1. The Ankle

2. Bones Tibia Fibula Talus

3. Movements Dorsal Flexion- most stable position Plantar Flexion- Most unstable Eversion Inversion

4. Ligaments Medial Side  Deltoid Ligament- has 4 attachments  Tibionavicular, tibiocalcaneal, anterior tibiotalar, posterior tibiotalar

5. Lateral Side Anterior talofibular (most commonly sprained) Calcaneofibular Posterior talofibular Anterior tibiofibular Posterior tibiofibular Posterior talocalcaneal Lateral talocalcaneal

6. Muscles, Arteries, Nerves See foot notes

7. Ankle Landmark Test Start Posterior then medial lateral last  Achilles Tendon  Medial Mallious  Deltoid Ligament  Lateral Mallious  Posterior Talofibular  Calcanealofibular  Anterior Talofibular  Base of the 5 th  MUST COMPLETE IN THIS ORDER FOR 4.

8. Sprains - 85% of injuries sprains - 90% of sprains are inversion

9. The Ankle Story Trainer focus on lower body movement during play When player goes down trainer trot to athlete Keep athlete down Look for abnormal angles

10. The Ankle Story cont. Ask questions- feel anything tear, pop, pain or discomfort, shooting pain If no deformity- ask if they can stand two man walk with leg up. If they cant stand two man carry

11. The ankle story cont Bare ankle  Look for swelling, discoloration  Find point tender spot palpate  Start posterior, Achilles, deltoid ligaments, navicular, base of 5 th, posterior Talofibular, calcaneofibular, anterior talofibular  Fracture Test  s/sx- vertical shooting pain, heel tap, mallelous tap lower leg squeeze

12. The Ankle Story Cont. Ligament stress test  Drawer stress- tear of anterior talofibular  Hand on top of leg other on heel pull up hard  Invesion stress- tear calcaneofibular  Turn heel in

13. The Ankle Story Cont. Range of Motion (ROM)  Passive and Active- DF,PF,IV, EV Manuel muscle Test- Tell athlete to not let you move foot in all ROM

14. The Ankle Story Bare Foot Test  Stand on toes of both feet  Jump with both feet- watch for double slap  Hop on injury  Walk forward and backward  Put Maximum Tape support  Have athlete run forward and backwards, figure 8, grapevine, slides, skip.  If pain stop

15. The ankle story cont. If unable to return RICE. If able to pass bare foot test return to play as tolerated.

16. Strains Can be independent of part or sprain Strain of the peroneal muscles  Usually part of lateral ankle sprain  Point tender over from base of 5 th (in severe xray to rule out avulsion fracture) posterior malleolus up lateral side of leg  Weakness with eversion on muscle test  Treatment- RICE, strength eversion.

17. Strains Anterior and dorsum muscle strains- extensor Cause by forced into extreme dorsal flexion, running backwards Point tenderness over nails of toes

18. Strains Achilles Tendinitis  Causes- overuse or acute, tight Achilles or part of ankle sprain, or independent  S/sx- point tenderness over achilles, pain with dorsal flexion, weakness with plantar flexion  Tx- Stretch achilles, strengthen plantar flexion, RICE, tape to play  Can lead to achilles tendon rupture.

19. Strains