By;Hikmah JayaIffa Andi Ita MaghfirahPutri Amanda ToboFradita Y Yunus GuzasiahResha DermawanDwiky Limbersia AriesAdvisor : dr. Nasrah/dr. Wendelin/ dr. NurJalalSupervisor : dr. M. Phetrus Johan, M.kes, Sp. OT

Department of Orthopedic and Traumatology Medical FacultyHasanuddin University

ANKLE INJURY ? Overuse injuries from componen of the ankle and foot Often associated with sports activities Appley System Orthopaedics and Fracture. Chapter 31: Injuries of The Ankle and Foot

FUNCTION OF ANKLESarwark JF. Foot And Ankle: Essential Of Musculoskeletal Care 4. Section 7. P. 733. 2010

STABILITY OF ANKLE

SYNDESMOSIS OF ANKLEThompson J.C., Netters Concise Orthopaedic Anatomy, 2nd ed., Saunders Elsevier. p.121

RANGE OF MOTION OF THE ANKLESarwark, JF. General Orthopaedics: Essential of Musculoskeletal Care, Section One. P.11.2010-2011

MUSCLE OF FOOTTibialis AnteriorEkstensor Hallucis LongusEkstensor Digitorum LongusGastronemiusSoleusStone. R J, Stone JA. Muscles Of The Leg and Foot . Atlas Of Musculoskeletal and Muscle. Chapter nine; P. 186-192.

Arteries Of FootMoore, Keith L.; Dalley, Arthur F., Clinically Oriented Anatomy, 5th Edition,

Nerves Of FootThompson J.C., Netters Concise Orthopaedic Anatomy, 2nd ed., Saunders Elsevier. p.121

PATHOPHYSIOLOGYChapman WM. Chapmans Orthopaedic Surgery. California 2001. Page 2208

ETIOLOGYAmerican Academy of Orthopaedic Surgeons. Tennis elbow. [online].2011.[cited,2014 May 29]. Available from: http://orthoinfo.aaos.org/topic.cfm?topic=a00068

ANKLE INJURYSPRAINSTRAINFRACTURE

ANKLE SPRAIN Overuse injury limited to ligament.

Common acute sports injury, 25% in every running or jumping sports

Mechanism : Invertion of the foot places significant on the lateral ligament Simon RR, Sherman SC, Koeningskec SJ. Lowe Extremities. Ankle; Emergency Orthopedics: The Extremities, 5th Edition.

PHYSICAL EXAM ANKLE SPRAINEssential Musculosceletal CareSwelling Ecchymosis Tenderness

SPECIAL TESTSAnterior Drawer Test

Invertion Stress Test(talar tilt test)Essential Musculosceletal Care

IMAGING OF ANKLE SPRAINT2 Weighted Axial image of ATFL tearUltrasound image of ATFL tear

ACHILLES TENDON INJURIES Ruptures typically occur after age 30.

Commonly occur in weekend athletes

Mechanism: dorsiflexed ankle with the knee extended (Maximal Streatching).Wheeless' Textbook of Orthopaedics: Achilles Tendon Injury

Hyper-dorsiflexion sign Palpable gap in tendon Tenderness Difficulty Standing on toes Examination Thompson Test

Wheeless' Textbook of Orthopaedics: Achilles Tendon InjuryPHYSICAL EXAM ACHILLES TENDON INJURY

Rebecca Aspden, Achilles Tendon Rupture USG OF ACHILLES TENDON INJURY

MRI ACHILLES TENDON INJURY

Handbook of Fractures, 3rd EditionAnkle fractures refer to fractures of the distal tibia, distal fibula, talus, and calcaneus.The highest incidence of ankle fractures occurs in elderly women.Open fractures are rare, accounting for just 2% of all ankle fractures.

Ankle Fracture

PHYSICAL EXAM ANKLE FRACTURESwelling EkimosisTendernessCannot put any weight on the injured footDeformity ("out of place"), particularly if the ankle joint is dislocated as wellHandbook of Fractures, 3rd Edition

Handbook of Fractures, 3rd Edition

LAUGE-HANSEN CLASIFICATIONHandbook of Fractures, 3rd EditionMECHANISM: Inversion of The foot places significant stress on the lateral ligaments

Mechanism Injury Laughe-Hensen

Handbook of Fractures, 3rd EditionMechanism Injury Laughe-Hensen

WEBER CLASIFICATIONHandbook of Fractures, 3rd EditionThe Weber classification system is based on the location of the fibula fracture.

Weber Afracture below the level of the ankle joint Weber Bfracture originates at the level of the ankle joint Weber Cfracture above the level of the ankle joint

ANKLE FRACTURE Normal FractureHandbook of Fractures, 3rd Edition

Handbook of Fractures, 3rd Edition

MORTISE X-RAY:This is taken with the foot in 15 to 20 degrees of internal rotation to offset the intermalleolar axis.A medial clear space >4 to 5 mm is abnormal and indicates lateral talar shift.Talocrural angle: The angle subtended between the intermalleolar line and a line parallel to the distal tibial articular surface should be between 8 and 15 degrees. The angle should be within 2 to 3 degrees of the uninjured ankle.Tibiofibular overlap 1 mm is abnormal.Handbook of Fractures, 3rd Edition

ANKLE SPRAIN TREATMENTSaluta, Jonathan. Managing foot and ankle injuries in athletes. Journal Of Musculoskeletal Med. September 2010RICEBRACINGNSAID

TENDON ACHILLES RUPTURE TREATMENT Nonsurgical Treatment : Acute RuptureRICEHeel LiftA. Metzl, Joshua. The ruptured Achilles tendon: operative and non-operative treatment options. Current Review in Musculoskeletal Medicine. 2008 1:161-164.

Surgical Treatment : Severe RuptureTENDON ACHILLES RUPTURE TREATMENT A. Metzl, Joshua. The ruptured Achilles tendon: operative and non-operative treatment options. Current Review in Musculoskeletal Medicine. 2008 1:161-164.

Nonsurgical Treatment : Stable FractureANKLE FRACTURE TREATMENTAnkle SplintAnkle BracingAmerican Academy of Orthopaedic Surgeons. Ankle Fractures [online]. 2011. [cited: 20 May 2014]. Available from: http://orthoinfo.aaos.org/topic.cfm?topic=a00391

Surgical Treatment : Unstable FractureANKLE FRACTURE TREATMENTAmerican Academy of Orthopaedic Surgeons. Ankle Fractures [online]. 2011. [cited: 20 May 2014]. Available from: http://orthoinfo.aaos.org/topic.cfm?topic=a00391

REHABILITATION OF ANKLEAmerican Academy of Orthopaedic Surgeons. Tennis elbow. [online].2011.[cited,2014 May 29]. Available from: http://orthoinfo.aaos.org/topic.cfm?topic=a00068Sarwark J.F. Physical Examination of the elbow and forearm. In Essentials of Musculoskeletal Care 4. USA. 2010. Page 375-6

HOME EXERCISE PROGRAM FOR ANKLE SPRINE

HOME EXERCISE PROGRAM FOR ACHILLES TENDINOSIS

COMPLICATION OF ANKLE INJURYCOMPLICATION OF ANKLE INJURY

THANK YOU

-Typical region of tenderness with a lateral ankle sprain*-anterior drawer test: the clinician will hold the leg with one hand while gently attempting to pull the foot forward with the other. This test is positive if there is excessive anterior translation of the foot with regard to the leg.-talar tilt test, the clinician holds the leg with one hand and then gently tilts the heel inward with the other. This test is positive if there is excessive tilting of the heel with this maneuver. Whether performing an anterior drawer test or talar tilt test, the uninjured ankle should always be tested first. This will serve as a baseline to determine an individual's normal degree of ligamentous laxity, or lack thereof.*From essential of musculoscletal carePicture from essential 12.27. Tendo calcaneus (4): Thomsontest: Normally when the calf is squeezed thefoot moves as the ankle plantarflexes. Loss ofthis movement is pathognomonic of an acuterupture of the tendo calcaneus*Achilles tendon rupture seen at sonography: discontinuity over several centimeters (red line). No fracture or avulsion (radiograph).Achilles tendon rupture seen at sonography: discontinuity over several centimeters (red line). No fracture or avulsion (radiograph).

Longitudinal sonogram showing partial partial-thickness tear Tendon is markedly thickened and hypoechoic.*Figure 1 shows magnetic resonance imaging (MRI) of a normal heel and Achilles tendon. Figure 2 shows a torn Achilles tendon with fluid collected at the site of the tear. *Open fractures are rare, accounting for just 2% of all ankle fractures. The highest incidence of ankle fractures occurs in elderly women.Most ankle fractures are isolated malleolar fractures, accounting for two-thirds of fractures, with bimalleolar fractures occurring in one-fourth of patients and trimalleolar fractures occurring in the remaining 5% to 10%.

**Essential Of Musculoskeletal p.766*Esential Musculosceletal care p.761*