The Ankle-Joint Complex: A Kinesiologic Approach to Lateral Ankle Sprains
Jennifer M. Medina McKeon, PhD, ATC, CSCS* and Matthew C. Hoch, PhD, ATC†
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Abstract
Copious research exists regarding ankle instability, yet lateral ankle sprains (LASs) persist in being among the most common recurrent musculoskeletal injuries. Key anatomical structures of the ankle include a triform articulating structure that includes the inferior tibiofibular, talocrural, and subtalar joints. Functionally, force absorption and propulsion through the ankle complex are necessary for any task that occurs in weight bearing. For optimal ankle performance and avoidance of injury, an intricate balance between stability and mobility is necessary to ensure that appropriate force transfer occurs during sports and activities of daily living. Consideration for the many structures that may be directly or indirectly involved in LASs will likely translate into advancements in clinical care. In this clinical review, we present the structure, function, and relevant pathologic states of the ankle complex to stimulate a better understanding of the prevention, evaluation, and treatment of LASs.
Keywords: anatomy, biomechanics, joint injury, lower extremity
Lateral ankle sprains (LASs) are the scourge of sport participation. As the most common lower extremity orthopaedic injury, approximately 23 000 ankle sprains occur daily in the United States. The LAS is the most frequent injury during athletic participation, affecting an estimated 1.5 to 2.0 million people in the United States each year. Athletes and other stakeholders also incur substantial costs from these injuries. Lost time from sport participation, school, or work and the associated monetary costs are markers of resource depletion directly related to LASs. Furthermore, LASs account for up to 1.6 million physician office visits, approximately 600 000 emergency department visits, and more than 8000 hospitalizations per year. Associated annual health care costs in the United States are estimated to be $4.2 billion. In addition, LASs often progress and become long-term problems, with residual symptoms, early-onset posttraumatic ankle osteoarthritis, and long-term deficits. These residual effects often lead to decreased physical activity, with the resultant increased health care costs and effects on quality of life.
One of the most common long-term consequences of LAS is chronic ankle instability (CAI), affecting 30% to 70% of those who experience a first-time LAS. The manifestation of CAI is a result of an LAS; the initial LAS is a criterion for diagnosis of CAI. Included in the clinical presentation of CAI are pain, the perception of ankle instability, and recurrent episodes of giving way, with these characteristics lasting at least 1 year after the initial injury. Various combinations of these key characteristics and other signs and symptoms have been included in models for 3 presentations of CAI (mechanical insufficiency, functional instability, and perceived instability) and the updated model of CAI that includes individuals who do not have obvious structural or functional deficits but still experience recurrent sprains. Although often viewed as mild injuries, LASs represent an important public health problem. Based on the high and persistent recurrence rate and frequency of subsequent comorbidities, current care and education concerning LASs are inadequate.
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