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Introduction

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Unbeknownst to most historians, Einstein started down the road of professional basketball before an ankle injury diverted him to science.

Gary Larson (cartoonist, creator of The Far Side) http://thinkexist.com/quotes/gary_larson/

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Ankle injury is arguably the most common sport injury. It ranked number 1 among 24 of the 70 sports for which there are quality data.1 In sports such as volleyball, ankle injuries make up almost half of all injuries.1

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Ankle injuries include, but are not limited to, “ankle sprains.” The first half of this chapter focuses on anatomy, clinical assessment, and management of lateral ligament injuries after ankle sprain. We also discuss two less common sequelae of ankle sprain—medial ligament injury and Pott’s fracture.

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The presentation of a “sprained ankle” can mask damage to other structures—such as subtle fractures around the ankle joint, osteochondral fractures of the dome of the talus, and dislocation or longitudinal rupture of the peroneal tendons. Such injuries persist much longer than would be expected with a straightforward lateral ligament sprain. This is often referred to as “the problem ankle”—it is discussed in the second half of this chapter.

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Functional anatomy

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The ankle contains three joints (Fig. 38.1):

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  • talocrural (ankle) joint

  • inferior tibiofibular joint

  • subtalar joint.

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Figure 38.1

Anatomy of the ankle

(a) Talocrural (ankle) joint

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(c) Ligaments of the ankle joint—lateral view

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(d) Ligaments of the ankle joint—medial view

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The talocrural or ankle joint (Fig. 38.1a) is a hinge joint formed between the inferior surface of the tibia and the superior surface of the talus. The medial and lateral malleoli provide additional articulations and stability to the ankle joint. The ankle joint can plantarflex and dorsiflex. Because the joint is least stable in plantarflexion, injuries are more common when the foot is in this position, and most stability is provided by the ankle ligaments alone.

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The distal parts of the fibula and tibia articulate at the inferior tibiofibular joint where they are supported by the inferior tibiofibular ligament or syndesmosis. The small amount of movement present at this joint is extremely important for normal walking and running. Injuries to this joint are more common than previously thought.

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The subtalar joint (Fig. 38.1b), between the talus and calcaneus, is divided into an anterior and posterior articulation separated by the sinus tarsi. The subtalar joint provides shock absorption, permits the foot to adjust to uneven ground, and ...

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