182:
short leg casts, walking boots, and custom orthoses. The degree of permitted weight bearing can be individualized dependent on tolerance and those with less injury are able to ambulate with full weight-bearing. Nevertheless, most use crutches to reduce the burden to some extent and those with more discomfort may be limited to "toe touch" on the affected side for one to two weeks. Some advocate the ability to climb and descend stairs with minimal discomfort as an indication to permit full, or at least progressive, weight-bearing. Early resistance exercise minimizes muscle atrophy and weakness and a variety of exercises—elastic bands, ankle weights, heel raise exercises—may be used in conjunction with a calf stretch. In the early stages, isometric strengthening and electrical stimulation will combat muscle atrophy and developing weakness.
178:
the ankle to aid in a full recovery. Recent research suggests that macrophages (immune cells responsible for muscle repair and growth) are necessary for muscle to grow back to its pre-injured state. The H.E.M. ankle rehab treatment suggests not icing the injury, and instead, following more proactive rehab techniques for recovery: "when ice is applied to a body part for a prolonged period, nearby lymphatic vessels begin to dramatically increase their permeability (lymphatic vessels are 'dead-end' tubes which ordinarily help carry excess tissue fluids back into the cardiovascular system). As lymphatic permeability is enhanced, large amounts of fluid begin to pour from the lymphatics 'in the wrong direction' (into the injured area), increasing the amount of local swelling and pressure and potentially contributing to greater pain."
127:
may also be delayed because swelling is usually minor or nonexistent and the true nature of the injury unappreciated. A variety of diagnostic tests have been described such as the 'squeeze' (compressing the tibia and fibula above the midpoint of the calf), 'dorsiflexion with compression' (patient dorsiflexes the foot while the examiner compresses the internal and external malleolus), and 'external rotation' (patient sits with leg dangling and ankle at 90° and external rotation then applied to the foot) etc. None of them performs sufficiently well to allow diagnosis to be made on the basis of a single test, and is usually made by combining multiple tests supplemented with appropriate imaging when indicated.
162:, will indicate an unstable or potentially unstable injury. However, 'normal' x-rays do not exclude significant ligament injury, and in one study, the ratio of diagnostic X-ray to known syndesmotic injury was only one in 17. By contrast, ultrasound may permit the injury to be visualized while the mortise is being stressed. Consequently, a diagnostic modality such as ultrasound or magnetic resonance imaging (MRI) that demonstrates the ligament itself may be helpful, if clinical suspicion remains.
174:
indicated as surgery and some form of internal fixation may be an option, if not a requirement. Second, a decision of degree of weight bearing, if any, to be permitted. The answer to this is partly related to stability, partly to the clinical estimate of ligament injury together with imaging findings, and partly related to discomfort when weight bearing. The final decision is largely individualized depending on the circumstances.
102:
player's skate strikes the boards and the foot is forced outward. It may also occur in football, for example, when a player is on the ground with their leg behind them, the foot at right angles, and a rotational force is suddenly applied to the heel, as when someone falls on their foot. Overall, the most common mechanism is external rotation and may occur with sufficient rapidity that the actual mechanism is unrecognized.
126:
Those who sustain high ankle sprains usually present with pain in the outside-front of the leg above the ankle, with increased discomfort when twisting (external rotation) is applied. In some cases, the diagnosis is only made after treatment for the more common, lateral, ankle sprain fails. Diagnosis
113:
and the medial collateral ligament. However, should these structures fail, then the force will be transmitted beyond the anterior inferior tibiofibular ligament to the strong membrane that holds the tibia and fibula together for most of their length. This force may then exit through the upper end of
181:
Rehabilitation is important. A significant percentage of these sprains also involve medial and/or lateral ankle ligament injury and slow recovery and continuing symptoms are common. However, limiting external rotation to protect healing ligaments is a primary concern and can usually be achieved by
177:
An alternative measure consists of H.E.M. (Healthy blood flow, Eliminate swelling and
Mobility). This treatment suggests increasing healthy blood flow to the ankle, including immune cells required for healing. The treatment also suggests improving healthy range of motion, stability and strength in
173:
Two important issues should be addressed early. First, a determination of whether the ankle is stable or unstable. This is usually answered by clinical assessment together with results of the imaging modalities previously described. In the case of suspected instability, specialist referral is
101:
reducing the angle between the foot and lower leg to less than 90°, then the mortise is confronted with an increasingly wider talus. The force is heightened when the foot is simultaneously forced into external rotation (turned outward). This chain of events may occur when the front of a hockey
109:, uniting the lower end of the tibia and fibula and playing an important role in the maintenance of the mortise. The injury to this ligament may vary from simple stretch to complete rupture. Some restraint to further injury is offered by the structures on the inside of the ankle, the
96:
resting within the mortise created by the tibia and fibula as previously described. Since the talus is wider anteriorly (in the front) than posteriorly (at the back), as the front of the foot is raised
323:
Mei-Dan O, Kots E, Barchilon V, Massarwe S, Nyska M, Mann G (May 2009). "A dynamic ultrasound examination for the diagnosis of ankle syndesmotic injury in professional athletes: a preliminary study".
358:
Nielson JH, Gardner MJ, Peterson MG, Sallis JG, Potter HG, Helfet DL, Lorich DG (July 2005). "Radiographic measurements do not predict syndesmotic injury in ankle fractures: an MRI study".
80:
joint for the ankle. High ankle sprains are described as high because they are located above the ankle. They comprise approximately 15% of all ankle sprains. Unlike the common lateral
213:
Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC (1998). "Persistent disability associated with ankle sprains: a prospective examination of an athletic population".
594:
170:
Treatment depends on severity and convalescence may be as short as a few days or as long as six months. Rest, icing, compression, and elevation is often recommended.
84:, when ligaments around the ankle are injured through an inward twisting, high ankle sprains are caused when the lower leg and foot externally rotates (twists out).
248:
587:
948:
580:
495:"Macrophages promote muscle membrane repair and muscle fibre growth and regeneration during modified muscle loading in mice in vivo"
249:"Ankle Syndesmosis Injuries – Orthogate – Improving orthopedic care, education and research with Internet technologies"
65:
782:
829:
252:
106:
136:
98:
289:"Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review"
918:
913:
686:
572:
132:
733:
446:"Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm"
792:
159:
115:
8:
680:
654:
272:
690:
676:
649:
519:
494:
470:
445:
418:
393:
367:
869:
603:
559:
555:
524:
475:
423:
371:
340:
230:
77:
35:
444:
Polzer H, Kanz KG, Prall WC, Haasters F, Ockert B, Mutschler W, Grote S (Jan 2012).
891:
797:
777:
551:
514:
506:
465:
457:
413:
405:
363:
332:
300:
222:
155:
110:
755:
615:
510:
305:
288:
819:
706:
226:
191:
942:
787:
409:
336:
923:
728:
696:
528:
479:
427:
375:
344:
81:
563:
542:
Meeusen R, Lievens P (1986). "The use of cryotherapy in sports injuries".
234:
607:
128:
40:
637:
461:
93:
905:
861:
769:
701:
668:
857:
664:
628:
602:
720:
105:
In this sequence of events, the most vulnerable structure is the
848:
843:
611:
151:
73:
61:
883:
807:
747:
716:
623:
212:
147:
143:
69:
357:
322:
901:
811:
765:
641:
879:
743:
492:
443:
273:
394:"Rehabilitation of syndesmotic (high) ankle sprains"
286:
30:Syndesmotic ankle sprain, syndesmotic ankle injury
940:
541:
439:
437:
588:
391:
241:
535:
434:
351:
595:
581:
387:
385:
360:Clinical Orthopaedics and Related Research
518:
469:
417:
304:
287:Sman AD, Hiller CE, Refshauge KM (2013).
208:
206:
107:anterior inferior tibio-fibular ligament
493:Tidball JG, Wehling-Henricks M (2007).
392:Williams GN, Allen EJ (November 2010).
382:
325:The American Journal of Sports Medicine
318:
316:
941:
282:
280:
576:
203:
76:in the lower leg, thereby creating a
313:
277:
146:, demonstration of widening of the
13:
368:10.1097/01.blo.0000161090.86162.19
14:
960:
949:Dislocations, sprains and strains
783:Anterior cruciate ligament injury
114:the fibula, creating a so-called
556:10.2165/00007256-198603060-00002
544:Sports Medicine (Auckland, N.Z.)
92:The ankle joint consists of the
486:
266:
1:
197:
154:'mortise', a fracture of the
511:10.1113/jphysiol.2006.118265
306:10.1136/bjsports-2012-091702
165:
121:
87:
7:
185:
139:may be used for diagnosis.
10:
965:
227:10.1177/107110079801901002
900:
878:
856:
842:
806:
764:
742:
715:
663:
636:
622:
499:The Journal of Physiology
34:
26:
21:
410:10.1177/1941738110384573
337:10.1177/0363546508331202
54:syndesmotic ankle sprain
919:Achilles tendon rupture
914:Patellar tendon rupture
66:syndesmotic ligaments
793:Patellar dislocation
160:Maisonneuve fracture
116:Maisonneuve fracture
681:Dislocated shoulder
734:Gamekeeper's thumb
691:Separated shoulder
650:Dislocation of jaw
462:10.4081/or.2012.e5
450:Orthop Rev (Pavia)
52:, also known as a
936:
935:
932:
931:
870:Rotator cuff tear
838:
837:
824:High ankle sprain
129:Plain radiographs
78:mortise and tenon
68:that connect the
50:high ankle sprain
46:
45:
22:High ankle sprain
16:Medical condition
956:
892:Pulled hamstring
854:
853:
798:Knee dislocation
778:Tear of meniscus
634:
633:
597:
590:
583:
574:
573:
568:
567:
539:
533:
532:
522:
490:
484:
483:
473:
441:
432:
431:
421:
389:
380:
379:
355:
349:
348:
320:
311:
310:
308:
284:
275:
270:
264:
263:
261:
260:
251:. Archived from
245:
239:
238:
210:
156:medial malleolus
111:medial malleolus
19:
18:
964:
963:
959:
958:
957:
955:
954:
953:
939:
938:
937:
928:
896:
874:
847:
834:
802:
760:
756:Hip dislocation
738:
711:
659:
627:
618:
601:
571:
540:
536:
491:
487:
442:
435:
390:
383:
362:(436): 216–21.
356:
352:
321:
314:
299:(10): 620–628.
293:Br J Sports Med
285:
278:
271:
267:
258:
256:
247:
246:
242:
221:(10): 653–660.
211:
204:
200:
188:
168:
142:In the case of
124:
90:
17:
12:
11:
5:
962:
952:
951:
934:
933:
930:
929:
927:
926:
921:
916:
910:
908:
898:
897:
895:
894:
888:
886:
876:
875:
873:
872:
866:
864:
851:
840:
839:
836:
835:
833:
832:
827:
820:Sprained ankle
816:
814:
804:
803:
801:
800:
795:
790:
785:
780:
774:
772:
762:
761:
759:
758:
752:
750:
740:
739:
737:
736:
731:
725:
723:
713:
712:
710:
709:
707:Bankart lesion
704:
699:
694:
684:
673:
671:
661:
660:
658:
657:
652:
646:
644:
631:
620:
619:
600:
599:
592:
585:
577:
570:
569:
550:(6): 398–414.
534:
505:(1): 327–336.
485:
433:
381:
350:
331:(5): 1009–16.
312:
276:
265:
240:
215:Foot Ankle Int
201:
199:
196:
195:
194:
192:Sprained ankle
187:
184:
167:
164:
123:
120:
89:
86:
44:
43:
38:
32:
31:
28:
24:
23:
15:
9:
6:
4:
3:
2:
961:
950:
947:
946:
944:
925:
922:
920:
917:
915:
912:
911:
909:
907:
903:
899:
893:
890:
889:
887:
885:
881:
877:
871:
868:
867:
865:
863:
859:
855:
852:
850:
845:
841:
831:
828:
825:
821:
818:
817:
815:
813:
809:
805:
799:
796:
794:
791:
789:
788:Unhappy triad
786:
784:
781:
779:
776:
775:
773:
771:
767:
763:
757:
754:
753:
751:
749:
745:
741:
735:
732:
730:
727:
726:
724:
722:
718:
714:
708:
705:
703:
700:
698:
695:
692:
688:
685:
682:
678:
675:
674:
672:
670:
666:
662:
656:
653:
651:
648:
647:
645:
643:
639:
635:
632:
630:
625:
621:
617:
613:
609:
605:
598:
593:
591:
586:
584:
579:
578:
575:
565:
561:
557:
553:
549:
545:
538:
530:
526:
521:
516:
512:
508:
504:
500:
496:
489:
481:
477:
472:
467:
463:
459:
455:
451:
447:
440:
438:
429:
425:
420:
415:
411:
407:
404:(6): 460–70.
403:
399:
398:Sports Health
395:
388:
386:
377:
373:
369:
365:
361:
354:
346:
342:
338:
334:
330:
326:
319:
317:
307:
302:
298:
294:
290:
283:
281:
274:
269:
255:on 2014-07-26
254:
250:
244:
236:
232:
228:
224:
220:
216:
209:
207:
202:
193:
190:
189:
183:
179:
175:
171:
163:
161:
157:
153:
149:
145:
140:
138:
134:
130:
119:
117:
112:
108:
103:
100:
99:(dorsiflexed)
95:
85:
83:
82:ankle sprains
79:
75:
71:
67:
63:
59:
55:
51:
42:
39:
37:
33:
29:
25:
20:
924:Shin splints
823:
729:Pulled elbow
697:ALPSA lesion
608:subluxations
604:Dislocations
547:
543:
537:
502:
498:
488:
453:
449:
401:
397:
359:
353:
328:
324:
296:
292:
268:
257:. Retrieved
253:the original
243:
218:
214:
180:
176:
172:
169:
141:
125:
104:
91:
57:
53:
49:
47:
41:Orthopedics
27:Other names
259:2008-03-05
198:References
133:Ultrasound
862:upper arm
702:SLAP tear
669:upper arm
629:ligaments
456:(1): e5.
166:Treatment
122:Diagnosis
88:Mechanism
36:Specialty
943:Category
858:Shoulder
830:Turf toe
665:Shoulder
655:Whiplash
529:17038433
480:22577506
428:23015976
376:15995444
345:19336613
186:See also
60:), is a
849:tendons
844:Muscles
721:forearm
616:strains
612:sprains
564:3538270
520:2075127
471:3348693
419:3438867
235:9801078
158:, or a
64:of the
624:Joints
562:
527:
517:
478:
468:
426:
416:
374:
343:
233:
152:fibula
144:X-rays
74:fibula
62:sprain
884:thigh
808:Ankle
748:thigh
717:Elbow
148:tibia
94:talus
70:tibia
904:and
902:Knee
882:and
860:and
812:foot
810:and
768:and
766:Knee
746:and
719:and
667:and
642:neck
640:and
638:Head
614:and
560:PMID
525:PMID
476:PMID
424:PMID
372:PMID
341:PMID
231:PMID
150:and
72:and
906:leg
880:Hip
846:and
770:leg
744:Hip
626:and
552:doi
515:PMC
507:doi
503:578
466:PMC
458:doi
414:PMC
406:doi
364:doi
333:doi
301:doi
223:doi
137:MRI
135:or
58:SAS
945::
687:AC
677:GH
610:,
558:.
546:.
523:.
513:.
501:.
497:.
474:.
464:.
452:.
448:.
436:^
422:.
412:.
400:.
396:.
384:^
370:.
339:.
329:37
327:.
315:^
297:47
295:.
291:.
279:^
229:.
219:19
217:.
205:^
131:,
118:.
48:A
826:)
822:(
693:)
689:(
683:)
679:(
606:/
596:e
589:t
582:v
566:.
554::
548:3
531:.
509::
482:.
460::
454:4
430:.
408::
402:2
378:.
366::
347:.
335::
309:.
303::
262:.
237:.
225::
56:(
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.