuries.

The diagnosis and management of lateral ankle injuries require the physician to obtain an accurate history, complete a thorough physical examination, and institute appropriate treatment protocol. Labeling all acute lateral ankle injuries as ankle sprains can lead to long-term mechanical and functional instability and chronic pain around the ankle. Appropriate and aggressive functional rehabilitation of the acute ankle limits the postinjury convalescence and need for surgical reconstruction. If surgical repair of the chronic or acute ankle is warranted, the Brostrom-Gould procedure serves as a highly successful anatomic repair. Lateral ankle tenodesing procedures also are effective; however, in most cases, the loss of rearfoot motion limits this procedure to a secondary reconstructive procedure.

Ankle↗
PubMed2000

The effectiveness of the parachutist ankle brace in reducing ankle injuries in an airborne ranger battalion.

The purpose of this study was to determine if the parachutist ankle brace (PAB) decreases the number and severity of ankle injuries in an airborne Ranger battalion. A retrospective study was performed covering a 38-month period. A computer database was used to track all jump injuries with a diagnosis of ankle pain, sprain, or fracture. The frequency was calculated for ankle injuries per 1,000 jumps and the average length of medically restricted duty per ankle injury. A total of 13,782 static line parachute jumps were conducted during the study period. Without the PAB, 35 ankle injuries were seen (4.5/1,000 jumps), with 9 fractures and 316 days of medical restriction per 1,000 jumps. Using the PAB, 9 ankle injuries were seen (1.5/1,000 jumps), with 3 fractures and 71 days of medical restriction per 1,000 jumps. The correct use of the PAB appeared to significantly decrease the incidence of ankle injuries in this battalion.

Absenteeism↗
PubMed1999

[Acute ankle injuries].

The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination, and clinical stress tests. If the clinical stress test is positive, stress radiography could be performed. There is no consensus about the usefulness of stress radiography in acute ankle sprain, particularly about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5 degrees to 30 degrees. Today MRI is not used for this indication, although it allows, with controlled positioning of the foot and with defined sections, visualization of injured lateral collateral ankle ligaments. In ankle injuries, plain radiographs form the established basis of diagnostic imaging and can provide definitive answers in most cases. CT is used in complex fractures for complete visualization. MRI is the method of choice for several diagnostic problem cases, including occult fractures and post-traumatic avascular necrosis. In tendon injuries, MRI is important if ultrasound is not diagnostic. Generally, for the evaluation of acute ankle injuries, MRI is the most important second-step procedure when radiographs are nondiagnostic.

Acute Disease↗
PubMed2000

Ankle injuries in the pediatric population.

Ankle injuries occur with considerable frequency in the pediatric population, although diagnosis is rarely straightforward. In this paper, we highlight the more common pitfalls in diagnosis and management, calling upon classic and contemporary literature and our own combined 30-year experience in managing pediatric lower extremity problems.

Ankle Injuries↗
PubMedDate not supplied

Video analysis of the mechanisms for ankle injuries in football.

BACKGROUND: Although ankle sprains are frequent in football, little is known about their mechanisms. PURPOSE: To describe the injury mechanisms for ankle injuries in male elite football. STUDY DESIGN: Prospective cohort study. METHODS: Videotapes and injury information were collected for 313 of 409 matches from Norwegian and Icelandic elite football during the 1999 to 2000 seasons. Video recordings of incidents that resulted in ankle injuries were analyzed and cross-referenced with injury reports from the team medical staff. RESULTS: A total 46 acute ankle injuries were reported to have occurred, that is, 4.5 injuries per 1000 match hours. Of these, 26 (57%) were identified on the videotapes. Two mechanisms thought to be specific to football were found: 1) player-to-player contact with impact by an opponent on the medial aspect of the leg just before or at foot strike, resulting in a laterally directed force causing the player to land with the ankle in a vulnerable, inverted position; and 2) forced plantar flexion where the injured player hit the opponent's foot when attempting to shoot or clear the ball. CONCLUSIONS: Systematic video analysis provides detailed information on the mechanisms for ankle injuries in football-for lateral ligament sprains and for the condition dubbed "footballer's ankle."

Adult↗