Managing ankle ligament sprains and tears: current opinion

Figures & data

Figure 1 Kleiger’s test for medial ankle sprain with (A) lateral and (B) medial view.

Figure 2 Anterior drawer test for anterior talofibular involvement with (A) lateral and (B) medial view.

Figure 3 Talar tilt test for calcaneofibular ligament involvement.

Table 1 A summary of the criteria recommended for defining CAI by the International Ankle Consortium

Inclusion criteria for further CAI research and study design (minimum)

History of at least one significant ankle sprain

12 months prior to sprains

Inflammatory symptoms

Caused at least one interrupted day of activity

Most recent injury must have occurred >3 months prior

History of recurrent ankle sprains and/or “giving way” and/or feelings of instability

Use of Ankle Instability Instrument, Cumberland Ankle Instability

Tool, and/or Identification of Functional Ankle Instability

Self-reported foot and ankle function questionnaire for level of disability

Foot and Ankle Ability Measure and/or Foot and Ankle Outcome Score

Exclusion criteria (minimum)

Previous surgical interventions to musculoskeletal structure in lower extremity

History of fracture in either lower extremity requiring realignment

Acute injury to musculoskeletal structures of any other lower extremity joints in the previous 3 months

Impacted joint integrity and function with at least 1 day of interrupted activity

Recommended information for comprehensive description of study participants

Quality of ankle injury history

History of previous ankle sprains with frequency (“giving way” and/or feelings of instability)

Scores of self-reported ankle instability instruments

Severity of injury

Diagnosis performed by health care professional or self-diagnosis

Timing of an ankle sprain

Timing of last ankle sprain

Number of weeks with supervised rehabilitation

Number of weeks post-rehabilitation

Potential confounding factors

Mechanical instability ratings

Rating of current level of physical activity

Co-commitment, nonsurgical injuries at the time of ankle sprain

Frequency of external ankle support

Functional or range-of-motion assessments

Presence of pain during functional activities

Abbreviation: CAI, chronic ankle instability.

Figure 4 Low-grade passive anterior–posterior glide of the talus.

Figure 5 Weight bearing ankle mobilization with movement.

Figure 6 Non-weight bearing ankle distraction mobilization using elastic bands with movement from a (A) plantar flexed position to a (B) dorsiflexion position.

Table 2 An example of sports-related training drills to be done with a speed ladder

Straightforward running with one foot in each box

Straightforward running with both feet in each box

High knees straightforward running with one foot in each box

High knees straightforward running with both feet in each box

Lateral shuffle with both feet in each box (repetition with both right and left side leading)

High knees lateral shuffle with both feet in each box (repetition with both right and left side leading)

On the side facing the ladder – alternating both feet in each box followed by both feet outside of box while moving down the ladder.

This will be a forward–backward–forward motion as you move down the ladder (repetition with both right and left side leading)

Icky shuffle – moving left to right and back to left. Start with alternating right and left foot in each box. Plant with right foot outside of box

Followed by left and right foot in second box. Plant with left foot outside of box. Continue this while moving up the ladder

Lateral carioca motion with one foot in each box (repetition with both right and left side leading)

Lateral carioca motion with both feet in each box (repetition with both right and left side leading)

Figure 7 Fibular repositioning taping technique.