Ferran NA, Maffulli N. Epidemiology of sprains of the lateral ankle ligament complex. As the anterior talo-fibular ligament (ATFL) is maximally stretched during inversion of the plantar-flexed foot and as it has the lowest tolerance to loads (approximately 150N [23, 24]), the ATFL is the first and often the only ligament injured. They occur when the ankle moves outside of its normal range of motion which can be seen mostly in active and sports populations [1]. The most critical risk factor for an ankle sprain is the history of a previous ankle sprain due to a reduced mechanical stability and reduced proprioceptive ability. The ankle sprain used to be the most common injury type in professional football players representing 10% to 36% of all injuries [6, 7], but recent studies proclaim a lower ankle injury rate, representing 10 to 15% of all injuries [7, 8]. Every time I get injured, I think about my life and wonder what it will be like without tennis, said Saville, who also had ACL surgery in 2013. sharing sensitive information, make sure youre on a federal There are no significant gender differences in the overall incidence rate of ankle sprains [15, 16]. Place foot on a towel; then curl toes, moving the towel toward body. Available from: Rehab My Patient. This article is part of the Topical Collection on Management of Ankle Instability. However, there is still a lack of research to design specific rehabilitation protocols for returning athletes to sports competition. Active and passive range of motion (AROM and PROM) 2. external support worn up to one year post-injury). Available from: Rehab My Patient. [4] Category A in NATA publication means that the recommendations are based on "consistent and good-quality patient-oriented evidence", and category B is defined by "inconsistent and limited- quality patient-oriented evidence". RTP management is a multifactorial and interdisciplinary process. Van Dijk CN, Mol BW, Lim LS, Marti RK, Bossuyt PM. Furthermore, residual disability of ankle joint sprains is often caused by an inadequate rehabilitation programme and early RTS [46]. Use of a stabilizing orthotic device or tape, with subsequent weaning, may be recommended during the early period of activity-specific training. According to Carole Doherty, the WTAs senior vice president, sport science and medicine, all its players receive comprehensive medical care, with services that include cardiology, checkups with dermatologists, bone-density exams, and nutrition and hydration advice. In elite football, the ankle sprain represents 10 to 17% of all related ankle injuries [5, 8, 9]. Higher ankle sprain rates have been reported predominantly in older athletes, dominant leg, during official games and occurring at the end of each half of a football match [3]. Concomitant injury to this ligament and the calcaneofibular ligament can result in appreciable instability.5 The posterior talofibular ligament is the strongest of the lateral complex and is rarely injured in an inversion sprain.5,7. End-stage ranges in mobility, speed, and directional changes are known to increase the number of injuries [1]. Gonell AC, Romero JA, Soler LM. The US has demonstrated to be an accurate tool for investigation of ligament sprains but may be difficult to interpret on retrospective review by other physicians. Ferreira JN, Vide J, Mendes D, Protsio J, Viegas R, Sousa MR. Hosea TM, Carey CC, Harrer MF. But suddenly, Zverev ran wide for a forehand, rolled his right ankle on its side and let out a bellow. Ligaments connecting the bones of the ankle are "stretched", causing a small amount of injury to the ankle ligaments. Kaikkonen A, Kannus P, Jrvinen M. A performance test protocol and scoring scale for the evaluation of ankle injuries. Ankle instability. This content does not have an Arabic version. [9][10], MRI: the gold standard for investigating intra-articular damage. Management of acute lateral ankle ligament injury in the athlete. Ankle Sprains: Evaluation, Rehabilitation, and Prevention . Grades I and II respond well to functional treatment. The time needed to RTS in lateral ligamentous ankle sprains depends on several factors, including the severity of the injury, the ability of the athlete, and the rehabilitation features available. Gn C, Unler EE, Vandenberk N, Karagz A, Sentrk GO, Oyar O. This test is performed with the patient's knee resting over the edge of the table. See permissionsforcopyrightquestions and/or permission requests. [9] The second guidelines are taken from a 2020 publication by the World Journal of Orthopaedic (WJO). Supervision by a multidisciplinary team and knowledgeable sport medicine staff is necessary and can be considered for all athletes, although unsupervised, home-based training was also reported to be effective [44]. That is usually the journal article where the information was first stated. [15] In addition, soft tissue massage and manual lymphatic drainage techniques are recommended. Khor YP, Tan KJ. Purpose of Review The purpose of this review is to describe the current evidence on the most common sports-related ankle injuries. during a touchdown), the higher the likelihood of a sprain. Giza E, Fuller C, Junge A, Dvorak J. Mechanisms of foot and ankle injuries in soccer. Our athletes are typically very young and not going to be doing this for 50 years. Use the acronym P.R.I.C.E: Protection, Rest, Ice, Compression and Elevation Giza E (2006) Chronic footballers ankle. When refering to evidence in academic writing, you should always try to reference the primary (original) source. 1 Acute ankle trauma is responsible for 10 to 30. The entire length of the tibia and fibula should be palpated to detect fracture of the proximal fibula (Maisonneuve fracture), which may be associated with syndesmosis injury. Once ranked world No. "The earlier musculoskeletal rehabilitation care started after an ankle sprain, the lower the likelihood of recurrence and the downstream ankle-related medical costs incurred".[11]. treatment plan: rest, ice, compression, and elevation. [4] The anterior talofibular ligament (ATFL) of the lateral ankle ligament complex is the most frequently damaged when a lateral ankle sprain occurs. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. 90% score), Human and Animal Rights and Informed Consent, Ankle injuries, Ligament injuries, Rehabilitation, Return to play. Therefore, functional treatment is preferred over surgery in most of the cases [34, 42]. HHS Vulnerability Disclosure, Help Resistance can be provided by contralateral foot, rubber tubing or weights. Alternatively, the foot and ankle may be cooled by immersion in water at a temperature of approximately 12.7C (55F). Recommendations were made for preventing primary and recurrent injury. Having achieved that goal, Thiem said, he suddenly lost his passion and motivation to play, prompting him to practice with a decreased level of intensity, ultimately leading to the injury. [ corrected] Although early motion and mobility are recommended, ligamentous strength does not return until months after an ankle sprain. Return to sports/work/activities without recurrent symptoms. After hours of scintillating shot-making, Zverev and Rafael Nadal were set to begin a second tiebreaker in their semifinal match at last years French Open. Exercises can be in conjunction with cold therapy. Maintain extremity in a nongravity position with compression. This usually means adopting the classic RICE regimen rest, ice, compression, and elevation. Skip to content Care at Mayo Clinic Care at Mayo Clinic About Mayo Clinic Request Appointment Find a Doctor The first goal is to decrease pain and swelling and protect the ligaments from further injury. Krips R, de Vries J, van Dijk CN. The worst thing that happens is you play bad and lose a match.. Various predisposing factors have been identified as risk factors for ankle sprains. The reported mean costs per ankle sprain are 360.60426.73 [19], but these are unmistakably higher in elite sports. If indicated on the basis of the Ottawa ankle rules, anteroposterior, lateral and mortise radiographs should be obtained after the initial physical examination. Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. For each exercise, hold 1 second for concentric component and perform eccentric component over 4 seconds; do three sets of 10 repetitions; repeat two times a day. It is essential to distinguish a simple distortion from a lateral ligament rupture since adequate treatment is associated with a better prognosis and time to return to play [26, 27]. These most common residual symptoms are chronic pain, recurrent instability, and muscular weakness. Inclusion in an NLM database does not imply endorsement of, or agreement with, The radiographs of an uncomplicated ankle sprain should appear normal, or they may show some lateral tilt of the talus on the anteroposterior or mortise projection. Rafael Nadal at the Australian Open in January, where he injured his psoas muscle. Ankle sprains are considered one of the most frequent traumatic injuries. In the acute phase of an ankle sprain injury, the treatment of choice is RICE, i.e. Ankle joint stability is a prerequisite to the institution of functional rehabilitation. Ankle proprioception ball control. The athlete is unable to bear weight and walk normal. Diagnostic accuracy depends on the skills of the personnel performing the test and the quality of the equipment. Circles and figure-eights are commonly employed for pattern running. Freeman MA, Dean MR, Hanham IW. 2013.Available from: Sports Injury Clinic.Sports Massage - Ankle Sprain. Moderate sprains require support to walk, there is the presence of significant pain, swelling and bruising. Renstrm PA, Konradsen L. Ankle ligament injuries. Pearce CJ, Tourn Y, Zellers J, Terrier R, Toschi P, Silbernagel KG, et al. Potential reasons for this declining trend involve successful injury prevention strategies (e.g. Use toes to pick up marbles or other small object. Its tough for an athlete whose only thought is, How can I get back, and what happens if I dont?. Andreescu has suffered multiple injuries since beating Serena Williams to win the 2019 U.S. Open. Although there exists a substantial body of research on ankle injuries, controversy remains concerning the best treatment for acute lateral ligament injuries, especially for grade III injuries in elite athletes. Basically, everything changes.. [3] These factors, when identified early, can signal to the practitioner to adopt a more aggressive approach during the initial conservative treatment period.[3]. Various devices have been specifically designed for this phase of rehabilitation. A syndesmotic, or 'high' ankle sprain is one that involves the ligaments binding the distal tibia and fibula at the Distal Tibiofibular Syndesmosis. The etiology and prevention of functional instability of the foot. Patients with lateral ligamentous ruptures report more immediate joint oedema and are more frequently prone to stop their activities [28]. 1. announced before the 2019 Australian Open that he would retire. A mild sprain is characterised by the patient's inability to run and jump, difficulty with stair climbing, and presence of discomfort. Ankle sprains account for 67 to 72% of all football player-related injuries to the ankle [3, 5, 9, 11, 12]. The prognosis is generally good, but there are a number of risk factors influencing recovery. The sensitivity and specificity of MRI for ATFL injuries are 92100% and 100%, respectively [30, 31]. CT or MRI studies should also be considered for ankle injuries that involve crepitus, catching or locking, because these symptoms may be associated with a displaced osteochondral fragment. The four components of rehabilitation are range-of-motion rehabilitation, progressive muscle-strengthening exercises, proprioceptive training and activity-specific training. Move ankle in multiple planes of motion by drawing letters of alphabet (lower case and upper case). If an ecchymosis is present, accompanied by palpatory pain or a positive stress test (or both), it is most likely that a partial lateral ligamentous rupture exists [26, 27]. PRICE needs updating, should we call the POLICE? Treatment with elastic bandages results in fewer complications versus taping but is associated with a slower return to sport and remaining instability versus a semi-rigid ankle brace [40]. The advantage of surgical repair is significantly less objective instability when compared with non-operative treatment [43]. Exercise therapy combined with progressive weight bearing is also an essential stage in the functional treatment of acute lateral ligamentous sprain [43]. Injuries, surgery and rehab are dreaded words in any athletes vocabulary. Diagnosis of ligament rupture of the ankle joint. Uncomplicated ankle sprains are treated without surgery. Range of motion must be regained before functional rehabilitation is initiated (Table 2). Weight-bearing should occur as tolerated. Petersen W, Rembitzki IV, Koppenburg AG, Ellermann A, Liebau C, Brggemann GP, Best R. Treatment of acute ankle ligament injuries: a systematic review. Cleland JA, Mintken PE, McDevitt A, Bieniek ML, Carpenter KJ, Kulp K, Whitman JM. 3), including tendinous and syndesmotic trauma, osteochondral lesions, and occult fractures. MRI can be very helpful in the diagnosis of suspected additional injuries including syndesmotic injury, tendon pathologies or in case of chronic ankle instability requiring further investigation.[10]. ANKLE SPRAIN REHABILITATION PROTOCOL Conclude each therapy session with application of ice. Dynamic balance is provided by muscle activation mainly. Intratester and intertester reliability during the star excursion balance test. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach, Predictive Factors for Lateral Ankle Sprains: A Literature Review. Wright IC, Neptune RR, van den Bogert AJ, Nigg BM. MOTION: 1. The effectiveness of a neuromuscular prevention strategy to reduce injuries in youth soccer: a cluster-randomised controlled trial. It was reported in an MRI study that 41% of the patients with an ankle inversion trauma have injured both the ATFL and CFL, whereas only 5% had damaged the PTFL [25]. That makes it even harder to come back., A version of this article appears in print on, The Difficulty of Coming Back From Serious Tennis Injuries, https://www.nytimes.com/2023/05/26/sports/tennis/french-open-alexander-zverev-injury.html. 1 There are three types of ankle sprain, the location of which is determined by the mechanism of injury: lateral ankle sprain (most common), medial ankle . Yeung et al. After repeated attempts to rehab the injury over the last four months, Nadal who has also suffered from chronic foot pain, a cracked rib and a torn abdominal muscle in the last 18 months withdrew from the French Open on May 18. Rehabilitation Protocol for Lateral Ankle Sprain: non-operative management This protocol is intended to guide clinicians through non-operative management of lateral ankle sprain. Andersen TE, Floerenes TW, Arnason A, Bahr R. Video analysis of the mechanisms for ankle injuries in football. The WTA takes injury prevention and rehabilitation seriously. Andreescu has rehabbed her body many times before, but she is also convinced that the mind-body connection is just as important. The revised clinical practice guideline (CPG) on ankle sprain, published in the April 2021 issue of the JOSPT, addresses issues related to both a first-time lateral ankle sprain and chronic ankle instability (CAI). RTS criteria should include functional performance tests (e.g. Pieter DHooghe, Flavio Cruz, and Khalid Al Khelaifi declare that they have no conflict of interest. Use ankle pain and ankle swelling as a guide. A case series of professional athletes who underwent surgical ligament repair reported a median RTS of 77days for isolated lateral ligamentous injuries and 105days for those with concomitant injuries [50]. Immobilisation is usually required for 10 or more days and surgery often becomes the treatment of choice. The patient then progresses to dynamic resistive exercises using ankle weights, resistance bands or elastic tubing (Figure 9). Although a recent study reported no differences in outcome 6months after treatment with tape, semi-rigid brace, or lace-up brace [41], a significant number of studies report superior results from protection with a brace [34, 42]. Medial ankle stability is provided by the strong deltoid ligament, the anterior tibiofibular ligament and the bony mortise (Figure 4). The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. Grade II (moderate) injuries include partial ligament tear with moderate pain, swelling and palpatory tenderness, mild to moderate instability, and moderate functional disability. Then, while competing in Tokyo last September, she tore her anterior cruciate ligament, requiring more surgery. MRI studies may be helpful in identifying syndesmosis sprains and peroneal tendon involvement.13 Injury to the tibiofibular syndesmosis ligaments, which bind together the distal ends of the tibia and fibula, is commonly referred to as a high ankle sprain. As a subscriber, you have 10 gift articles to give each month. Tests can progress from relatively simple tasks (like the single-legged balance test [52]) to more complex tasks (such as the Star Excursion Balance Test [53], the Y-balance test [54], and the agility T-test [55]). Wrapping your leg with a light compression bandage and elevating it, in . Air-filled or gel-filled ankle braces that restrict inversion-eversion and allow limited plantar flexion-dorsiflexion facilitate rehabilitation.18. Compression: is applied for management of swelling and for improvements in quality of life. Bony fractures, cartilage defects, and syndesmotic lesions are frequently seen in association with the more severe type of ankle sprains. Zverev is hardly the first player to be forced into an extended layoff because of a serious injury. In case of a more severe ankle sprain, this mean number rises to approximately 28days of absence. After a lateral ligamentous injury, it is difficult to predict precisely when the athlete can return to sports (RTS). Emphasis is placed on the eccentric component; exercises should be performed slowly and under control. Push foot inward (toward midline of body). However, some athletes tend to dislike braces because they do not fit well in the usual football shoes. The https:// ensures that you are connecting to the Physical examination is sufficient for the diagnosis of sprained ankles. Ankle injuries are nowadays the fourth most common injury type in elite football, and they are preceded by the knee, the thigh, and the lower leg [7, 8]. Van Dijk CN, Lim LS, Bossuyt PM, Marti RK. Physical examination, arthrography, stress radiography, and sonography compared in 160 patients after inversion trauma. [10] Assists with a diagnosis of acute tears of the anterior talofibular and calcaneofibular ligaments. Surgical treatment can be considered in high-level athletes with acute grade III injuries. An epidemiological survey on ankle sprain. Halabchi and Hassabi[4] in their guidelines published in the WJO, use clinical evidence levels 1, 2 and 3 to support their recommendations: Level 1: evidence is obtained from at least one properly designed randomised controlled trial. Relationship between the Y-balance test scores and soft tissue injury incidence in a soccer team. Evidence was also presented to support interventions for . Cloke DJ, Ansell P, Avery P, Deehan D. Ankle injuries in football academies: a three-centre prospective study. Continue to use ACE wrap for compression if swelling persists. Available from: Rehab My Patient. Note that approximately 40% of the athletes with a lateral ligament rupture present with pain upon palpation over the medial malleolus, whereas 60% report tenderness upon palpation over the AITFL (without rupture of this ligament), probably due to a tear of the anterior capsule [28]. 2014. Waldn M, Hgglund M, Ekstrand J. Time-trends and circumstances surrounding ankle injuries in mens professional football: an 11-year follow-up of the UEFA champions league injury study. When walking a specified distance is no longer limited by pain, the patient may progress to a regimen of 50 percent walking and 50 percent jogging. 2022.Available from: Rehab My Patient.Ankle Dorsiflexion | Plantar Flexion Strengthening. An audible snap or crack sound may accompany ligament sprains. Bony structures and all ligamentous entities around the ankle joint should be palpated for tenderness, including the fibular bone and the base of the fifth metatarsal on the lateral side of the foot. Initially, the treatment during the inflammatory phase is aimed towards avoiding swelling and ongoing injury. A simpler approach is to divide these injuries into two groups: complicated and uncomplicated. If you have severe pain and swelling, rest your ankle as much as possible for the first 24-48 hours. Stress radiographs often are not indicated in the routine diagnosis of lateral ligament sprain, as they are challenging to perform and have a relatively low impact on the treatment protocol. One leg stand forward reach. [1] Then I felt the pain, and I knew this was real.. To milk edema fluid away from the injured tissues, the ankle should be wrapped with an elastic bandage. The anterior talofibular ligament is the most easily injured. Resistance exercises should be performed with an emphasis on eccentric contraction.23 The patient is instructed to pause one second between the concentric and eccentric phases of exercise and to perform the eccentric component over a four-second period. Objective: To outline rehabilitation concepts that are applicable to acute and chronic injury of the ankle, to provide evidence for current techniques used in the rehabilitation of the ankle, and to describe a functional rehabilitation program that progresses from basic to advanced, while taking into consideration empirical data from the literat. Dizon JM, Reyes JJ. Roos EM, Brandsson S, Karlsson J. Validation of the foot and ankle outcome score for ankle ligament reconstruction. Diagnosing an acute lateral ligament rupture during a delayed physical examination has a sensitivity of 96%, with a specificity of 84% [26, 27]. Increase intensity and incorporate activity-specific training.*. Three sets of 10 repetitions; repeat two times a day; progress walking as tolerated. Compression modalities include elastic bandaging or splints. I cant forget, Thiem said, that all the time when I didnt play, the other players were playing, they were practicing and improving and moving ahead of me. You cant do your job, and you no longer have a clear plan. Cycling with minimal resistance 3. In Canada, 35% of injuries are related to sport or exercise. Kofotolis ND, Kellis E, Vlachopoulos SP. van Rijn RM, van Os AG, Bernsen RMD, Luijsterburg PA, Koes BW, Bierma-Zeinstra SMA. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Mild tenderness and swelling around the ankle, typically recovers in 5-14 days. Thus, patient compliance may differ under these . Am J Sports Med. The following are the guidelines proposed by the National Athletic Trainers Association (NATA) and published in 2013. 2). Grade III ankle sprain: 10 days of immobilisation using a below-knee cast or rigid brace (level 2, category B), followed by controlled therapeutic exercises (category B). The reported RTS in amateur and professional football players has been between 7 and 1519days, respectively [5, 11]. Frequency and trends in foot and ankle injuries within an English premier league football club using a new impact factor of injury to identify a focus for injury prevention. His opponent that day, Nadal, hasnt played a tour match since he hurt the psoas muscle between his lower abdomen and upper right leg during the Australian Open in January. However, non-operative measures can be prescribed for the majority of acute grades IIII lateral ligament sprains with good to excellent outcome [34]. Box: 29222, Doha, Qatar. When Thiem thinks back on his wrist injury, he connects the dots to when he won the U.S. Open. If there is no pain upon palpation over the ATFL, there is probably no lateral ligament rupture apparent [26, 27]. Level 3: evidence is obtained from well-designed controlled trials without randomisation. An ankle sprain is a common musculoskeletal injury that involves the stretch or tear (partial or complete) of the ligaments of the ankle. On the medial side, the strong, deltoid ligament complex [posterior tibiotalar (PTTL), tibiocalcaneal (TCL), tibionavicular (TNL) and anterior tibiotalar ligaments (ATTL)] is injured with forceful "pronation and rotation movements of the hindfoot".[5]. Dead Bug- Resistance. Wobble board exercises can be performed with eyes open or closed and with or without resistance. This protocol briefly suggests typical exercises for each phase, but More severegrade IIIlateral ligament ankle injury remains controversial. When US is performed after an inconclusive delayed physical examination, the sensitivity increases to 100% and specificity to 72% [27]. For the physical examination, the anterior drawer test evaluates the ATFL instability, whereas the talar tilt test aims at identifying CFL (calcaneus fibular ligament) instability. The lateral stabilizing ligaments, which include the anterior talofibular, calcaneofibular and posterior talofibular ligaments, are most often damaged. 1173185. J Sci Med Sport. The Football Association medical research programme: an audit of injuries in academy youth football. Martin RL, Davenport TE, Fraser JJ, Sawdon-Bea J, Carcia CR, Carroll LA, Kivlan BR, Carreira D. Knapik DM, Trem A, Sheehan J, Salata MJ, Voos JE. Sprains with complete ligament tears (grade III) may require surgical intervention. Approximately 60% of all ankle sprains in athletes arise as a result of direct trauma or due to contact [4, 5]. 2019. Forced plantar flexion when the injured footballer hits the foot of the opponent when attempting to shoot on the goal or clear the ball [22]. In terms of overall mean time loss, this represents an average of 1624 calendar days for every ankle sprain [1, 3, 5, 9]. The outcome of these tests should be evaluated throughout the rehabilitation process, thereby quantifying progress and comparison against pre-injury level and the contralateral side. It is the syndesmotic joint that allows the tibia-fibula complex to adapt as a whole to the varying width of the upper articular surface of the talar bone, and this minimal movement is vital for enabling normal walking and running. official website and that any information you provide is encrypted It is unclear whether an external brace is more effective than taping [48], since both have their advantages and disadvantages. Vereijken AJ (2012) Risk factors for ankle sprain injury in male amateur soccer players: a prospective cohort study. 2019 Jun;18 (6):217-223. doi: 10.1249/JSR.0000000000000603. [3] They are divided into two categories: intrinsic and extrinsic. 1 While there is general agreement that the best approach to an ankle sprain is immediate rest, there is some conflicting advice about what comes next. To design a return-to-work schedule with activity limitations and participation restrictions. [1] conducted an epidemiological study of unilateral ankle sprains and found that the dominant leg is 2.4 times more vulnerable to ankle sprains than the non-dominant leg. If pain occurs with this maneuver, the test is positive.10. Prolonged immobilization of ankle sprains is a common treatment error.20,21 Functional stress stimulates the incorporation of stronger replacement collagen.20 Functional rehabilitation begins on the day of injury and continues until pain-free gait and activity are attained. Different functional treatment strategies for acute lateral ankle ligament injuries in adults. While cold therapy is being used, exercises should be initiated to maintain range of motion and assist lymphatic drainage. Lamb SE, Marsh JL, Hutton JL, Nakash R, Cooke MW, Collaborative Ankle Support Trial (CAST Group) Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomized controlled trial. Elevation: the RICE protocol states elevation can be beneficial, but there are currently no controlled trials to determine its individual clinical effectiveness in the treatment of ankle sprains. Dr. Kurt J. hofmann Physical therapy protocols Accelerated Ankle or Foot Fracture Achilles Tendinopathy Partial Tear Achilles Tendon Debridement, FHL Transfer Ankle Scope Debridement Ankle Scope Microfracture Ankle Sprain Ankle or Foot Fracture Ankle or ST Fusion Brostrom Ligament Reconstruction Cheilectomy Flatfoot Reconstruction Great Toe Fusion Long-term immobilization (>2weeks) leads to poorer outcomes than functional treatment [34, 38]. Continuing sport-specific rehabilitation will help to minimize this risk. Bedics and her mental health team encourage players to manage their expectations upon their return to play. The current literature lacks formal criteria to assist in the decision to RTS of athletes with a lateral ligament injury. Tenderness along the base of the fifth metatarsal may indicate an avulsion of the peroneal brevis tendon. The history, physical examination and radiologic evaluation should be adequate for determining whether orthopedic referral is indicated. Available from: Rehab My Patient. Verhagen EA, van Tulder M, van der Beek AJ, Bouter LM, van Mechelen W. An economic evaluation of a proprioceptive balance board training programme for the prevention of ankle sprains in volleyball. Delayed physical examination (45days) of the lateral ankle ligament complex gives better results than the one that is done within 48h. The majority of acute lateral ligament injuries of the ankle can be treated conservatively with an adequate rehabilitation protocol. The reduced intrinsic intra-articular stability during plantar flexion could explain why most ligamentous injuries are seen in plantar flexion [10]. Complicated ankle sprains usually require surgical management.
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