The Ankle latin “ angulus ” - bent

The Anklelatin “angulus” - bent

Key PlayersBones:Tibia, fibula, talus and calcaneusLigaments:Anterior Tibiofibular Ligament

(ATFL)Posterior Tibiofibular Ligament

(PTFL)Anterior Talofibular Ligament

(ATL)Posterior Talofibular Ligament

(PTL)

Talocrural JointBetween the tibia, fibula and

talusThis is a hinge joint and allows

most of the motion with plantar flexion and dorsiflexion.

________________

________________Talocrural Jt.

Subtalar JointThe articulation between the

talus and the calcaneus is referred to as the subtalar joint. Motion allowed by this joint is inversion (roll inward)/eversion (roll outward) as well as rear foot pronation (inward tilt of the calcaneus) and supination (outward tilt of the calcaneus) .

calcaneus

Talus

---Subtalar Joint

Medial aspect of foot

Ankle LigamentsThere are three lateral ligaments

predominantly responsible for the support and maintenance of bone apposition (best possible fit). These ligaments prevent inversion of the foot.

These ligaments are:◦Anterior talofibular ligament◦Calcaneofibular ligament◦Posterior talofibular ligament

Talus

FibulaTibia

Ant. Talofibular Ligament

Ant.Ti

biofibu

lar

Lig.

Post. Tibiofibular Lig.

<- Fibula

<- Ant. Talofibular Lig

<- Talus

Peroneal Tendons

Calca

neofi

bula

r Lig

amen

tCalcaneus

Subtalar Joint Space

Cuboid

calcaneus

<-Fibular head

Posterior tibiofibular Ligament

Achilles Tendon

Talus

Posterio

r

talofibular lig.

Peroneal tendons

The deltoid ligamentThis is located on the medial

aspect of the foot. It is the largest ligament but is actually comprised of several sections all fused together. This ligament prevents (eversion) of the ankle. The deltoid ligament is triangular in shape and has superficial and deep layers. It is the most difficult ligament in the foot to sprain.

Tibia

X

X

XNavicular ---

-- Talus

Tibial

is Pos

terior

Tendon

Tibi

alis

Ant.

Tend

on

Deltoid LigamentX

Ankle SprainsThe ankle is weakest when it is

plantar flexed.

Ankle SprainsInversion Sprain “rolling

over on your ankle”Mechanism: landing

from a jump while PFAffects the lateral

ligaments of the ankleFirst time sprain, 90% of

the time on uneven ground. Multiple sprains, could be on flat ground

Ankle SprainsEversion SprainsLess common due

to:◦ Strength of the

deltoid ligament (medially)

If forceful ankle eversion occurs, usually a tip of medial maleolus (tibia) chips off

What ligaments could be damaged from:

A. Inversion Sprain?• Lateral

ligaments: most commonly the Anterior Talofibular Ligament,

B. Eversion Sprain?• Deltoid ligament

(despite its strength)

Prevention of Injury to the Ankle

Stretching of the Achilles tendonStrengthening of the surrounding

musclesProprioceptive training: balance

exercises and agilityWearing proper footwear and or

tape when appropriate

Achilles Tendon Tear and Repair

Preventative Taping and Orthosis

Taping is often post injury treatment. Some will argue that taping will weaken the ankle. This has not been proven without a doubt but exercise and strengthening of the ankle is always advised.

Othotics will help rectify conditions that are permanent and will not be fixed by any other means.

Tape vs. BraceWhy choose one over anotherTaping may be more time consuming over

braceBraces may or may not allow more support

over tapeTape allows more functional movement and

often feels more stableTape will loosen with timeBraces will often loosen with timeIt really is based on the quality of the brace

vs. the ability of the person to tape. Both have advantages and disadvantages.

Lab ActivityFind out if you are prone to leg, ankle and foot

injuries by completing the exercises on the handout.

Any interesting findings?1. Length of legs: unbalanced,

overcompensation of one side of the body2. Morton’s Toe: stress on metatarsals could

increase risk of Metatarsal Stress Syndrome3. Pronation: risk of PFS, Tibial Stress

Syndrome and plantar fascitis, among other things

Shoe ShoppingFeet come in many shapes and sizes. How

can one shoe size capture all these?Oftentimes we need different footwear for

different activities!

Things to consider:Midsole materials

◦ Firmer◦ Softer

Heel counter◦ Rigid (prevents foot pronation)◦ Less rigid

Tips for Shoe ShoppingShop where there are

knowledgeable clerksKnow the spectrum of foot typesKnow the spectrum of shoe types

Questions?See your family doctor or

podiatrist