Ankle Injury: Grades, Anatomy, Biomechanics, and Rehabilitation

This presentation provides an overview of ankle injuries, including grades, anatomy, biomechanics, and rehabilitation exercises. It discusses the severity of ligament sprains and the importance of range of motion, strengthening, and balance exercises for recovery. The presentation also includes references to relevant studies and research.

Ankle Injury

Scenario
• A 24 years old female tennis player is suffering
from grade 2 ATFL and grade 1 calcaneofibular
ligament sprain.

Introduction to Injury
• Among various musculoskeletal injuries, ankle sprain
incidences covers about 15 to 20% of the total number of
sports injuries.
• The ankle is supported by various ligaments from various
positions. It is supported laterally by calaneofibular
ligament (CFL), anterior talofibular ligament (ATFL),
posterior talofibular ligament (PTFL) and (Kadel, 2017).
• Such kinds of ankle sprain are acute and are further
classified into three different grades on the basis of
severity of injury.

Grading and Severity of Injury
According to the traditional grading system of
ligament injuries-
• Grade 1 signifies that the ligament get stretched at
microscopic level and known as microscopic injury.
• It is a moderate type of injury that will show a little
tenderness and swelling with no loss of function
• The patient reported in the case is suffering grade
1 CFL injury and will show the above mentioned
physiological issues.

Grading and Severity of Injury
• Grade 2 signifies that there is a stretching in
ligament at macroscopic level; however, the
ligament is still intact.
• There will be moderate level of swelling and
impact on the functionality. There will be
reduced ROM, proprioception and instability.
• The patient reported in the case is having grade
2 ATFL injury and will show these symptoms
(Keane et al., 2013, p 32).

Grading and Severity of Injury
• Grade 3 signifies that there is a complete
rupturing of the ligament.
• There is high swelling, pain and loss of
function of the ligament.
• There is an enhancement of instability within
the person (Taylor, 2017, p 32).

Anatomy of ankle injury-
• The most frequently damaged
ligament among the sports
person is anterior talofibular
ligament (ATFL).
• The mechanism of sprain
injury and their anatomical
location mean that the
posterior talofibular and
calcaneo fibular are quite
unlikely carry any damaging
load(Williams et al. ,2016).
• The stab
• The distal Tibio-fibular
syndesmosis stabilising
ligaments are the transverse
anterior-inferior, posterior-
inferior tibio-fibular ligaments
and, inferior transverse
ligament and the interosseous
membrane ligament.
• A severe ankle sprain occurs
along with dorsiflexion of
ankle and external rotatio of
leg. (Kearney et al., 2015, p
45).

Biomechanics of Ankle injury
• The biomechanics of ankle joint is quite complex and it
largely depends on the integrity of ankle ligament.
• After the trauma, the pain is inevitable that is due to injury
caused to antero-fibular ligament eventually leading to
mechanical dissociation of talus from ankle-mortise.
• The non-physiological movement of feet required a force
that is dependent on individual’s configuration of bony
structure of hind foot and articular structure. (Bamber, Fog
& Healer, 2018, p 22).
• As compare to flat foot, pes cavus are less protected to
suffer from the ankle sprain.

Biomechanics of Ankle injury
• With the decrease in peroneal muscle leverarm, there is
an increase in the plantarflexion of the foot. It resulted in
lack of protection from the supination stress (Kearney et
al., 2015, p 45).
• The objective of treating ankle spray is it needs to re-
activate the mechanical action of ankle joint. The orthoses
at ankle has a greater role to play against excessive plantar
flexion and supination stress.
• The ankle injury prevention can be improved significantly
by recognition of mechanical disposition of individual
(Taylor, 2017, p 32).

Rehabilitation

Rehabilitation
Range of motion exercises- This kind of exercise begins
right after the injury.
• It is performed by putting ice on the ankle. It is
reportedly have a good outcome and give relief from
pain (Kadel, 2017).
• The two different kind of range of motion exercise
includes trace the alphabet with toe and encourage
the movement in all direction.
• The second one is to sitting on the chair with foot flat
on floor and moving the knees for 3 minutes.

Range of motion exercises

Rehabilitation
Strengthening exercise-
• This kind of exercise is reported to be very
effective against the ATFL and CFT ligament
sprain. Reports suggest that it helps in regaining
the ligament function faster (Williams et al.,
2017)
• Typically, the strengthening exercise starts when
the athletes are able to stand without swelling
or increased pain.

Strengthening exercises

Rehabilitation
Control and balanced exercise-
• The balance and controlled exercise can start once the
person is able to stand without pain.
• It is very effective for the sports person after an injury
(Strom et al., 2016). It is recommended not to try such
exercise if it is not done before.
• The control and balance exercise can be started with
the ankle injury is completely cured to regain the
functionality of the ankle (Tsikopolous et al., 2018, p
243)

Rehabilitation
Strengthening exercises-
• Standing by raising the calf and lift the body
on the toes for 15 seconds
• Heel walking by lifting the front of the foot off
the floor
• Hand Foot war- It can be done by putting the
right hand against right foot

Control and Balance exercises

References
• Kearney, R.S., Parsons, N., Underwood, M. and Costa, M.L., 2015. Achilles tendon rupture rehabilitation: a mixed methods
investigation of current practice among orthopaedic surgeons in the United Kingdom.
Bone & joint research,
4(4), pp.65-
69.
• Keene, D.J., Schlüssel, M.M., Hagan, D., Thompson, J., Williams, M.A., Byrne, C., Gwilym, S.E., Goodacre, S., Cooke, M.W.,
Hormbrey, P. and Bostock, J., 2017. Development and external validation of a prognostic model for predicting poor
outcome in patients with acute ankle sprains.
Physiotherapy,
103, pp.e32-e33.
• Taylor, N., 2017. The addition of supervised physiotherapy sessions for management of acute ankle sprain does not aid
recovery more than providing standardised written instruction about early management [synopsis].
Journal of
physiotherapy,
63(2), p.115.
• Bamber, Z.A., Fong, D. and Wheeler, P., 2018. ASSESSING LATERAL ANKLE SPRAIN RISK USING LOWER LIMB
ANTHROPOMETRICS.
ISBS Proceedings Archive,
36(1), p.334.
• Tsikopoulos, K., Mavridis, D., Georgiannos, D. and Cain, M.S., 2018. Efficacy of non-surgical interventions on dynamic
balance in patients with ankle instability: A network meta-analysis.
Journal of science and medicine in sport,
21(9),
pp.873-879.
• Kadel, N. J. (2017). Foot and Ankle Injuries in the Adolescent Dancer. In
Prevention of Injuries in the Young Dancer (pp.
147-165). Springer, Cham.
• Strøm, M., Thorborg, K., Bandholm, T., Tang, L., Zebis, M., Nielsen, K., & Bencke, J. (2016). Ankle joint control during single-
legged balance using common balance training devices–implications for rehabilitation strategies.
International journal of
sports physical therapy,
11(3), 388.
• Williams, V. J., Nagai, T., Sell, T. C., Abt, J. P., Rowe, R. S., McGrail, M. A., & Lephart, S. M. (2016). Prediction of dynamic
postural stability during single-leg jump landings by ankle and knee flexibility and strength.
Journal of sport
rehabilitation,
25(3), 266-272.