Ankle Instability - Heath Taylor 26/6/2001

Anatomy -            

ATFL - from distal anterior fibula to body of talus just anterior to the articular facet                                            

PTFL - from medial surface of lat mall to posterior aspect of talus

CFL - from just below the ATFL to the lateral border of the calcaneum

Clinical -                 Hx - inversion, plantar flexion, int rotation injury.

                                Exam - point tenderness, pain on inversion, laxity, ant drawer (ATFL), inversion (CFL)

Ix -                           XR (#'s), Talar tilt (>10 - 15 º), MRI, arthrogram

Classification -     Graded I - III - but many variations!

Management -     prevention - taping ? improves proprioception, training, muscle strengthening, bracing, footwear, etc...

Non-operative - ? to immobilise in pop, RICE, bracing (Aircast type), maintain dorsiflexion, avoid plantarflexion and inversion, then physio, with ROM and proprioception training

Operative - acute repair      - controversial - ? in young athletes with overt instability - use Brostrom (direct repair of ATFL & CFL)

                    chronic - ?cause of chronic pain - either use 'anatomic', or 'reconstructive'