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Original Editor - Naomi O'Reilly Lead Editors - Naomi O'Reilly, Kim Jackson, Lucinda hampton, Joanne Garvey, Rachael Lowe, Ewa Jaraczewska, Admin, WikiSysop, Simisola Ajeyalemi, Vidya Acharya, Khloud Shreif, Kirenga Bamurange Liliane, Olajumoke Ogunleye, Evan Thomas, Oyemi Sillo, Tarina van der Stockt, Rucha Gadgil and Jess Bell The ankle joint is a hinged synovial joint that is formed by the articulation of the talus, tibia, and fibula bones. Together, the three borders (listed below) form the ankle mortise.
The talus articulates inferiorly with the calcaneus and anteriorly with the navicular.
Anatomy[edit | edit source]This 7-minute video is a good summary of the ankle. [2] Structure and Function[edit | edit source]
Articulating Surfaces[edit | edit source]
Joint Capsule[edit | edit source]The articular capsule surrounds the joints, and is attached, above, to the borders of the articular surfaces of the tibia and malleoli, and below, to the talus around its upper articular surface. The joint capsule anteriorly is a broad, thin, fibrous layer. Posteriorly, the fibres are thin and run mainly transversely, blending with the transverse ligament. Laterally the capsule is thickened and attaches to the hollow on the medial surface of the lateral malleolus. The synovial membrane extends superiorly between Tibia & Fibula as far as the Interosseous Tibiofibular Ligament.[3] Ligaments[edit | edit source]The main stabilizing ligaments are deltoid ligament medially, anterior, posterior talofibular and calcaneofibular ligament laterally. Medial Ligament[edit | edit source]The deltoid ligament, consists of four ligaments that form a triangle connecting the tibia to the navicular, the calcaneus, and the talus. It stabilises the ankle joint during eversion of the foot and prevents subluxation of the ankle joint. [3]
Lateral Ligament[edit | edit source]Laterally the ankle has stabilization from three separate ligaments, the anterior and posterior talofibular ligaments, and the calcaneofibular ligament. [1]The lateral ligaments stabilize the ankle, and serve as a guide to direct ankle motion by attaching the lateral malleolus to the bones below the ankle joint. They are responsible for resistance against inversion and internal rotation stress. [3]
Muscles[edit | edit source]The muscles of the leg divide into anterior, posterior, and lateral compartments.
A complete listing of muscles are described below. Plantarflexion[edit | edit source]Muscles which contribute to Plantarflexion
Dorsiflexion[edit | edit source]Muscles which contribute to Dorsiflexion
Blood Supply[edit | edit source]Derived from Malleolar Branches of:
Nerve Supply[edit | edit source]Clinical Significance[edit | edit source]Ankle Fracture - Ankle fractures are common in all ages with the involvement of one or both malleoli. The fracture pattern determines the stability of the fracture. Patients typically present with pain, swelling, and inability to bear weight on the ankle joint. Management of stable fractures includes a short leg cast for 4 to 6 weeks. Unstable fractures require an open reduction and internal fixation (ORIF) to restore a congruent mortise and fibular length. Talus Fracture - This injury usually occurs from a high energy injury like a motor vehicle accident or a fall from a height. The talus has a tenuous blood supply and is at high risk of avascular necrosis (AVN) in displaced fractures.[1] Ligament Injury - Ankle sprain is one of the most common musculoskeletal injuries, Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity.[4] Motions Available[edit | edit source]
Closed Packed Position[edit | edit source]Open Packed Position[edit | edit source]Structures Limiting Movement[edit | edit source]
Clinical Examination[edit | edit source]Assessment[edit | edit source]
Special Tests[edit | edit source]Clinical Prediction Rules[edit | edit source]
Outcome Measures[edit | edit source]
Pathology/Injury[edit | edit source]Physiotherapeutic Techniques[edit | edit source]Rehabilitation of ankle injuries should be structured and individualized.
Below are examples of techniques that could be incorporated in rehabilitation. Manual Therapy[edit | edit source]Balance Retraining[edit | edit source]
Return to activity specific training[edit | edit source]For sports persons an example is given below: When pain-free walking is achieved, progress to a regimen of 50% walking and 50% jogging. Using the same criteria, jogging eventually progresses to running, backward running, and pattern running. Circles and figures of 8 are commonly employed patterns. The final phase of the rehabilitation process is the athlete can perform sport-specific exercises pain-free and at a level consistent with pre-injury status. These routines represent the final phase of ankle-joint rehabilitation, and completion of this program is essential for the recovery of ankle stability. Physiotherapists need to create exercises and movement patterns that will increasingly challenge the neuromuscular coordination of the injured athlete.[7] Procedures[edit | edit source]Resources[edit | edit source]References[edit | edit source]
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