Kategoriarkiv: Foot, ankle

tape-description

Ligament injury in the ankle joint, inner ligament



Objective: Stabilise the ankle joint (talocrural and subtalar joints) against too great a lateral twist (supination and pronation) without reducing the normal mobility of the ankle joint (plantar and dorsal flexion). With a heavy sprain the applications include “stirrups”, “ankle lock” and possibly “figure-8”, however, light sprains normally require just “stirrups”.
The tape is utilised the whole day in the beginning of the course, being gradually reduced over the following three months. The tape is finally only used in connection with particular loads where there is risk attached.

Type: ANKLE TAPE – LATERAL STABILISATION:
“STIRRUP”
Application: The foot should be kept in a neutral position when applying the tape, at an angle of 90 degrees from the lower leg. One or two tape anchors are applied around the lower leg 10-20 cm above the ankle joint (A), followed by application of three stirrups. The stirrups are started from the anchor on the inner side of the leg if it is the outer tendons that are injured (95%), and the other way around in the rare cases where it is the inner tendons that are damaged. The stirrups are taken under the heel and drawn up to the anchor on the outer side of the leg. When applying the stirrups the outer border of the foot is pushed slightly up, whilst at the same time pulling the border slightly up with the tape. A stirrup (B) is applied with the rear half of the outer ankle knuckle directly under the tape. A sloping stirrup (D) starts from the anchor on the front side of the leg slanting down over the lower leg over the front half of the inner ankle knuckle, under the foot and over the front half of the outer ankle knuckle, and slanting in over the leg up to the anchor. Finish with a further strip on top of the anchor A.

Type: ANKLE TAPE – LATERAL STABILISATION:
“ANKLE LOCK”
Application: One or two tape anchors are fixed around the lower leg 10-20 cm above the ankle joint (A). Begin on the anchor on the inner side of the leg, draw the tape forward in front of the leg, down over the outer ankle knuckle, behind the heel directly under the Achilles tendon, down under the heel and up over the outer side of the leg to the anchor. The ankle lock can be applied the other way around if the inner tendon is damaged. Finish with a further strip on top of the anchor A.

 

Type: ANKLE TAPE – LATERAL STABILISATION:
“FIGURE-8 BANDAGE”
Application: Begin just in front of the ankle joint and draw the tape in under the arch of the foot on the inner side, and up over the outer side, continuing over the start tape in front of the ankle joint and round behind the leg and back again to finish in front of the ankle joint.

 

Type: ANKLE TAPE – LATERAL STABILISATION:
“DOUBLE FIGURE-8 BANDAGE”


Especially used with sprains of the tendon in the front of the ankle joint (lig. tibiofibular anterior), where pain is experienced when flexing the foot powerfully upwards (dorsal flexion).
This tape must be rolled loosely on, and must not be drawn tight. If the tape becomes tight all the same, which often happens, it must be loosened.
Application: Start at the back of the foot just in front of the ankle joint and draw the tape down around the outer border of the foot (A), under the sole and up to the back of the foot. Continue over the lower part of the ankle knuckle behind the heel under the Achilles tendon (B). The tape crosses down under the inner side of the heel and up to the outer border of the foot (C). The tape continues over the lower part of the inner ankle knuckle behind the heel under the Achilles tendon. The tape crosses the earlier tape, goes down under the outer side of the heel (D) and up to the inner border of the foot to finish on the back of the foot.

examination-article3

Ligament injury in the ankle joint, inner ligament

SportNetDoc

Is stress radiography necessary in the diagnosis of acute or chronic ankle instability?

Frost SC, Amendola A. Clin J Sport Med 1999 Jan;9(1):40-5.

BACKGROUND.
Clinicians often use the talar tilt (TT) and anterior drawer (AD) stress x-rays to diagnose acute or chronic mechanical ankle instability. However, the wide range of TT and AD values in normal and injured ankles makes interpretation of the test results difficult.

OBJECTIVE.
To critically review the literature and determine the accuracy of stress radiography in the diagnosis of mechanical ankle instability.

DATA SOURCES.
MEDLINE was searched for relevant articles published since 1966 using MEDLINE subject headings (MeSH) and textwords for English articles related to ankle injuries and radiography. Additional references were reviewed from the bibliographies of the retrieved articles. The total number of articles reviewed was 67. Of these, 8 studies met criteria for inclusion and were analyzed.

STUDY SELECTION.
Only clinical studies that used surgical exploration as the gold standard for diagnosing lateral ligament rupture were evaluated for this study. Cadaver or laboratory studies were excluded.

DATA EXTRACTION AND SYNTHESIS.
In reviewing the literature, pertinent strengths of the different study designs were emphasized. From these data, particular attention was paid to the diagnostic accuracy of each study in comparing TT and AD stress x-rays to surgical confirmation of lateral ligament rupture.

MAIN RESULTS.
A total of eight prospective clinical series satisfied the inclusion criteria. Seven of the eight assessed acute ankle instability as the outcome and one assessed chronic ankle instability. Of the seven studies that focused on acute ankle injuries, only one concluded significant benefit in using stress views to diagnose lateral ligament rupture. Three of the seven reported a positive relationship between stress radiography and surgical findings, although all six studies concluded that TT and AD stress x-rays are not reliable enough to make the diagnosis. The authors who assessed chronic ankle instability stated that TT and AD stress views combined were not useful in defining ankle instability.

CONCLUSION.
The published data regarding TT and AD stress x-rays are too variable to determine accepted normal values compared with injured values. There are insufficient data for comparison of the use of mechanical versus manual techniques, or use of local anesthetic to facilitate the stress test. Because the treatment evolution of all acute ankle sprains is toward functional nonoperative treatment and because treatment does not depend on the degree of ankle instability on stress views, the TT and AD stress x-rays have no clinical relevance in the acute situation. In cases of chronic instability, the large variability in TT and AD values in both injured and noninjured ankles precludes their routine use.

cause-article2

Ligament injury in the ankle joint, inner ligament

SportNetDoc

Tendon sheath injuries of the foot and ankle.

Duddy RK, Meredith R, Visser HJ, Brooks JS. J Foot Surg 1991 Mar-Apr;30(2):179-86.

Tendon sheath injuries of the foot and ankle are a common clinical entity secondary to trauma and abnormal biomechanics. These injuries are often misdiagnosed and/or inappropriately treated. This article presents an historic review, etiology, classification, diagnosis, and treatment protocol for these injuries.

cause-article1

Ligament injury in the ankle joint, inner ligament

SportNetDoc

Associated injuries found in chronic lateral ankle instability.

DIGiovanni BF, Fraga CJ, Cohen BE, Shereff MJ. Foot Ankle Int 2000 Oct;21(10):809-15.

Sixty-one patients underwent a primary ankle lateral ligament reconstruction for chronic instability between 1989 and 1996. In addition to the ligament reconstruction, all patients had evaluation of the peroneal retinaculum, peroneal tendon inspection by routine opening of the tendon sheath, and ankle joint inspection by arthrotomy. A retrospective review of the clinical history, physical exam, MRI examination, and intraoperative findings was conducted on these 61 patients. The purpose was to determine the type and frequency of associated injuries found at surgery and during the preoperative evaluation. At surgery no patients were found to have isolated lateral ligament injury. Fifteen different associated injuries were noted. The injuries found most often by direct inspection included: peroneal tenosynovitis, 47/61 patients (77%); anterolateral impingement lesion, 41/61 (67%); attenuated peroneal retinaculum, 33/61 (54%); and ankle synovitis, 30/61 (49%). Other less common but significant associated injuries included: intra-articular loose body, 16/61 (26%); peroneus brevis tear, 15/61 (25%); talus osteochondral lesion, 14/61 (23%); medial ankle tendon tenosynovitis, 3/61 (5%). The findings of this study indicate there is a high frequency of associated injuries in patients with chronic lateral ankle instability. Peroneal tendon and retinacular pathology, as well as anterolateral impingement lesions, occur most often. A high index of suspicion for possible associated injuries may result in more consistent outcomes with nonoperative and operative treatment of patients with chronic lateral ankle instability.