By;

Hikmah Jaya
Iffa
Andi Ita Maghfirah
Putri Amanda Tobo
Fradita Y Yunus Guzasiah
Resha Dermawan
Dwiky Limbersia Aries
Advisor : dr. Nasrah/dr. Wendelin/ dr. NurJalal
Supervisor : dr. M. Phetrus Johan, M.kes, Sp. OT
Department of Orthopedic and Traumatology
Medical Faculty
Hasanuddin 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 ANKLE

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

STABILITY OF ANKLE

SYNDESMOSIS OF ANKLE

Thompson J.C., Netters Concise Orthopaedic Anatomy, 2 nd ed., Saunders Elsevier. p.121

RANGE OF MOTION OF THE ANKLE

Sarwark, JF. General Orthopaedics: Essential of Musculoskeletal Care, Section One. P.11.2010-2011

MUSCLE OF FOOT
Tibialis Anterior

Ekstensor Hallucis
Longus

Ekstensor Digitorum
Longus

Gastronemius

Soleus

Stone. R J, Stone JA. Muscles Of The Leg and Foot . Atlas Of Musculoskeletal and Muscle. Chapter nine; P. 186-192.

Arteries Of Foot

Moore, Keith L.; Dalley, Arthur F., Clinically Oriented Anatomy, 5th Edition,

Nerves Of Foot

Thompson J.C., Netters Concise Orthopaedic Anatomy, 2 nd ed., Saunders Elsevier. p.121

PATHOPHYSIOLOGY

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

ETIOLOGY

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

ANKLE INJURY

SPRAIN

STRAIN

FRACTURE

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, 5 th Edition.

PHYSICAL EXAM ANKLE SPRAIN

Swelling
Ecchymosis
Tenderness

Essential Musculosceletal Care

SPECIAL TESTS

Anterior Drawer Test

Invertion Stress Test(talar tilt test)

Essential Musculosceletal Care

IMAGING OF ANKLE SPRAIN

T2 Weighted Axial image of ATFL tear

Ultrasound 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

PHYSICAL EXAM ACHILLES TENDON

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

Wheeless' Textbook of Orthopaedics: Achilles Tendon Injury

USG OF ACHILLES
TENDON INJURY

Rebecca Aspden, Achilles Tendon Rupture

MRI ACHILLES
TENDON INJURY

Ankle Fracture
Ankle 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.
Handbook of Fractures, 3rd Edition

PHYSICAL EXAM ANKLE FRACTURE

Swelling
Ekimosis
Tenderness
Cannot put any weight on the
injured foot
Deformity ("out of place"),
particularly if the ankle joint is
dislocated as well

Handbook of Fractures, 3rd Edition

Mechanism Injury Laughe-Hensen

LAUGEHANSEN
CLASIFICATIO
N

MECHANISM: Inversion of The foot places

significant stress on the lateral ligaments

Handbook of Fractures, 3rd Edition

Mechanism Injury Laughe-Hensen

Handbook of Fractures, 3rd Edition

WEBER CLASIFICATION

The 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
Handbook of Fractures, 3rd
Edition

ANKLE FRACTURE
Normal

Fracture

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 cm indicates
syndesmotic disruption.
Talar shift >1 mm is abnormal.
Handbook of Fractures, 3rd Edition

ANKLE SPRAIN TREATMENT

RICE

BRACING

NSAID
Saluta, Jonathan. Managing foot and ankle injuries in athletes. Journal Of Musculoskeletal Med. September 2010

TENDON ACHILLES RUPTURE

TREATMENT
Nonsurgical Treatment : Acute Rupture

RICE

Heel Lift

A. Metzl, Joshua. The ruptured Achilles tendon: operative and non-operative treatment options. Current Review in
Musculoskeletal Medicine. 2008 1:161-164.

TENDON ACHILLES RUPTURE

TREATMENT
Surgical Treatment : Severe Rupture

A. Metzl, Joshua. The ruptured Achilles tendon: operative and non-operative treatment options. Current Review in
Musculoskeletal Medicine. 2008 1:161-164.

ANKLE FRACTURE TREATMENT

Nonsurgical Treatment : Stable Fracture

Ankle Splint

Ankle Bracing

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

ANKLE FRACTURE TREATMENT

Surgical Treatment : Unstable Fracture

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

REHABILITATION OF ANKLE

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

COMPLICATION
OF ANKLE
INJURY

THANK
YOU