An Introduction to the Wonderful Anatomical World of the Ankle Joint
Like mentioned in my previously published article; ”Prophylactic Sports Taping – An Introduction…” the ankle joint is the first anatomical structure this sports taping guide will focus on; therefore an overview of the anatomy of the ankle, including ligaments and muscles involved in various sports movements is essential for understanding why we tape the way we do. This article will focus on just that; the wonderful anatomical world of the ankle joint; the taping itself will be presented in the next section.
“May those who love us, love us; and those who don't love us, may God turn their hearts; and if He doesn't turn their hearts, may he turn their ankles so we'll know them by their limping.” Irish blessing
Anatomy of the ankle:
Bones and articulations:
The ankle joint is located where the foot and the leg come together. It is also known as the talocrural joint, a hinge joint which connects the distal ends of the lower limb skeletal bones; tibia and fibula, with the proximal end of the talus bone in the foot.
The medial malleolus of the tibia and the lateral malleolus of the fibula along with the inferior surface of the distal tibia articulate with three facets of the talus bone, these articulation surfaces are all covered by cartilage. The anterior part of the talus is wider compared with its posterior part, thus when the foot is in dorsiflexion the wider part of the superior talus moves into an articulating position with the surfaces of the tibia and fibula, creating a more stable joint than when the foot is in plantar flexion.
Peroneus brevis- and longus are two of the most important muscles in terms of ankle motion; they allow the joint to move into eversion and plantarflexion. The peroneus longus (the largest of the two) runs from the head of the fibula, down the bone, becomes a tendon (attaches ligaments to bone) which extends posteriorly around the lateral malleolus of the ankle, then continues on the underside of the foot, before it attaches to the medial cuneiform and first metatarsal.
Tibialis anterior has the opposite function of the peroneus muscles, and is therefore one of its antagonists, as it allows the joint to move into inversion and dorsiflexion. It runs from the upper 2/3 of the lateral aspect of the tibia before it inserts into the medial cuneiform and first metatarsal, like peroneus longus.
Tibialis posterior is the main stabilizing muscle of the lower leg. Like peroneus, it allows the ankle joint to move into inversion and plantarflexion, and it also an antagonist to tibialis anterior.
The gastrocnemius muscle located on the back part of the lower leg has two heads, which runs from just above the knee down to the heel. It ends in the Achilles tendon which inserts into the posterior surface of the calcaneus. Its main actions are plantarflexion of the ankle joint and it also flexes the knee. It is heavily involved in standing, walking, running and jumping, and is therefore an essential muscle for athletes. The soleus muscle is closely connected to the gastrocnemius muscle and some anatomists consider them to be a single muscle, its name is derived from the Latin word, “solea”, meaning “sandal”. Its main action is plantarflexion of the ankle.
The ankle joint is bound and supported by the strong medially placed deltoid ligament and three ligaments on the lateral aspect; the anterior talofibular ligament, the posterior talofibular ligament and the calcaneofibular ligament.
Like mentioned previously, the ankle is most stable in dorsiflexion and therefore a spraining injury is most likely to occur when the foot is plantar flexed. The anterior talofibular ligament is the ligament most commonly effected by ankle injuries like these; most commonly occurring in a plantarflexed- and inversed foot position, colloquially called an inversion sprain. Which is further divided into various sprain degrees depending on its presentation. The biomechanical position in which the ankle joint was when the ligament damage occurred might give valuable information to which ligament is injured. As mentioned, with the foot in inversion and plantarflexion the likely injury is to the anterior talofibular ligament. With the foot in neutral and inversion the calcaneofibular ligament is likely to be injured. Lastly, with the foot in dorsiflexion and inversion the posterior talofibular ligament is most likely to be injured.
“Inversion sprains are the most common sport injuries seen in relation to the ankle joint.”
Management of ankle sprains
'PRICEMMM' is the mnemonic for treating ankle sprains;
· Protection (immobilization of the joint is important in the acute phase to prevent further damage to the affected ligament(s)
· Rest (avoid return to full activity too soon)
· Ice (to limit swelling and pain; indirect contact with skin only, 15second intervals, several times a day)
· Medication (NSAIDS and paracetamol for pain relief and to limit swelling in initial phase)
· Mobilisation (Return to activity as soon as painfree, with gradual increase in intensity)
· Modalities (specific exercise and proprioceptive training programmes to decrease chance of reoccurrence)
Another common ankle injury, which might result in similar symptoms to that of an ankle sprain, is an ankle fracture. On clinical examination it is important to ask the patient if he/she heard a crack during the impact, and to pinpoint the exact location of the pain. It is also clinically important to assess the condition of the nerves and vessels which might have been compromised during injury. As a standard, the Ottawa ankle rules are used to evaluate ankle injuries for fracture, these rules were developed in 1992 by a team of doctors in the Urgent Care department of the Ottawa Hospital in (you guessed it) Ottawa, Canada. They were originally created to minimize unnecessary X-rays.
The Ottawa Ankle Rules:
The guidelines state that X-rays are only required if there is any pain in the malleolar zone (medial- or lateral malleolus) and any one of the following:
· Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR
· Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR
· An inability to bear weight both immediately and in the emergency department for four steps
Before the introduction of the Ottawa Ankle Rules only approximately 15-20% of X-rays were positive for fracture, whereas other patients had sprains or other injuries. Stiell et al (1992) found that the rules had a sensitivity (the proportion of actual positives which are correctly identified as such) of 100% and reduced the number of annual ankle X-rays taken by 35%.
As ankle and foot injuries often go hand in hand (pun intended); this article will also feature the Ottawa Foot Rules; they state that a foot X-ray series is indicated if there is any pain in the midfoot zone and any one of the following:
· Bone tenderness at the base of the fifth metatarsal (for foot injuries), OR
· Bone tenderness at the navicular bone (for foot injuries), OR
· An inability to bear weight both immediately and in the emergency department for four steps.
This finishes off the introduction of the anatomy of the ankle joint and the common sports injuries associated with it. In the next part, prophylactic sports taping of the ankle will be discussed in great detail. Until then, may health follow you wherever your wonderful ankles might roam.
Have you ever suffered from an ankle sprain?See results without voting
More by this Author
Medical Differential Diagnosis Practice Case #3 (Leg Pain). The following case is meant to function as a practice case for students within medicine, neurology, chiropractic, osteopathy or similar healthcare professions...
Words of Oceanic Wisdom. My Top 25 Surfing Quotes. This is merely a list of my top 25 surfing quotes, words of wisdom which have inspired me to succeed in becoming a better surfer, continuously seeking ways of improving...
Fixing Adobe Media Encoder Export Failure in Premiere Pro CS5 on Windows 7. I recently invested in Premiere Pro CS5 and was having all sorts of fun editing my HD files (.m2ts) using this magnificent video...