What are the most common types of ankle injuries. How can you identify the symptoms of different ankle sprains. What are the best treatment options for various ankle ligament injuries. When should you seek medical attention for an ankle injury.

Understanding the Anatomy of the Ankle

The ankle is a complex joint that plays a crucial role in our mobility and stability. To fully comprehend ankle injuries, it’s essential to have a basic understanding of its anatomy.

The ankle joint is formed by three main bones:

• Tibia (shin bone)
• Fibula (thinner bone next to the tibia)
• Talus (foot bone above the heel)

These bones are connected by various ligaments, which are tough, flexible tissues that provide stability to the joint. The ankle joint allows for up-and-down movement of the foot, while the subtalar joint, located below the ankle joint, enables side-to-side motion.

Key anatomical features of the ankle include:

• Medial malleolus: The bony bump on the inside of the ankle, part of the tibia
• Lateral malleolus: The bony bump on the outside of the ankle, part of the fibula
• Posterior malleolus: The bony prominence at the back of the ankle, also part of the tibia

Common Types of Ankle Injuries

Ankle injuries are prevalent and can occur in various forms. Understanding the different types of injuries can help in proper diagnosis and treatment.

Sprained Ankle

A sprained ankle is one of the most common ankle injuries. But what exactly is a sprained ankle? It occurs when one or more ligaments in the ankle are stretched or torn, usually due to an accidental twist or turn of the foot. The severity of a sprain can range from mild to severe, depending on the extent of ligament damage.

High Ankle Sprain

A high ankle sprain, also known as a syndesmotic injury, involves damage to the ligament that joins the tibia and fibula. This type of sprain often results in pain and swelling similar to a regular ankle sprain but may take longer to heal due to the location and nature of the injury.

Ankle Fracture

An ankle fracture refers to a break in any of the three bones that make up the ankle joint. The most common ankle fractures involve the tibia or fibula. Fractures can range from small cracks in the bone to severe breaks that pierce the skin.

Ankle Ligament Injuries: A Closer Look

Ankle ligament injuries are a significant subset of ankle injuries. They can be classified into three main categories based on the location of the affected ligaments:

1. Lateral Ankle Sprain
2. Medial Ankle Sprain (Deltoid)
3. Ankle Syndesmosis (High Ankle Sprain)

Lateral Ankle Sprain

Lateral ankle sprains are the most common type of ankle ligament injury. They occur when the foot turns inward and downward, causing the ankle to roll outward. This motion can stretch or tear the ligaments on the outer side of the ankle.

The outer ankle has three main ligaments:

• Anterior talofibular ligament (ATFL)
• Calcaneofibular ligament (CFL)
• Posterior talofibular ligament (PTFL)

In most cases, the ATFL is the first to be injured, followed by the CFL in more severe sprains. The PTFL is rarely affected unless the injury is particularly severe.

Medial Ankle Sprain

Medial ankle sprains, also known as deltoid ligament sprains, are less common than lateral sprains. They occur when the foot rolls outward, putting stress on the inner side of the ankle. The deltoid ligament is a strong, fan-shaped ligament on the inner ankle that provides stability.

Ankle Syndesmosis (High Ankle Sprain)

A high ankle sprain involves injury to the syndesmotic ligaments, which connect the tibia and fibula above the ankle joint. These injuries often result from a forceful outward twisting of the foot and can be more severe and take longer to heal than typical ankle sprains.

Recognizing Symptoms of Ankle Injuries

Identifying the symptoms of an ankle injury is crucial for proper treatment and recovery. While symptoms can vary depending on the type and severity of the injury, some common signs include:

• Pain, especially when bearing weight
• Swelling and bruising
• Limited range of motion
• Tenderness to touch
• Instability in the ankle
• Possible popping sound at the time of injury

How can you differentiate between a sprain and a fracture? While it can be challenging without medical imaging, some general guidelines include:

• Sprains typically allow for some weight-bearing, albeit painful
• Fractures often make weight-bearing impossible
• Severe pain, deformity, or an open wound may indicate a fracture

Diagnosis and Treatment of Ankle Injuries

Proper diagnosis is essential for effective treatment of ankle injuries. Healthcare professionals use various methods to assess the extent of the injury:

• Physical examination
• X-rays to rule out fractures
• MRI or CT scans for detailed soft tissue imaging
• Stress tests to check ligament stability

Treatment options vary depending on the type and severity of the injury. Common approaches include:

Conservative Treatment

For mild to moderate sprains, the RICE method is often recommended:

• Rest: Avoid putting weight on the injured ankle
• Ice: Apply cold packs to reduce swelling
• Compression: Use an elastic bandage to minimize swelling
• Elevation: Keep the ankle raised above heart level when possible

Additional conservative treatments may include:

• Pain medication
• Physical therapy
• Ankle braces or supports

Surgical Treatment

In severe cases or when conservative treatment fails, surgery may be necessary. Surgical options can include:

• Ligament repair or reconstruction
• Fracture fixation with pins, plates, or screws
• Arthroscopic procedures for joint cleaning or repair

Prevention and Rehabilitation of Ankle Injuries

Preventing ankle injuries is always preferable to treating them. Some effective prevention strategies include:

• Proper warm-up before physical activities
• Wearing appropriate footwear for your activity
• Strengthening exercises for the ankle and lower leg
• Balance and proprioception training
• Taping or bracing for added support, especially in high-risk activities

Rehabilitation is crucial for recovery and preventing future injuries. A comprehensive rehabilitation program may include:

• Range of motion exercises
• Strength training for ankle and leg muscles
• Balance and coordination exercises
• Sport-specific training for athletes
• Gradual return to normal activities

When to Seek Medical Attention for Ankle Injuries

While many minor ankle injuries can be treated at home, certain situations warrant immediate medical attention. You should seek professional help if:

• You’re unable to bear any weight on the affected foot
• There’s severe pain, even when not bearing weight
• You hear a popping sound at the time of injury
• There’s visible deformity of the ankle
• You experience numbness or tingling in the foot
• The pain and swelling don’t improve after several days of home treatment

Early intervention can prevent complications and ensure proper healing, so it’s always better to err on the side of caution when it comes to ankle injuries.

Long-Term Effects and Complications of Ankle Injuries

While many ankle injuries heal without long-term consequences, some can lead to ongoing issues if not properly treated. Potential long-term effects and complications include:

Chronic Ankle Instability

Chronic ankle instability can develop after repeated ankle sprains or inadequately treated injuries. This condition is characterized by a persistent feeling of the ankle “giving way” and may lead to frequent sprains.

Post-Traumatic Arthritis

Severe ankle injuries, particularly fractures, can increase the risk of developing arthritis in the joint later in life. Post-traumatic arthritis can cause pain, stiffness, and reduced range of motion.

Persistent Pain and Swelling

Some individuals may experience ongoing pain and swelling, even after the initial injury has healed. This can be due to various factors, including scar tissue formation or incomplete rehabilitation.

Reduced Athletic Performance

For athletes, ankle injuries can have a significant impact on performance. Even after healing, there may be a period of reduced speed, agility, or confidence in the affected ankle.

To minimize the risk of these complications, it’s crucial to:

• Seek proper medical care for significant injuries
• Follow through with recommended rehabilitation programs
• Take preventive measures to avoid re-injury
• Address any lingering symptoms or instability promptly

By understanding the potential long-term effects of ankle injuries, individuals can make informed decisions about their treatment and take steps to protect their ankle health in the future.

Image, Function, Conditions, & More

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The ankle is a large joint made up of three bones:

• The shin bone (tibia)
• The thinner bone running next to the shin bone (fibula)
• A foot bone that sits above the heel bone (talus)

The bony bumps (or protrusions) seen and felt on the ankle have their own names:

• The medial malleolus, felt on the inside of your ankle is part of the tibia’s base
• The posterior malleolus, felt on the back of your ankle is also part of the tibia’s base
• The lateral malleolus, felt on the outside of your ankle is the low end of the fibula

The ankle joint allows up-and-down movement of the foot. The subtalar joint sits below the ankle joint, and allows side-to-side motion of the foot. Numerous ligaments (made of tough, moveable tissue) surround the true ankle and subtalar joints, binding the bones of the leg to each other and to those of the foot.

Ankle Conditions

• Sprained ankle: Damage to one of the ligaments in the ankle, usually from an accidental twist or turn of the foot. Rehabilitation can prevent pain and swelling from becoming a long-term problem.
• High ankle sprain: The ligament joining the two bones of the lower leg (tibia and fibula), called the syndesmotic ligament, is injured. A high ankle sprain causes pain and swelling similar to a true ankle sprain, but can take longer to heal.
• Ankle fracture: A break in any of the three bones in the ankle. Most commonly, the bones of the lower leg (tibia or fibula) is fractured.
• Ankle arthritis: While it’s not common, osteoarthritis, the most common form of arthritis, can affect the ankle.
• Rheumatoid arthritis: An autoimmune form of arthritis in which the body attacks joint tissue, causing inflammation, pain, and swelling. Any joint may be affected by rheumatoid arthritis, including the ankle.
• Gout: A form of arthritis in which crystals periodically deposit in joints, causing severe pain and swelling. The ankle may sometimes be affected by gout.
• Psoriatic arthritis: This form of arthritis, which causes swelling and pain, is associated with the skin condition psoriasis. Many joints, including the ankle, may be affected by psoriasis.
• Septic arthritis: Caused by bacterial infections that may occur in the ankle, this form of arthritis develops quickly, causing severe pain, swelling, fever, and difficulty moving the ankle.

Ankle Ligament Injuries – Podiatry, Orthopedics, & Physical Therapy

ANKLE LIGAMENT INJURIES IN ADULTS
Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.

There are different types of ankle sprains which involved different aspects of the ankle complex. Injuries to the ankle ligaments can vary depending on the position of the ankle during injury, the direction the body fall during injury, the type of shoegear one is wearing during injury, the activity in which the injury occurred and the force in which the injury occured. In some cases there is a combination of injuries. There are three main categories of ankle ligament injuries.

A. Lateral Ankle Sprain
B. Medial Ankle Sprain (Deltoid)
C. Ankle Syndesmosis (High Ankle Sprain)

A. LATERAL ANKLE SPRAIN

LATERAL ANKLE LIGAMENT INJURIES (Outer Ankle)
Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S.

The ankle is a complex joint composed of three bones, cartilage, tendons and joint lining.  The ankle joint itself lets us move forward as the ankle motion is primarily up and down.  While the ankle does have some side-to-side motion, most of that movement is performed at the joint below the ankle called the subtalar joint.

Ligaments connect bones together in the ankle.  On the outside of the ankle there are three ligaments.  On the inner ankle there are five.  There are also four ligaments that connect the two bones of the leg together called the tibia and fibula.   Ankle ligament injuries occur whenever any of these ligaments are stressed beyond its elastic limits. 

Outer ligament injuries occur when the foot turns down and in and the ankle rolls to the outside.  These ligament injuries are the most common type of ankle ligament injuries and can occur in any sport, falling off of a high-heeled shoe or even just stepping down off of a step.  When the ankle ligament turns excessively, the ligament could stretch, partially tear or completely tear.  When the main ligament (ATFL-anterior talofibular ligament) tears, then the secondary outer ligament called the calcaneal fibular ligament (CFL) can stretch, partially or completely tear.  Usually at that point the injury stops but in some severe cases the ligament in the back of the ankle called the posterior talofibular ligament (PTFL) tears. 

LATERAL ANKLE SPRAINS (OUTER) 

The degree of injury to the outer ligaments dictates what has been felt or what is seen after the injury.  Mild stretch injuries will typically allow the patient to weightbear immediately after the injury.   When a pop is felt, it is usually the ligament tearing and more pain is usually present.  There is very often tenderness and swelling along the inside of the ankle.  This occurs when the outer ligaments tear and the inside of the ankle bones hit each other (talus hits tibia) and bone contusions develop.  Tears are often accompanied by diffuse and immediate swelling on the outside of the ankle.  Over a day or two the outer ankle will become somewhat discolored or black and blue.  Sometimes that spreads towards the inside of the ankle as well.  (The greater the injury the more difficult it would be to weightbear).

How are these ligaments evaluated?

• A thorough history and physical examination is performed by one of our doctors.
• The mechanism of injury is sought, as this gives us a lot of information about the degree of injury and what other structures have been affected by it.
• During the physical exam each ligament is palpated to assess which ligament has been stretched, partially torn or completely torn.
• Stressing the ankle joint gives us information about the degree of instability to the ankle region.  Palpating the inside of the ankle gives us further information about the degree of injury to the outside of the ankle.  The more tenderness there is on the inside, the greater the degree of injury on the outside.
• It is imperative to evaluate the entire lower extremity with ankle ligament injuries.  Some patients have a complete predisposition to having these ligament injuries and once the treatment for the acute injury is complete, then addressing the predisposing factors becomes critical. 

Signs and Symptoms:

• Patient should usually have mild, moderate or diffuse swelling to the outside of the ankle depending on the degree of injury to the ligaments.
• Patients may be able to fully weightbear for mild injuries or be completely unable to put the foot down due to severe ligament injuries to the ankle.
• Swelling may develop immediately and usually occurs over the ligaments that have been injured.
• Swelling may extend or occur on the inside of the ankle due to a bone contusion that develops with a severe outer ankle ligament injury. 
• Discoloration usually develops within a few days.  The degree of discoloration usually coincides with the degree of injury to the ankle. 

X-ray Examination:

• X-rays are performed to rule out fractures to the ankle. 
• Ankle ligament injuries may be associated with an injury to the joint surface of the talus called an osteochondral injury (OCL).  If one is seen, then the treatment changes and we often go towards a CT scan.

MRIs:

• MRIs are not initially taken unless we suspect an osteochondral injury (OCL) that is not seen on a standard x-ray.
• MRIs may be necessary when we suspect subluxation of the peroneals or an injury to the tendon structures around the ankle. 
• MRIs, although not used initially, may be used at six weeks or later if an acute ankle injury does not heal or move along the pathway of healing in the normal suspected timeframe.   We also will utilize MRIs if pain is greater than what we would expect to see from the ankle ligament injury that presented to us. 

CT Scans:

• CT scans are rarely necessary for the ankle unless on an x-ray or an MRI an osteochondral lesion (OCL) is suspected.  The CT scans allow us to grade the injury to the joint surface (OCL) and help dictate formalized treatment.
• CT scans give us more information about the bony architecture of the ankle and whether other ankle injuries have occurred before. 
• Bone spurs are often seen on CT scans more clearly than an MRI or x-rays. 
• The CT scans may be necessary when underlying arthritis is present in the ankle and we are contemplating an arthroscopic surgical procedure. 

Treatment:

There is no standard of grading for ankle ligament injuries, although doctors often grade these injuries with Grade I as a stretch injury, Grade II as a partial tear and Grade III as a complete tear.   We try to generally stay away from grading injuries and evaluate each patient individually based on their prior history of injury, degree of present injury and desire to return to sports and activities. 

1. Stretch injuries to the ankle ligament injuries are usually associated with general low-grade swelling and low-grade soreness to the outer ankle.  These stretch ligament injuries can be treated conservatively with an ankle brace.  Ankle braces are utilized to stabilize the ankle and prevent further injury.  We strongly advise all our patients to wear their ankle braces to sleep, as it will keep the foot at a 90-degree angle and prevent stress to the ankle ligament when it is trying to repair itself.  Anti-inflammatories are always contraindicated.  They should not be taken with acute ankle ligament injuries, as Mother Nature wants to cause some inflammation to the area.  Inflammation is the precursor or the most important thing necessary for the ankle ligament injury to heal.   Without inflammation we do not heal as well because inflammation gives us scar tissue to mend the ligament.  In some cases patients with a stretch injury have a long history of minor ankle sprains and weakness to the muscles on the outside of the ankle.  In those cases we strongly encourage a short course of physical therapy and home exercises to allow the patients to return back to sports.  In women we tell them to avoid wearing heels, as this puts undue stress on the ligaments as it is attempting to heal.  Sports activities should be limited in some cases for a week or more and utilizing the brace is best for 2-4 weeks until there is pain free range of motion and the examination has shown that there is complete stability and strength back to the ankle.  If the foot has a posture that favors rolling out excessively (high arches), then some type of orthotic or custom bracing should be made to prevent more chronic instability from developing.

2. Partial tears occur when the main ligament on the outside of the ankle (ATFL-anterior talofibular ligament), stretches beyond its elastic limits and partially tears.   Patients will have slightly more swelling and pain when they begin to weightbear.  Discoloration may develop within 24 hours.  These injuries, when accompanied by difficulty weightbearing, usually require immobilization in an ankle brace and boot (Cam walker).  The boot allows the patient to weightbear in most cases completely free of pain.  The ankle brace gives it further stability and is necessary when the patient sleeps to keep the foot at a 90-degree angle to the leg and prevent stress at the attempted repair of the ligament.  Again, in all cases anti-inflammatories should be avoided.  Tearing of the ligament is a signal to the body to get inflammation.  Inflammation is the most important part of healing.  Taking anti-inflammatories such as Advil, Motrin, ibuprofen, Aleve, or Naprosyn would not provide the best chance of long-term healing.  Immobilization may be necessary for 2-4 weeks.  If the patient has had multiple injuries before, then it is more important to keep the ankle immobilized for a longer period of time to allow healing to take place.   A short course of physical therapy is necessary to restore range of motion, strength and stability back to the ankle.  In most cases patients can go back to participating in practice and then their sport in 3-4 weeks.  Women should avoid wearing high heels for at least one month.

3. Complete tears of the main ligament (ATFL-anterior talofibular ligament) are usually accompanied by more pain, difficulty weightbearing, swelling and discoloration to the outside of the ankle.  These ligament injuries require immobilization to allow the ligament to heal primarily.  In most cases a hard weightbearing cast or an ankle brace and a boot is all that is necessary.  Patients can immediately weightbear as pain allows.  The ankle brace should again be used in the nighttime while the patient sleeps and the boot should be used any time the patient weightbears.  If it occurs on the right ankle, the boot can come off while the patient drives but the brace should remain on at all times.   Immobilization may be necessary for four weeks.  No anti-inflammatories should be used at any time.  Physical therapy is usually begun once stability begins to take hold in the ankle and that could take 2-3 weeks.  Physical therapy’s aim is to restore range of motion, strength and stability back to the ankle.  Return to sports may take 4-6 weeks.  These injuries are often accompanied by a mild stretch or partial tear to the secondary ligament on the outside of the ankle called the calcaneal fibular ligament (CFL).  If present, similar protocol is needed.  This partial ligament tear will heal in the same timeframe as the main ligament injury.

Complete ligament injury to the anterior talofibular and calcaneal fibular ligaments creates a more unstable ankle.  This ankle ligament injury is often accompanied by a mild, moderate or severe bone contusion on the inside of the ankle.  This bone contusion causes a lot of pain and swelling as well as pinpoint tenderness to the inner ankle joint region.   These injuries always require some form of immobilization.  In young athletes we prefer to get the patient in a hard cast for 2-4 weeks.  While the patient is in a cast they can weightbear to tolerance.  Crutches are not necessary.  In some cases the bone contusions on the inside of the ankle cause more discomfort than the ankle ligament injury.  This may preclude pain free weightbearing and crutches may be necessary.  Following the cast removal then a boot and brace is applied.  This allows further immobilization.  However, physical therapy usually can begin at about 3-4 weeks.  During the process, an ankle brace is necessary while the patient sleeps.  This will take away stress from the ligaments while they are attempting to heal.  All anti-inflammatories should be avoided for at least six weeks.  A return to practice in sports may take 5-6 weeks and a return to sports may take 6-8 weeks.  If this ligament injury has occurred once or twice, then conservative care usually works well to allow complete healing of the ligament injury.   Surgery for complete ligament tears in a patient that sprains their ankle once or twice is typically not necessary, as these patients will heal with conservative care uneventfully with an excellent long-term outcome.

It is critical to understand which ligaments have been injured.  It is also important to understand the history of the injury and whether the patient is at risk for further injury due to their foot type.  People that are flatfooted typically do not have as many recurrent outer ankle ligament injuries.  People with high arches typically do.  In people with high arches it is even more important to immobilize the area to prevent chronic instability.  In people with high arches, when the ankle ligaments tear the secondary stabilizers called the peroneal tendons have to over work and they often develop a split tear, which may require surgery.  It is likewise critical to never use anti-inflammatories for acute ankle ligament injuries, as this will delay the inflammatory process and limit healing.   Anti-inflammatories usually can be used at 5-6 weeks if there is an abundance of swelling after the ligaments have been assessed and checked for healing.  If we suspect further damage to the joint and the patient does not heal in the appropriate timeframe, we will do an MRI to further evaluate the injury and when necessary get a CT scan if an osteochondral lesion (OCL) is suspected.

CHRONIC INSTABILITY: 

Chronic ankle instability can occur when the ankle ligaments have not healed and the ankle has no stability during sports, activities or in a female when she wears a high-heeled shoe. 

Signs and Symptoms:

• Feels like the ankle will give out when walking on any uneven surface.
• Patients usually have to watch where they walk for fear of stepping on a pebble or an object that causes the ankle to roll.  Inner ankle gets “jammed up”.
• Female patients typically have to watch the height of the heel they are wearing to prevent falling when walking.
• Pain, low-grade swelling and tenderness are along the outer ligament complex.
• Tenderness along the muscle-tendon unit (peroneal tendons) as they try to stabilize the ankle.
• Swelling and tenderness on the inside of the ankle due to the ankle constantly rolling. 
• Palpation of a bone spur on the inside of the ankle due to repetitive stress of the talus against the tibia.
• Frequent need to wear an ankle brace to get a feeling of more stability and prevent the ankle from rolling. 

Treatment:

• For mild to moderate instability, conservative care usually consists of bracing an ankle during sports and activities.  Contrary to many beliefs, it does not cause atrophy to the muscle.  It does help support the ankle and prevent the ankle from rolling.  In some cases bracing may not provide enough stability.  If the foot has a tendency to roll to the outside due to the increased arch, an orthotic made for their running shoe or cleat may be invaluable to take away some of the torque and twist to the outside of the ankle.  
• Moderate to severe cases are very common when athletes have had frequent ankle sprains and the ligaments have failed to heal.  Cortisone injections will not help provide any stability but they can provide some temporary pain relief when there is inflammation in the ankle joint.  Prolotherapy is something that can be performed to help increase inflammation, hopefully obtaining some scar tissue to add some stability to the ankle.  These are small injections that are given weekly into the ankle ligament to hopefully create more thickening and more stability to the ligament that will hopefully provide stability.
• When conservative treatment fails, surgery is an excellent option.  In most cases the surgery is performed after a thorough evaluation of the injury and the long history of the injuries that have occurred before.  MRIs are always performed and CT scans occasionally to fully evaluate the extent of injury to the ankle.  In most cases we are able to take the patient’s native ligament structures, shorten them and tie them back to the bone with small drill holes and thick sutures.   The procedure most commonly performed is called a “Brostrom”.  It is an outpatient procedure performed under a twilight or a general anesthetic.  An incision is either placed in the front of the fibula or around the outside of the fibula and one (ATFL) or two (ATFL and CFL) ligaments are repaired.  Postoperatively patients are placed in a cast and nonweightbearing for 3-4 days.  Postoperatively the patient is seen at day four and placed in a weightbearing cast.  They are able to weightbear to tolerance.  Casting is usually necessary for six weeks.  During the casting process patients are allowed to get on an exercise bike and go to the gym to perform a lot of activities.  Leg extensions, leg curls, Smith machine squats and leg presses are all permissible.  This is because once the foot and ankle are in a cast the surgical repair is completely protected and no further injury can occur to it.  At the end of the immobilization process a 4-6 weeks course of physical therapy is necessary to help restore range of motion, strength and stability back to the ankle.   Once the patient returns back to sports, an ankle brace is usually necessary for one or more months to allow them to get back to sports while minimizing the risk of reinjury.

Prognosis:

• The prognosis is usually excellent when a Brostrom procedure is performed.  Patients usually can return to all sports and activities without any problems. 
• In some cases the patient’s ankle ligaments are of such poor quality that repairing them back to bone will fail.  In those cases other surgical procedures may be necessary to afford long-term stability.  In some cases we will use an allograft (cadaver tendon) weaved through the bone to create stability.  In other cases we will split one of the tendons on the outside of the ankle and weave it through the bone to provide long-term stability.  Postoperative course is similar to the Brostrom procedure.  The long-term prognosis is usually excellent as well.
• In evaluating which patients require a particular procedure, we take everything into account, which includes foot type, history of injury, quality of native ligaments and general stability of the ankle.   This evaluation helps us provide the best possible care for our patients.  We are able to choose the best procedure to provide the best long-term prognosis.

  

 

This is a picture of the CFL being repaired with suture during peroneal tendon repair

Repair of ATFL for chronic ankle instabiity

 

This is a picture of the CFL being repaired with suture during peroneal tendon repair

Repair of ATFL for chronic ankle instabiity

This is a picture of the CFL being repaired with suture during peroneal tendon repair

Repair of ATFL for chronic ankle instabiity

Pic of CFL behind the peroneal tendons

B. MEDIAL ANKLE SPRAIN

           

 

DELTOID LIGAMENT INJURY
“Medial Ankle Sprain”
Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.

The deltoid injury consists of five ligaments that connect the lower leg bone (tibia) to the foot.

Causes:

• Usually caused from a traumatic event where the ankle gets hit from the outside causing the foot to roll in.  Injuries to the deltoid ligament may be partial or complete and also may be associated with fractures to the tibia or fibula.
• Severe flatfoot deformities cause the foot to move in a down and in position.  Over time all the motion is taken up by the foot and further motion is necessary, causing the ankle to tilt, injuring the deltoid ligament (tilted ankle).

Signs and Symptoms:

• Injuries to the deltoid ligament when acute cause pain with any attempted weightbearing, diffuse swelling, tenderness and often ecchymosis (discoloration).
• For simple injuries the patient may be able to weightbear.  For severe injuries the injured person will not be able to put any weight on the foot and ankle.
• Extreme tenderness is present to palpate some or all of the deltoid ligaments.  It is important to rule out other injuries that may have occurred at the same time.  This can include injuries to the syndesmosis and/or tibia and fibula.
• Standing or weightbearing examination may be needed to rule out severity of a flatfoot deformity.  Tilting of the ankle may be easily seen clinically.

X-rays:

• X-rays are necessary to rule out any bony injury or an increase in the space between the talus and the tibia.
• A tilted ankle where there is an increase in joint space in the inside of the ankle may also be seen with severe or chronic injuries to the foot and ankle.

MRIs:

• MRI may be necessary to rule out other injuries to the ankle and to fully evaluate the injury.

Treatment:

• For simple injuries; to the deltoid without associated bony injuries (fractures), immobilization in a cast or boot may be necessary.   This immobilization may be necessary for 2-6 weeks.  Depending on the injury, crutches may be needed during that time.  Following removal of immobilization, physical therapy is started to restore range of motion, strength and stability back to the ankle.
• Surgery is rarely if ever necessary for isolated deltoid ligament injuries.

Prognosis:

• If the deltoid ligament is isolated (not associated with any bony injuries), prognosis is excellent and patients may return to sports within 4-12 weeks, depending on the number of injuries in the deltoid ligament complex.  Bracing may be needed for 3-4 months to prevent recurrence of injuries.
• If the deltoid ligament is associated with other bony fractures, the fractures may need to be openly reduced and fixed.  During the immobilization of these injuries the deltoid ligament will heal most often primarily without any long-term issues.
• If severe foot deformities are present, it may be necessary to treat these deformities to prevent worsening of a tilted ankle.
• If pain, stiffness and impingement are present status post deltoid ligament injury, ar

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Ankle Sprains (for Teens) – Nemours KidsHealth

What Is an Ankle Sprain?

An ankle sprain is when the ligaments that support the ankle get overly stretched or torn. It can happen when you step in a hole, twist your ankle while walking or running, or put your weight down on your foot awkwardly.

When most ankle sprains happen, the ankle is flexed and inverted (the foot turned inward toward the opposite foot). Ankle sprains are common, making up 25% of all sports-related injuries.

With rest and proper treatment, most ankle sprains heal within 4–6 weeks. But some can take longer.

What Are the Signs & Symptoms of an Ankle Sprain?

The signs of an ankle sprain depend on how serious it is. Common symptoms include:

• pain
• soreness
• swelling
• trouble bearing weight or walking on the ankle
• bruising

What Causes Ankle Sprains?

Most ankle sprains happen when the ankle twists, or when the foot rolls onto its side. Most happen during athletic activities. But you don’t have to be playing sports to injure an ankle — sprains can happen from taking an awkward step or tripping on the stairs.

How Are Ankle Sprains Diagnosed?

To diagnose ankle sprains, doctors ask about the injury and do an exam. They’ll check the bones and soft tissue of the ankle, watch the person’s range of motion, and do strength tests.

Sometimes, the doctor may order an X-ray or other imaging study to see if there are other injuries, such as a broken bone.

How Are Ankle Sprains Treated?

Treatment for an ankle sprain usually includes:

• protecting the ankle by taping, wearing a lace-up ankle brace, or ankle splint
• rest to prevent reinjury and limit swelling. How long somebody needs to take it easy depends on the injury. If no ligaments tore, 10–14 days might be long enough.
• pain medicine
• treatments to help with swelling such as:
  • ice wrapped in a towel placed on the area for about 20 minutes every 1–2 hours
  • an elastic bandage wrapped around the area or elastic sleeve to provide compression
  • raising the injured area
• warm compresses or a heating pad (only after the swelling goes down)
• when the pain and swelling are better, stretching exercises
• before returning to activity, strengthening exercises

Doctors may treat a more serious ankle sprain with a splint or temporary cast. Very rarely, a person might need surgery.

Can I Go Back to Sports?

If you have an ankle sprain, you’ll probably need to take some time off from sports and other strenuous physical activities. Make sure your sprained ankle is completely healed first.

You can go back when:

• The swelling goes down.
• The sport does not cause pain.
• The doctor says it’s OK.
• You can bear weight without a limp.
• You have your full range of motion.
• Your strength returns to normal.

Can I Prevent a Sprained Ankle?

It’s impossible to prevent all ankle sprains. But these tips can make another one less likely:

• Stretch regularly to keep your ankles flexible.
• Do ankle range of motion and strengthening exercises to keep your muscles strong.
• Always warm up before playing sports, exercising, or doing any other kind of physical activity.
• Watch your step when you’re walking or running on uneven or cracked surfaces.
• Don’t overdo things. Being tired can make an injury more likely. 
• Use tape, lace-up ankle braces, or high-top shoes to support the ankle.
• Wear shoes that fit well. Tie any laces and close any Velcro or other straps to make the shoes as supportive as possible.
• Don’t wear shoes with high heels.

What Else Should I Know?

Not overdoing things is key when it comes to sprains. So follow your doctor’s advice and don’t push yourself or feel pressure to get back into sports or other activities too soon. Sprains usually heal well, but they need time to get fully better.

Tips for Preventing Foot and Ankle Injuries

Be careful running too many hills

Running uphill is a great workout, but make sure you gradually build this up to avoid injuries. Be careful when running downhill too fast, which can often lead to more injuries than running uphills!

Prevent recurrent injuries

Athletes who have experienced ankle injuries previously may benefit from using a brace or tape to prevent recurrent ankle injuries.

Listen to your body

If you experience foot and ankle pain during a sport, stop the activity or modify the activity until the pain subsides. Also, if you have been injured, you should go through a period of rehabilitation and training before returning to the sport to prevent recurrent injuries.

Running and Tennis Injuries

Running and tennis injuries include ankle sprains, Achilles tendonitis and plantar fasciitis. Ankle sprains, a partial or complete tear of any of the ligaments responsible for supporting and stabilizing the ankle joint, usually result from landing on an uneven surface and having the foot turn awkwardly.

Injury to the Achilles tendon, the strongest and largest tendon that connects the back of the calf muscle to the heel bone, occurs from overuse and is usually an acute inflammation or a partial tear. If the tendon is weak, it can rupture with the right force.

It is also common for the plantar fascia, the tough tissue that maintains the arch of the foot and runs from the heel to the toes, to become inflamed, resulting in heel or arch pain.

Runners also may experience injury to the tendons or ligaments located on the outside and inside of the ankle and stress fractures of the foot bones. In running, any one incident may not be enough to fracture the foot; however, over time, repetition of abnormal forces or stress can cause the bone to weaken or break. Five to 15 percent of all running injuries are stress fractures. Of those injuries, 49 percent occurred in those who ran between 25 miles to 44 miles per week.

Soccer Injuries

Unlike foot and ankle injuries in tennis and running, which are usually overuse injuries, soccer injuries often result from trauma such as a direct blow to the lower leg. Because soccer is a contact sport, collision injuries from striking another player are common, accounting for 30 percent of all soccer injuries.

Ankle injuries in soccer account for 20 to 30 percent of all soccer injuries—the most common being ankle sprains. Soccer players also may experience turf toe, a sprain that results from stubbing the toe while running or improperly planting one’s cleats.

Treatment

Treatment for these injuries varies depending on the severity of the injury. Most strains and sprains can be treated with rest, ice, compression and elevation (RICE). Moderate to severe cases, however, may require some form of immobilization such as a brace or a cast. Certain injuries that don’t heal within the expected time frame may require surgery.

It is important to seek medical attention as soon as possible for foot and ankle injuries, especially if it is causing you to limp or there is swelling. Prompt and appropriate treatment and rehabilitation ensures the best possible recovery.

What are the Most Common Ankle Problems?: Next Step Orthopedics: Orthopedic Surgeons

The ankle is the joint that creates the intersection for the foot and leg bones. It also makes it possible for the foot to hinge upward and downward. Typically when people talk about the ankle, they are referencing the joint and the area around it, extending from the top of the foot to the base of the leg. A person may experience ankle pain if the muscles, tendons, ligaments, tendons, or bones in the area became damaged or inflamed. Pain in the ankle is often experienced alongside other symptoms such as weakness, stiffness, or instability; bruising, redness, or swelling; or sensations of pins-and-needles, burning, or numbness.

Often, ankle injuries occur during athletics, but it is easy to twist an ankle on an uneven sidewalk or any other context outside of sports. These injuries strike people at all ages. Interestingly, 15-24-year-old males are likelier than females of the same age to experience ankle sprains; however, among those aged 30 and above, women are more susceptible than men to the injury. Sports are responsible for half of ankle sprains. An incredible 25,000 people suffer from ankle sprains daily in the United States. Ankle injuries, as a general category, result in over 1 million emergency room visits annually. Fractures and sprains are the most frequently occurring ankle injuries. However, tendon tears and strains can also happen.

Let’s look at three broad conditions that might cause someone to experience pain and other symptoms in their ankles.

Fractures, sprains, and strains

When we talk about ankle injuries, the most logical way to do so is to categorize the types of damaged tissue: tendon, ligament, or bone. The talus of your foot connects with the fibula and tibia of the leg at the ankle. Ligaments, connective bands of tissue that allow the ankle to move while stabilizing bone position, are responsible for binding these bones to one another at the ankle. Finally, muscles are connected with bones via tendons, allowing for motion and stability.

If you experience an ankle fracture, that means you break a bone or multiple bones at your ankle. If you sprain your ankle, that means that you have pulled or stretched ligaments beyond their capacity, resulting in injury. Sprains can be complete ruptures or tears, or they can be composed of various tiny tears. Finally, muscles and tendons can become strained – which is stretching beyond the range of motion.

People will often experience strains of the muscles or tendons in the lower back and legs. The strains that occur within the ankles typically involve the peroneal tendons that shield the ankle and give it stability. When these tendons are subjected to a force or are overused, inflammation – called tendinitis – can result. An incident of trauma can result in acute tears of the tendon. A person might develop tendinosis if they experience excessive stretching over and over, resulting in many different microscopic tears. A rupture is also possible, as is a subluxation, in which the tendon shifts from its natural position.

Arthritis

Osteoarthritis, rheumatoid arthritis, and gout are all types of arthritis that can impact the ankles – bringing with them symptoms such as pain and inflammation:

• Osteoarthritis (OA) is a chronic condition and the most frequently occurring type of arthritis. In OA, there is degeneration of the cartilage that acts as the padding at the ends of your bones where they connect to the joints. Without the cartilage there is bone-on-bone friction – producing pain, giving rise to stiffness, and decreasing mobility. In the region, OA is most often experienced in the big toe; but it can also occur in the ankle.
• Rheumatoid arthritis is characterized by the body’s immune system errantly targeting the membrane around the joints, the synovium. Pain, inflammation, and disability can result. Approximately 9 out of every 10 people who have rheumatoid arthritis experience it in the joints of their ankles and feet.
• Gout occurs when uric acid, which is a waste product, is left within the joints and other tissues as deposits of monosodium urate crystals. The beginning of gout is often pain or inflammation in the big toe following an injury or illness. Additional joints, such as the ankles, are often impacted thereafter. If the disease progresses, tophi, uric acid lumps, can start accruing under the skin at the ankles.

Achilles tendinitis

One other common ankle problem is Achilles tendinitis. In this condition, the tendon becomes inflamed. Inflammation occurs naturally when disease or injury occurs. Achilles tendinitis can be subdivided by the region of the tendon in which inflammation occurs:

• Noninsertional Achilles tendinitis – In this version, fibers in the middle of the tendon develop tiny tears, become thicker, and swell.
• Insertional Achilles tendinitis – In this version, the lower heel is impacted at the point where the heel bone and tendon connect.

Conclusion

Are you experiencing pain or other symptoms in your ankles? As a board-certified orthopedic surgeon, Dr. Dominique Nickson provides diagnosis and treatment to patients with ankle problems. Learn more.

Varying Degrees of Ankle Sprains

A sprained ankle is a very common injury. A sprained ankle can happen to athletes and non-athletes, children and adults. It can happen when you take part in sports or even by stepping on an uneven surface.

Ankle sprains occur when the foot twists, turns or rolls beyond its normal motions. A sprain can also occur if the foot is planted unevenly on a surface, beyond the normal force of stepping. This causes the ligaments to stretch beyond their normal range in an abnormal position. A ligament is an elastic structure. Ligaments usually stretch within their limits, and then go back to their normal positions. When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers.

There are three grades for ankle sprains determined by the amount of force.

• Grade 1: Stretching or slight tearing of the ligament with mild tenderness, swelling and stiffness. The ankle feels stable and it is usually possible to walk with minimal pain.
• Grade 2: A more severe sprain, but incomplete tear with moderate pain, swelling and bruising. Although it feels somewhat stable, the damaged areas are tender to the touch and walking is painful.
• Grade 3: This is a complete tear of the affected ligament(s) with severe swelling and bruising. The ankle is unstable and walking is likely not possible because the ankle gives out and there is intense pain.

A physician can diagnose a sprained ankle. X-rays are sometimes needed to rule out a broken bone in the ankle or foot. Broken bones can have similar symptoms of pain and swelling. If there is no broken bone, your physician will be able to tell you the grade of the ankle sprain based upon the amount of swelling, pain and bruising.

Depending on the grade of injury, the following rehabilitation steps are suggested.

• Grade 1: Use R.I.C.E. (rest, ice, compression and elevation). Ice should be applied immediately to help keep swelling down for 20-30 minutes up to four times daily. The ankle should be elevated above the chest for 48 hours. Rest your ankle and try not to walk on it. Use compression dressings and wraps to immobilize and support the ankle.
• Grade 2: Utilize the R.I.C.E. guidelines and allow more time for healing to occur. An immobilization device or splint is also recommended.
• Grade 3: Permanent instability can occur with a grade three sprain. A cast or a brace may be required for a couple weeks. Anti-inflammatory drugs like ibuprofen can be used to control pain and inflammation with a sprain. Surgery may be considered in younger, athletically active patients.

If an ankle sprain isn’t treated with the necessary attention and care, chronic problems of pain and instability can result. The best way to prevent ankle sprains is to maintain good strength, muscle balance and flexibility. Here are some additional prevention steps:

• Wear good shoes
• Warm up before doing exercises and vigorous activities
• Pay attention to surfaces on which you run and walk
• Reinforce the foot and ankle’s stability with a brace if needed
• Pay attention to the body’s warning signs to slow down when you feel fatigue or pain.

Ankle Sprains: High vs. Low

The ankle is one of the most complex and heavily used joints in the entire body, as a result there are an estimated 25,000 ankle injuries each day in the US alone. Chances are that you or somebody you know has suffered an ankle sprain but not all sprains are alike. Depending on where the injury is located, both low and high ankle sprains are possible.

High Ankle Injury

Known medically as a syndesmotic ankle injury, high ankle injuries occur when the foot and ankle rotate together, stretching the tissues that hold the tibia and fibula together. High ankle injuries get their name from occurring above the ankle joint itself and generally require a longer rehabilitation period to fully recover compared to a low ankle injury.

Low Ankle Injury

A low ankle injury is what most people think of when they picture the classic ankle sprain. The most common low ankle injury is called an inversion ankle sprain.  This occurs when the ankle rolls inwards, stretching the connecting tissue within the ankle joint. Eighty percent of all low ankle injuries are inversion sprains, with the remainder being eversion sprains. An eversion ankle sprain occurs when the ankle rolls outward.

Recovery

If you’ve suffered from an ankle injury, it is crucial to see a foot and ankle doctor who will build a treatment plan that suits your unique injury.

After your sprain has healed, your physician may recommend an icing regimen, additional rehabilitation exercises, or the use of an ankle brace as a means of preventing future injuries. Each time an ankle sprain happens, the affected ligaments loosen, increasing the odds of a subsequent injury.

If you’ve suffered from an ankle sprain, our team of foot and ankle physicians can help you on the road to recovery. Request an appointment online, or call us at 904-825-0540 today.

 

KURTIS HORT, MD
Diplomate of the American Board of Orthopaedic Surgery and a member of the American Orthopaedic Foot and Ankle Society.

Ankle fractures – operations and treatment in Moscow, prices on the website of the GVKG im. N.N. Burdenko

October 16, 2021

Ambulance Yulia Vasilievna

These people give us back the joy of being, allowing us to be happy again. They are professional, hardworking, disinterested and modest, with honor they carry the title of “Man in a White Coat” through life. Noli nocere! Words of gratitude: Head of the 3rd Department of Emergency Traumatology, GVKG them. ac. N.N.Burdenko Kerimov Artur Aslanovich, attending physician Igor Vladimirovich Khominets, anesthesiologist Pankratova Ksenia Yurievna and all middle and junior medical personnel of the department.In this profession, there are no random people, only the real, the most … Often dynasties remain in it. Thank you very much and bow for your hard and noble work. You are my precious people, Those who were, who are and who will be, Grace from heaven I pray And I say thank you for everything. Healed Ambulance Yu.V., wife of a reserve colonel. October 2021

10 October 2021

Volkova Svetlana Yurievna

I consulted Daria Aleksandrovna Naida in October 2018, about pain in the knee, after the surgeon’s verdict in the district clinic that I was disabled, the joint was destroyed, my activity was over.According to the results of Daria Alexandrovna’s consultation: 1. The knee was operated on (arthroscopy of the knee meniscus) – successfully. 2. Rehabilitation is successful. 3. My activity has been restored! (Alpine skiing, mountain bike (enduro) – Successful! Many thanks for the professionalism, for “immersion in the patient’s life” and for your understanding, for your attentive attitude! Doctor from God! I recommend!

16 August 2021

Alexey Korabtsev

I want to express my gratitude to the medical specialists of the 3 emergency trauma department, for their treatment, attention, good attitude and understanding.For telling me about each stage of treatment and our further joint actions to restore my health. Thank you so much for your attention, care, understanding. They will always support you with a kind word, and will tell you what to do and how, with all the professionalism they do their job, and at the same time they will always cheer you up and cheer! Head of the department, Artur Arslanovich Kerimov, traumatologist Boris Vladimirovich Tyulkevich, I would like to express special gratitude to the attending physician, traumatologist Evgeny Anatolyevich Kukushko for the excellent operation.As well as medical brothers: Lapin Oleg Igorevich, Yumashev Nikita Vladimirovich; to nurses Marina Vasilievna fornication, Oksana Mukha. Junior staff: Elena Anatolyevna Balashova, Elena Leonidovna Sablina. Sister hostess Ishutina Nadezhda Leonidovna, senior nurse Shushpannikova Oksana Sergeevna, dressing honey. brother Shelikhov Daniil Dmitrievich. Thank you very much for returning us to normal life. Health to you!

16 August 2021

Korabtsev Alexey Viktorovich

Was in the 3rd trauma emergency department.I want to express my deep gratitude for the treatment, attention, good attitude and understanding, sensitivity, professionalism, humanity in relation to patients. For the fact that they talked about each stage of treatment and further joint actions to restore my health. I would like to express my special gratitude to the department staff: head of the department Kerimov Artur Apslanovich, traumatologist Tyulkevich Boris Vladimirovich, medical brothers: Lapin Oleg Igorevich, Yumashev Nikita Vladimirovich, med. sisters: The Prodigal Marina Vasilievna, Musa Oksana.Junior staff: Balashova Elena Anatolyevna, Sablina Elena Leonidovna, sister hostess: Ishutina Nadezhda Leonidovna, senior honey. sister Shushpannikova Oksana Sergeevna, dressing honey. brother Shelikhov Daniil Dmitrievich. I would especially like to express my gratitude to the attending physician Evgeny Anatolyevich Kukushko. On July 15, 2021, I once again ended up in the 3rd department of the Burdenko hospital. Evgeny Anatolyevich was my attending physician. From the first meeting with him, I felt trust in him. He listened to me very attentively, carefully studied the materials, and approached the preparation of the operation professionally.On July 22, he underwent a complex operation to REMOVE METAL STRUCTURES FROM THE LEFT HIM BONE, EXCUTE SCARS, CORRECTING OSTEOTOMY AT THE HEIGHT OF DEFORMATION. The operation took about six hours. After the operating period went well. Now I’m on the mend. Remembering and strictly adhering to the advice of Evgeny Anatolyevich. Dear honey. staff of 3 departments! Thank you very much for your work in bringing us back to normal life.

06 August 2021

Moiseenko Vladimir Alekseevich

Good afternoon. On September 9, 2020, I underwent surgery on my right shoulder joint. I want to express my deep gratitude to the entire team of the 3 traumatology department (emergency). You are real professionals, God grant you health and long life, so that you can help people and return them to a normal, fulfilling life. Thanks to you, I feel great, I am fully engaged in sports, my hand works in full force.Words cannot convey what you feel. Very, very grateful to everyone.

28 June 2021

Urazbiev Sulumbek Saidievich

Thank you very much for your help. A very good and helpful doctor. I am very pleased with the performed operation. I hope that with the second joint I will get to your hospital.

May 13, 2021

Gorshenev Sergey Alexandrovich

Was consulted by Darya Alexandrovna and then operated on with her for a chronic injury.Everything went great, I didn’t even expect it! The doctor did not formally, but scrupulously and thoroughly studied my problem, suggested a treatment plan, performed the operation with high quality and continues to advise me throughout the rehabilitation period. Along with modern medical equipment, I was impressed by the professionalism and well-coordinated work of the entire medical team of the traumatology department. Low bow to everyone who heals people!

13 May 2021

Sergey Alexandrovich Gorshenev

Was consulted by Daria Alexandrovna Naida and then operated on with her for a chronic injury.Everything went fine, I didn’t even expect it. The doctor did not formally, but scrupulously and thoroughly studied my problem, suggested a treatment plan, performed a high-quality operation, and consulted at the stage of rehabilitation. I was impressed by the professionalism and coordination of the work of the entire medical team of the Department of Traumatology. Low bow!

May 11, 2021

Lyubov Vladimirovna Kondratyeva

I express my deep gratitude to the attending physician Daria Alexandrovna Nayda and the entire team of the center of traumatology and orthopedics for their high professionalism, responsibility and dedication to their work.I myself am a doctor, I came for treatment from Yekaterinburg. On the very first day, a diagnosis was made (different from the guided one), the next day I successfully operated on, at all stages I felt the attention, care and well-done work of the whole team. Low bow to you, be healthy and happy!

01 May 2021

Vyvolokina Olga Stalyevna

Operated twice in the hospital with the attending physician Boris Vladimirovich Tyulkevich. Thank you so much for your professionalism, sensitivity and responsiveness.I would also like to express my gratitude to all the medical staff of the 3rd trauma department.

90,000 Healed her leg and was able to travel to the country: the difficult case of the patient

On the eve of the summer season, it is important to be more attentive to your health and not to ignore the alarm bells of the body. We continue our rubric, in which we tell you how to stay healthy and in what cases it is better not to delay going to the doctor.

By Arthur Glumakov, orthopedic surgeon of the Open Clinic on Prospekt Mira:

“Some injuries have long-term consequences.And behind others lie completely different diagnoses, which even an experienced doctor is not always capable of suspecting. As happened with my 40-year-old patient, whose ankle injury that worried her for a long time became a signal of a completely different pathology.

A 40-year-old woman complained of pain in the ankle joint, external edema and movement restrictions. She was very worried about this, and indeed, she was overly emotional and even whiny.

When taking an anamnesis, I found out that in 2018, two years before the visit to me, a woman had a two-ankle fracture of the ankle.She fell and twisted her leg. Fracture of both ankles on one ankle is a fairly common occurrence when the foot is twisted – soft tissues “pull” the bones behind them, and ligaments are torn off. Football players often face such injuries. On this occasion, the lady was given an open reposition and a metal structure was installed.

It looks like this: a plate is installed on one of the ankles and a dynamic screw is passed parallel through both ankles to fix them in one position in order to maintain the support of the leg.Usually, three months after such a reduction, the patient walks in an orthosis or a soft cast, and about a year later, when the bones finally grow together, the metal structure (plate and screw) is removed in the operating room. This is followed by rehabilitation measures.

Photo: Natalia Gubernatorova

This was exactly the case for this woman – a year later she underwent an operation to remove the metal structure, and she lived an ordinary life. It should be noted that her work is active, involving many movements.And this activity is optimal for the joint.

However, in 2020, a pandemic began, and many of us went home. The patient I am talking about was also transferred to a remote location: she started working from home, and her activity dropped sharply. If earlier she took 10-11 thousand steps a day, then she “wound up” only 3-4 thousand in a pandemic. The load on the joints of the lower extremities was greatly reduced, which was highly discouraged in her situation. Another important point: this woman is overweight, and the weight puts additional stress on the joints.

As a result, after a while, she began to be bothered by a aching feeling in the joint, and in the evening she developed a slight transient edema. Like many in such situations, she smeared her leg with heparin and anti-inflammatory ointment, but since the place did not hurt much, she did not pay much attention to it.

At the beginning of the summer, she moved with her parents to a dacha, and there her activity began to slowly recover. She worked in the garden, she had to move a lot. However, it was at this time that the woman began to notice that her pain had become permanent.It was already soreness, and not an aching feeling of discomfort. The pain increased when climbing stairs. In addition, there was a pronounced swelling in the ankle joint, which was accompanied by noticeable redness.

However, the dacha with her eternal concerns did not let go, and the woman put off the visit to the doctor. In addition, there was simply no medical facility nearby to go to. Therefore, the patient tried to protect her leg, continued “therapy” with her ointments and waited for everything to go away by itself.However, with each passing day, things only got worse. As a result, she came to me only in September with already very pronounced complaints. During the appointment, she cried almost every five minutes, and I calmed her down for a long time, because I realized that the problem was not so difficult, but she was very worn out.

Primary approaches to diagnosis in such cases are standard: first, an ultrasound scan of the joints is prescribed, which makes it possible to assess the presence of fluid, wear and the condition of the ligamentous apparatus (the latter is extremely important, because there are about forty bones on the foot and between each of them there are two or three ligaments) …Ultrasound showed a violation of the ligamentous apparatus on the external and external ankle, where there was pronounced swelling. But X-ray under load revealed a picture of pronounced arthrosis, which, of course, occurs in patients after ankle surgery, especially with a decrease in activity. But! In this situation, I was very embarrassed that the patient was only forty years old – usually at such an early age, the phenomena of arthrosis are not observed. In such situations, I send a person for a blood test to assess the rheumatoid factor – and it turned out to be elevated.And this is a reason to immediately go to a rheumatologist. After all, if the patient’s history is complicated by a rheumatological diagnosis, no matter how much you treat him, you will not be cured until the main problem is solved. According to statistics, I refer about 2 patients out of 10.

to a rheumatologist.

Photo: Natalia Gubernatorova

A rheumatologist diagnosed rheumatoid arthritis, an autoimmune disease that requires anti-inflammatory therapy. Most likely, it was the reason for the deterioration of this woman’s condition.On the other hand, the disease until that time had proceeded secretly, however, changes in the load on the joints against the background of excess weight provoked its exacerbation, which made it possible to diagnose it at a fairly early stage.

For three weeks, the patient underwent a course prescribed by a rheumatologist to bring down acute inflammation, and then she was prescribed lifelong maintenance therapy. When blood tests showed that the inflammation was gone, we began to symptomatically treat arthrosis and arthritis. I picked up compresses and an ankle bandage for her and prescribed medications to relieve the swelling.Then she underwent physiotherapy, received an intra-articular injection of hyaluronic acid and finally achieved remission. Finally, after two years of agony, she noticed positive changes in her health and calmed down.

The woman is now under my supervision. Now she is engaged in parallel with her weight in order to relieve unnecessary stress on the joints. And soon he will go to the dacha again. And now she knows: if something starts to bother her, she will not drag out a visit to the doctor. “

Read the following material with doctor’s advice on Monday 19 April. If you want to ask a question to the doctor, then we are waiting for your letters to the e-mail address of the editorial office [email protected].

90,000 Injuries to the legs (ankles, feet, toes)!

1. Injuries to the legs

Nearly all people have minor injuries to their toes, feet, or ankles at one time or another that cause pain or swelling.

Injuries to the ankle, feet or toes are most likely to occur during:

• Sports or outdoor activities;
• In the process of work related to physical activity;
• During homework.

In children, injuries to the legs , feet, ankles most often occur during falls or playing sports. Leg injuries are common in sports such as jumping, playing football or basketball, which require faster and more drastic changes in direction.Foot injuries in children require special attention, as injuries to the bones near the joints can affect physical development as the child grows.

The risk of leg fractures, ankle and foot injuries is increased in the elderly . Natural aging weakens bone strength and muscle mass is lost. The risk of injury is also increased by loss of vision and the ability to maintain balance.

Most minor foot injuries in the ankle, feet, or toes are not serious and will heal on their own.And treating the injury at home can help relieve leg pain and other unpleasant symptoms until they go away.

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2. Acute leg injuries

Severe injury and trauma to the leg may result from a direct impact, penetrating injury or fall, and twisting, jerking, getting stuck or abnormally bending limbs.The pain in the leg in this case can be severe and sharp. Bruising and swelling may appear soon after injury. Acute leg injury can be different:

• Bruises (contusions) . After an ankle injury, the bruising can spread to the toes due to the effects of gravity.
• Puncture wounds. Puncture wounds in the legs can be from sharp objects – nails, buttons, knives, needles, animal teeth. A puncture wound in the leg increases the risk of infection because it is difficult to clean and the wound provides warmth and high humidity – conditions favorable for the growth of bacteria.One of the most common infections is a foot wound, when the puncture occurs through the sole of the shoe.
• Injuries to ligaments, supporting joints;
• Injuries to tendons, the most common of which is rupture of the Achilles tendon;
• Joint injuries, joint dislocations;
• Muscle stretching. The muscles in the foot and ankle may hurt from sprains. Severe stretching can rupture the muscles;
• Bone fractures. Most often a toe or ankle fracture;
• Bone dislocation , dislocation – a condition when a bone is displaced from its normal location in relation to other bones. It can occur in the joints of the kneecap, hip, toe, elbow, or shoulder;
• Severe trauma , leading to constriction syndrome.

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3.Overworking injuries

Trauma to the legs, ankle, foot or toe injury can occur not only due to sudden exposure to some factors, but also when some activity is repeated too often and for a long time. Overwork injuries can be as follows:

• Bursitis – inflammation of the bursa (mucous bag in the joint area). Bursitis causes swelling and tenderness in the back of the heel and ankle. The pain usually gets worse when you wear shoes or put your feet in some kind of physical activity.And during rest, the pain decreases.
• Tendonitis of the Achilles tendon (tendopathy) is an inflammation of the tissues in the area of ​​the Achilles tendon, which connects the calf muscles and the calcaneus;
• Microcracks in the bone;
• Plantar Fasciitis – Inflammation of the plantar fascia, the broad flat ligament on the bottom of the foot that runs from the front of the heel to the base of the toes and helps support the arch of the foot;
• Metatarsalgia – pain in the foot in the front of it (metatarsal part of the foot).

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4. Treatment of injuries of the foot, injuries of the ankle, foot and toes

Treatment for a toe, foot or ankle injury depends on several factors – the location, type and severity of the injury; the general state of human health and the type of his activity; time of injury.

First aid for a leg injury (foot, ankle, toe) may include a splint or brace. Subsequently, you may need to wear special orthopedic shoes, physical therapy, medication, and in some cases, surgery.

90,000 Do running shoes reduce the risk of injury?

• Claudia Hammond
• BBC Future

November 14, 2014

Photo by Thinkstock

Traders in sports stores tell us that running shoes with good cushioning and a slightly raised heel help prevent injury.But is it really so? Correspondent

BBC Future found that there is almost no definitive evidence.

If you – like me – run regularly and have special trainers for this, then the joy of buying each new pair can be overshadowed by the need to run in full view of the store along the track while the sales assistant analyzes your running style. My style is probably described by the phrase “lack of technique and coordination”, but the consultant does not give marks for artistry.It evaluates your pronation, which is how your foot turns when landing and taking off. I am considered to be a moderately hyper-pronator (my foot rotates from outside to inside) and I need a shoe of the correct design to avoid injury. But are hyper-pronated runners really at greater risk? And if so, how can you deal with it?

Most runners land on the outside of the heel. As their foot makes contact with the ground, it twists slightly.It is a natural load distribution mechanism that protects bones, ligaments and joints from excessively hard impacts during impact. This is especially true for people who do not have a very pronounced arch of the foot.

Over the past forty years, athletic shoe manufacturers have been constantly improving the design of sneakers, claiming that their developments help runners who do not have ideal cushioning of the foot due to hyperpronation (less often – hypopronation, when the foot is turned from the inside out). The shoe is thought to help flatten the foot, stabilize it, and reduce shock loads, with a shock-absorbing landing and heel lift.

Photo Credit, Thinkstock

Photo Caption,

Treadmill testing does not always help to choose the right shoes

In June, scientists from Singapore published a meta-analysis of 29 previous studies on how foot type relates to injury risk. They found that people with hyper- or hypopronation were 23% more likely to develop injuries to their feet, ankles, knees, and hips. One of the reasons why research in this area is so controversial is that different experts define and measure pronation differently.Scientists from Singapore have calculated that trauma is associated with hyper- and hypopronation, identified both visually and using a special diagnostic technique that evaluates six different parameters of foot movement.

But the authors emphasize that the type of foot alone is not a significant factor in injury. In other words, only a small number of injuries occur directly from it. Between 37 and 56% of recreational runners are injured each year, mostly not from falls and accidents, but from repetitive stress.

Do specialized footwear save you from injuries? The data on this topic is so fragmentary that some critics consider such statements to be empty words. In 2009, Craig Richards of Newcastle University in Australia scoured the scientific literature for evidence of the benefits of raised heel cushioning sneakers and other devices designed to help hyper-pronators. To his surprise, he hardly found even general evidence of the harm of running on a hard surface.Richards also found no randomized clinical trials on the benefits of raised heel soles or scientific journal articles that looked at the effects of shoes on injury risk, performance, or comfort in long-distance running.

Photo author, Thinkstock

Photo caption,

Press? Or maybe you just need different sneakers?

Richards and his co-authors concluded that for more than 20 years now we have proposed a generally accepted solution, the effectiveness of which has not been proven in any way – and this despite the fact that the absence of such evidence has already been stated by several recognized experts in this field.Scientists did not blame physical therapists, trainers or sales consultants from running stores – they rather blamed athletic shoe designers for not doing proper research to support their designs.

Scientists have continued to study this issue. In 2010, US Army specialists conducted a study involving 1,600 Marine Corps recruits. Half of them were given sneakers that, in theory, matched their foot type and were supposed to protect them from injury.Soldiers with a low arch of the foot were given shoes that actively reduce pronation; those with normal arches were given “stabilizing” shoes with an average level of resistance to pronation; and recruits with a high arch of the foot just got shock-absorbing shoes. The other half of the subjects received stabilizing sneakers. After 12 weeks of training, it turned out that the special shoes had no effect on the number of injuries.

In 2011, there was even a study that claimed that runners with pronation-reducing shoes were more likely to sit at home with injuries.True, only 12 hyperpronators participated in this experiment.

Convenience is the main thing?

This past summer, controversy flared up with renewed vigor – a large-scale study was published in which novice runners took part. Through advertisements in Danish newspapers and gyms, 927 subjects were recruited between the ages of 18 and 65. They were each assessed for pronation, and then all were given the same lightweight shoe with no extra cushioning or raised heels.In fact, many of them were given shoes that store consultants and other professionals would find unsuitable.

During the year, the subjects ran as much as they saw fit, and in total they ran almost 327 thousand kilometers. A quarter of them were injured, but the type of foot did not have any effect on the frequency of injury. Among those who ran 20 kilometers or more per week, hyper-pronators were injured even less often than others.

Based on the results of this study, it can be concluded that the frequency of injuries sustained in conventional sneakers does not depend on the type of foot.However, what would happen if hyper-pronators were wearing shoes of the appropriate design? It cannot be ruled out that they could have had even fewer injuries. In addition, those who, at the time of the start, were already running in special shoes, were not allowed to participate in the study. Perhaps these runners are the most prone to injury and are helped by their running shoes to avoid damage.

Photo author, Thinkstock

Photo caption,

If you run and do not get injured, then you have the right running shoes!

So, what should an amateur runner do if neither the benefits nor the harm from special running shoes has been proven? Some people abandon high-tech shoes altogether, the fashion is spreading to run in sneakers with very thin soles or even barefoot.I myself have tried running without shoes, and it gives a feeling of freedom. But this is unlikely to become my habit: I mostly run on the wet and dirty London sidewalks, and not on the sun-drenched beaches. Experts have tried to figure out how barefoot running affects the landing angle of the foot, but again, there has been no serious research on this topic, and we do not know if the absence of shoes helps to avoid injury.

The author of the Danish study described above, Rasmus Nielsen of Aarus University, says that clinical professionals should focus on training schedules, lengths, durations and intensity, rather than the choice of footwear.

And Benno Nigg of the Human Opportunity Laboratory at the University of Calgary, Canada, believes that if your shoes are comfortable for you, they are less traumatic. A group of scientists under his leadership gave the soldiers a choice of insoles of one of six types – different thickness, elasticity and shape. The subjects were asked to keep a trauma diary for the next four months. It turned out that whichever insoles they chose, they had fewer injuries than the control group, which ran in regular shoes. The insoles chosen by different runners varied greatly in cushioning properties, so it seemed it was not a question of cushioning, but of comfort.

Craig Richards has this advice for long distance runners: The ideal type of shoe has not been established, but for those who are running and not getting injured, it is better not to change the type of shoe. It’s worth looking for a new model only if it hurts to run. Well, for those who are just starting to run, it seems that you need to try on many different sneakers and choose the most comfortable ones.

Legal information. This article is for general information only and should not be construed as a substitute for the advice of a physician or other healthcare professional.The BBC is not responsible for any diagnosis made by the reader based on the materials of the site. The BBC is not responsible for the content of other sites linked to on this page, nor does it recommend commercial products or services mentioned on these sites. If you are concerned about your health condition, see your doctor.

Practical aspects of risk management. Injury risk curve for assessing passenger protection in a frontal collision – RTS-tender

GOST R 55234.1-2012 / ISO / TR 7861: 2003

Group E65

NATIONAL STANDARD OF THE RUSSIAN FEDERATION

OKS 43.020

Date of introduction 2013-12-01

Foreword

1 diagnostics of technical systems “(ANO” NITs KD “) on the basis of its own authentic translation into Russian of the international document specified in clause 4

2 INTRODUCED by the Technical Committee for Standardization TC 10″ Risk Management “

Agency for Technical Regulation and Metrology of November 29, 2012N 1271-st

4 This standard is identical to the international document ISO / TR 7876: 2003 * “Road vehicles. Trauma risk curve for assessing passenger protection in a frontal collision” (ISO / TR 7876: 2003 “Road vehicles – Injury risk curves for evaluation of occupant protection in frontal impact “).

________________

* Access to international and foreign documents mentioned in the text can be obtained by contacting the User Support Service.- Note from the manufacturer of the database.

The name of this standard has been changed from the name of the specified international document to bring it in line with GOST R 1.5 (subsection 3.5).

When applying this standard, it is recommended to use, instead of the reference international standards, the corresponding national standards of the Russian Federation, information about which is given in the additional appendix YES

5 INTRODUCED FOR THE FIRST TIME

Rules for the application of this standard are established in GOST R 1.0-2012 (section 8). Information on changes to this standard is published in the annual (as of January 1 of the current year) information index “National Standards”, and the official text of changes and amendments is published in the monthly index “National Standards”. In case of revision (replacement) or cancellation of this standard, the corresponding notice will be published in the next issue of the monthly information index “National Standards”. Relevant information, notice and texts are also posted in the public information system – on the official website of the Federal Agency for Technical Regulation and Metrology on the Internet (gost.ru)

Many researchers have proposed the use of injury risk curves to simulate hazardous situations, based on published biomechanical data. The risk curves provided in this standard can be used by regulatory authorities as well as by vehicle manufacturers to determine occupant protection levels based on the acceptable risk of injury in a frontal collision. This standard does not set precise limits for the values ​​of such risk, as it is the responsibility of the regulatory authorities to determine the levels of risk.

The international document used in this standard was developed by the technical committee ISO / TC 22, Road transport.

This standard provides injury risk curves that can be used to assess the risk of injury as part of an assessment of passenger protection in a frontal collision. Measurements were carried out in a frontal crash test simulation using human exposure dummies with an acceptable level of biological accuracy in accordance with ISO / TR 12349-1 and ISO / TR 12349-2 used in frontal crash simulation procedures.

_______________

Crash test is an impact test in a frontal collision of a vehicle.

This standard uses normative references to the following documents *:

_______________

* The table of conformity of national standards to international ones see the link. – Note from the manufacturer of the database.

ISO / TR 12349-1 Road vehicles. Seat belt test dummies. Part 1.Adult dummies (ISO / TR 12349-1, Road vehicles – Dummies for restraint system testing – Part 1: Adult dummies)

ISO / TR 12349-2 Road vehicles. Seat belt test dummies. Part 2. Child dummies (ISO / TR 12439-2, Road vehicles – Dummies for restraint system testing – Part 2: Child dummies)

3.1 General

All trauma risk curves given in Appendix A are shown in in the form of graphs on normal probabilistic paper.The graph shows the mean (indicated by the dash above the parameter) and standard deviation for each risk curve.

3.2 Head Injury Risk Curve

Appendix A provides three curves for the risk of a human head injury from a frontal collision of a vehicle. The rationale for using these curves is given in [1], [2] and [3]. The risk curves for a skull base fracture as a function of the HIC criterion with a 15 ms impact duration and maximum acceleration of the head center of gravity are shown in Figures A.1 and A.2. A traumatic brain injury risk curve for AIS4 as a function of HIC at 15 ms stroke duration is shown in Figure A.3.

_______________

HIC is the Head Injury Criteria, a criterion for the severity of head injuries that characterizes the risk of injury to the head of the driver and passenger. HIC is the maximum integral of the deceleration in the hazardous area, taken over a segment not exceeding 36 ms.

Impact duration.

AIS (abbreviated injury scale) – Based on an abbreviated injury scale, a score developed by the Association for the Advancement of Automotive Medicine (AAAM).

3 9038 9000

904

2

3 9038 9038 9038

93 9038 9038 9038 9038 9038

AIS value	Damage severity
0	no damage
moderate (moderate)
3	serious (worrisome)
4
4
threatening (critical)
6	maximum (lethal)
9	NFS it is impossible to establish the severity of damage …3 Neck Injury Risk Curve Appendix A shows three normalized neck injury risk curves for AIS 3, based on measurements of the cervical condyles condition under tension and / or tension of neck muscles on dummies of the CRABI and Hybrid III families. These curves are derived from the data given in [4], [5] and show the variability of the breaking neck tension as a function of the driver’s age [5]. Figures A.4, A.5 and A.6 show the risk curves for maximum (peak) normalized neck tension, maximum normalized neck tension torque and combined maximum neck tension and torque.Normalized values ​​for various sizes of dummies are given in the descriptions of the graphs and correspond to a neck injury risk of 3%, 5% and 2% for AIS 3 with minimal passive muscle tension. These standardized values ​​are the limit values ​​for airbag testing, the methods of which are specified in Ref. [20]. Curves can also be used to assess the risk of injury at different levels of perceived muscle tension. For this, the following evaluation procedure is applied: a) Determine the maximum value of each normalized function based on the test data; b) calculate on the basis of these values ​​the values ​​of the expected load on the muscles: 1) normalized neck tension , 2) normalized neck tension force , 3) combined indicator of normalized neck tension and torque , where, – the maximum tension and torque of the neck tension force due to the pre-tension of the neck muscles; – the assumed coefficient of the maximum passive tension of the neck muscles from the interval 01. These differences are used to assess the risk of damage from the curves shown in Figures A.4, A.5 and A.6. A method for assessing the maximum values ​​of stress and tensile force moment at different levels of pretensioning of the neck muscles for different sizes of dummies, based on statistical test data, is given in [5]. The corresponding stress and tensile torque values ​​are given in Table A.1. There is no test data on CRABI infant dummies because the infant cannot be aware of a collision threat. 3.4 Chest Injury Risk Curve 3.4.1 General There are two types of chest loads for which the risk curves have been constructed: lack of airbags; b) distributed chest load with airbags and no seat belts. 3.4.2 The load caused by the use of seat belts According to [6], there is a correlation between the results of observations of real accidents, in which the chest was injured, when using three-point seat belts, and the values ​​of the pressure on the chest, obtained during tests on dummies type Hybrid III, when using restrained seat belts when simulating emergency situations. These data were used to construct the AIS 3 seat belt pressure risk curve for chest injury shown in Figure A.7 as a function of the thorax deformation of the Hybrid III manikin. This risk curve can be used in situations where the body is constrained by the shoulder harness, even if the general safety system includes an airbag. It should be borne in mind that the results of observations of real accidents were not normalized for the size of people, and therefore, when applying the curve, the estimate of the risk of injury for the 50th percentile of adult males at a low level of risk is overestimated. In [7], the results of a study of the correlation between the results of observations of real accidents, in which the chest were injured, of people limited by three-point seat belts and loads of restraining seat belts, head airbags and conventional seat belts, are presented in [7].Figure A.8 shows the chest injury risk curve for AIS 3 as a function of the maximum seat belt pressure. For this curve to be applied, the prerequisite is for the seat belt geometry to match the geometry of the seat belts used in the model test. 3.4.3 Distributed load Figure A.9 shows the chest injury risk curve from distributed chest pressure for AIS 3. Normalized values ​​corresponding to 5% risk are given in the risk curve description.The graph does not show the chest injury risk curves for AIS 3 for children. This is due to the fact that the child’s low elasticity limit during bending of the ribs allows the child to withstand large deformations of the chest without breaking the ribs, which is the predominant type of chest injury in impact due to a frontal collision. Chest injury corresponds to AIS = 3. Figure A.10 shows the chest injury risk curve described in Ref. [4] for AIS 4 with distributed chest loading, for example with airbags.The risk curve is given as a function of the normalized chest deformity. Normalized values ​​corresponding to 5% risk for different types of dummies are shown in Figure A.10. The AIS 4 heart and / or lung injury risk curve as a function of the maximum chest compression rate described in Ref. [4] is shown in Figure A.11. Such a curve can be applied to dummies of all sizes, since the internal stress level of an organ depends only on the intensity of chest compression, and not on the size of the person. In accordance with [8], trauma to the heart and / or lung of a person can be obtained as the product of the indices of the intensity of compression and the normalized deformation of the chest: compression criterion. Figure A.12 shows the heart and / or lung injury risk curve for AIS 4 as a function of the compression criterion. Standardized values ​​are not given for CRABI dummies because these dummies are not equipped with sensors to measure chest compression. When using the compression criterion, it must be borne in mind that instruments and sensors used for processing biomechanical data, as a rule, do not have sufficient reproducibility, therefore, measurements should be performed in real conditions to obtain values ​​with the required accuracy. 3.5 Risk curves of lower extremity fracture 3.5.1 Hip fracture To assess the impact of a knee blow by a person in a frontal collision, data from studies of the bodies of those killed in a car accident were analyzed [10, 11, 12, 13, 14, 15 , 16]. On the basis of the Merz-Weber method [17], a curve of the risk of hip fracture was obtained as a function of axial compression during knee impact, shown in Figure A.13. 3.5.2 Fractures of the tibial axis Three-point bending tests of 16 samples of intact male tibia are described in [18].Analysis of the median [19] of the maximum bending moment at fracture allowed us to construct a risk curve for fracture of the tibial axis, shown in Figure A.14. 3.5.3 Ankle / foot fractures [19] describes impact tests on the lower limbs of 50 fatalities, which resulted in fractures of the calcaneus, talus and ankle, as well as rupture of the ligaments. The data were analyzed using the Merz-Weber method [17] and the risk curve for ankle and / or foot fractures was plotted as a function of the axial compression force of the tibia, shown in Figure A.15. Appendix A (mandatory) Figure A.1 – Risk of fracture of the skull base for AIS 2, as a function of HIC with a 15 ms impact duration Figure A.2 – Risk of fracture of the base of the skull for AIS 2 as a function of the maximum acceleration of the center of gravity of the head Figure A.3 – Risk of craniocerebral injury for AIS 4, as a function of HIC with a 15 ms impact duration 9012 9012 9038 Hybrid III – Small woman Figure A.4 – Risk of neck injury for AIS 3 CRABI and Hybrid III dummies as a function of the maximum normalized neck tension Dummy 9395 (H) CRABI – 12 months 780 Hybrid III – 3 years 1130 Hybrid III – Hybrid III – Hybrid III – Hybrid III – Hybrid III – Hybrid III – 2070 Hybrid III – Medium man 3290 Hybrid III – Large man 95 Dummy (9387 (9387 m) CRABI – Infants up to 12 months 11 Hybrid III – 3 years 17 9000 Hybrid III – Small woman 39 Hybrid III – Medium man 77 Hybrid Hybrid8 – Large Figure A.5 – Risk of neck injury for AIS 3 CRABI and Hybrid III dummies as a function of the maximum normalized neck tension torque Dummy ( ) (Nm) CRABI – Infants under 12 months 1470 17.0 – 30006 Hybrid III 26.8 Hybrid III – 6 years old 2820 38.4 Hybrid5 III8 – Small woman 9000 61.2 Hybrid III – Average Male 6200 122 Hybrid III – Large man 7480 162 Figure 6 – Risk of neck injury for AIS 3 CRABI and Hybrid III dummies as a function of the sum of the maximum rated stress and maximum rated torque for the neck Figure A.7 – Risk of chest injury due to seat belt pressure for AIS 3 as a function of the maximum chest deformation of the Hybrid III dummy Figure A.8 – Risk of injury to the chest for AIS 3 as a function of the maximum seat belt pressure 9038 III Small woman 52.9390 Dummy (mm) 39.0 Hybrid III – Average man 47.7 Hybrid III – Large man Figure A.9 – Risk of chest injury from distributed chest pressure for AIS 3 as a function of the maximum normalized chest deformity Dummy 9000 ( 9000 9000 CRABI – Infants under 12 months 31.2 Hybrid III – 3 years 35.8 9000 39.7 Hybrid III – Small woman 52.5 Hybrid III – Medium man 64.3 64.3 Hybrid III – Big Man 71.2 Figure A.10 – Risk of chest injury from distributed chest load for AIS 4 as a function of maximum normalized chest deformity 8000 904 87 Figure A.11 – Risk of heart and lung injury for AIS 4 as a function of maximum chest compression Dummy s) CRABI – Infants up to 12 months 7.6 Hybrid III – 3 years 8.0 6 0 III years 8.5 Hybrid III – Small woman 8.2 Hybrid III – Average man Hybrid III – Large Man 8.2 9000 – 3 years old Dummy (mm) 122 Hybrid III – 6 years old 143 Hybrid III – Little woman 18000 III – Medium man 229 Hybrid III – Large man 254 Figure A.12 – Risk of heart and lung injury for AIS 4 as a function of the compression criterion Figure A.13 – Risk of hip fracture as a function of axial compression on knee impact with maximum force Figure A.14 – Risk of tibial axis fracture as a function of the maximum bending moment of the tibia axis at fracture Figure A.15 – Risk of fracture of the ankle and / or foot bones as a function of the axial compression force of the tibia Table A.1 – Maximum passive muscle tension 90 – 9038 90 – 9038 9038 9385 90 – 9038 CRABI – Infants under 12 months 3 Dummy Maximum passive muscle tension Tension, N Tensile torque, Nm CRABI – Infants up to 6 months – – CRABI – Infants up to 18 months – 3 – 9000 Child 3 years old 378 5.2 9 0005 Hybrid III – Child 6 years old 500 7.4 Hybrid III – Small woman 693 9000 9000 Hybrid III – Middle Man 1100 23.7 Hybrid III – Big Man 313 Appendix YES (reference) Table YES.1 Designation of the referenced international standard Degree of conformity Designation and designation of the relevant national standard ISO – * ISO / TR 12349-2: 1999 – * * RelevantPrior to its approval, it is recommended to use the Russian translation of this International Standard. The translation of this international standard is in the Federal Information Fund for Technical Regulations and Standards. [ [1] Prasad, P. and Mertz, HJ, The Position of the United States Delegates to the ISO Working Group 6 on the Use of HIC in the Automotive Environment , SAE 851246, 1985 [2] Mertz, H.J., Prasad, P. and Nusholtz, G., Head Injury Risk Assessment for Forehead Impacts, SAE 960099, February 1996 [3] Mertz, HJ, Prasad, P. and Nusholtz, G., Head Injury Risk Assessments Based on 15 ms HIC and Peak Head Acceleration Criteria, Proceeding of AGARD Meeting on Impact Head Injury, November 7-9, 1996 [4] Mertz, HJ, Prasad, P., and Irwin, AL, Injury Risk Curves for Children and Adults in Frontal and Rear Collisions, SAE 973318, Forty-First Stapp Car Crash Conference, November 1997 [5] Mertz , H.J. and Prasad, P., Improved Neck Injury Risk Curves for Tension and Extension Moment Measurements of Crash Dummies, Stapp Car Crash Journal, 00SC05, November 2000 [6] Mertz, HJ, Horsch , JD, Horn, G., and Lowne, RW, Hybrid III Sternal Deflection Associated with Thoracic Injury Severities of Occupants Restrained with Force-Limiting Shoulder Belts, SAE 2, February 1991 [7] Foret-Bruno, J.-Y., Trosseille, X., Le Coz, J.-Y., Bendjellal, F., Steyer, C., Phalempin, T., Villeforceix, D., Dandres, P. and Got, C., Thoracic Injury Risk in Frontal Car Crashes with Occupant Restrained with Belt Load Limiter, SAE 983166, 42nd Stapp Car Crash Conference, November 1998 [8] Viano, DV and Lau, I.V., Thoracic Impact: A Viscous Tolerance Criterion, Proceedings of the Tenth Experimental Safety Vehicle Conference, July 1985 [9] Melvin, J.W., and Nusholtz, G. S., Tolerance and Response of the Knee-Femur-Pelvis Complex to Axial Impacts: Impact Sled Test, University of Michigan, Highway Safety Research Institute, Ann Arbor, Report No. UM-HSRI-80-27, 1980 [10] Morgan, R.M., Eppinger, R.H. and Marcus, J.H., Human Cadaver Patella-Femur-Pelvis Injury due to Dynamic Frontal Loading to the Patella, 12th ESV, Paper No. 89-4A-0-13, May 1989 [11] Cheng, R., Yang, KH, Levine, RS, King, AI, and Morgan, R., Injuries to the Cervical Spine Caused by a Distributed Frontal Load to the Chest, Twenty-Sixth Stapp Car Crash Conference, October 1982 [12] Leung, YC, Hue, B., Fayon, A., Tarriere, C., Hamon, H., Got, C., Patel, A., and Hureau, J., Study of ” Knee-Thigh-Hip “Protection Criterion, Twenty-Seventh Stapp Car Crash Conference, October 1983 [13] Cheng, R., Yang, K., Levine, RS, and King, AI, Dynamic Impact Loading of the Femur Under Passive Restrained Condition, Twenty-Eighth Stapp Car Crash Conference, November 1984 [14] Roberts , D. p., Donnelly, BR, and Morgan, R., Cadaver Response to Axial Impacts of the Femur, Eleventh International Technical Conference on Experimental Safety Vehicles, May 1987 [15] Donnelly , B.R., and Roberts, DP, Comparison of Cadaver and Hybrid III Dummy Response to Axial Impacts of the Femur, Thirty-First Stapp Car Crash Conference, November 1987 [16] Morgan, RM, Schneider, DC, Eppinger, RH, Nahum, AM, Marcus, JH, Awad, J., Dainty, D., and Forrest, S., Interaction of Human Cadaver and Hybrid III Subjects with a Steering Assembly, Thirty-First Stapp Car Crash Conference, November 1987 [17] Mertz, H.J. and Weber, DA, Interpretations of the Impact Responses of a 3-Year Old Child Dummy Relative to Child Injury Potential, Proceedings of the Ninth International Technical Conference on Experimental Safety Vehicles, Kyoto, Japan, November 1-4, 1982. ( Republished in SAE 826048, SP-736 Automatic Occupant Protection Systems, February 1988) [18] Nyquist GW, Chen, R., El-Bohy, A., and King, AI, Tibia Bending: Strength and Response, SAE 851728, Twenty-Ninth Stapp Car Crash Conference, October 1985 [19] Crandall, J.R., etal, Mechanismc of Injury and Injury Criteria for the Human Foot and Ankle, IRCOBI, September 1997 [20] FMVSS 208: 1997, Occupant crash protection 21] ISO 3560, Road vehicles – Frontal fixed barrier or pole impact test procedure [22] ISO 7862, Passenger cars – Sled test procedure for evaluating restraint systems in simulated frontal collisions [23] ISO TR 10982, Road vehicles – Test procedures for evaluating out-of-position vehicle occupant interactions with deploying air bags [24] ISO TR 14645, Road vehicles – Test procedures for evaluating child restraint system interactions with deploying air bags [25] 9 0005 ISO 15828, Road vehicles – Offset frontal impact test procedure __________________________________________________________________________ UDC 658: 562.014: 006.354 OKS 43.020 E65 Magnetic resonance imaging (MRI) of the ankle We will select a clinic or diagnostic center for free. Magnetic resonance imaging (MRI) of the ankle joint provides high quality visualization of the structures of the ankle, which helps doctors diagnose a wide range of diseases and conditions. Patients who have pain in the ankle may be referred for an MRI scan. Most often, an MRI scan of the ankle is prescribed to diagnose injuries to the bones, tendons, ligaments and cartilage of the ankle. Imaging with MRI can also diagnose tumors, arthritis, and joint infections. Various tendons and ligaments in the ankle, including the Achilles tendon, provide flexibility and range of motion. Forcing the ankle in an uncomfortable position outside of the typical range of motion can damage the tendons and ligaments of the ankle. MRI of the ankle can detect both tears and complete tears of ligaments and tendons. For most injuries of the ankle tendons and ligaments, MRI is the most informative and reliable diagnostic method.Thinning and changes in the structure of the cartilage tissue of the ankle joint of an involutionary degenerative nature are also well visualized using MRI of the ankle. The bones of the ankle (including the talus and calcaneus), the bones of the foot are well visualized with MRI of the ankle and allow determining the presence of fractures. MRI of the ankle can also determine the presence of bruises, dislocations, or manifestations of ostearthritis. In addition, MRI of the ankle gives good information about the presence of tumors, accumulation of blood in the soft tissues around or inside the ankle.MRI of the ankle can also assess the condition of the distal tibial or peroneal tissue, as well as the muscles of the foot. The introduction of contrast allows a more detailed visualization of the structures of the ankle and the identification of small morphological changes. Main MRI indications of the ankle: Tendon injuries Ligament injuries Cartilage injuries Fractures Tumors (soft tissues and bones) Infection Aseptic necrosis False joints or unconsolidated fractures Arthritis, arthrosis Tendinitis, tendinosis Presence of a tumor in the joint area The presence of pathology on radiography Congenital malformations Pain, swelling, redness in the ankle area Decreased range of motion in the joint Unclear genesis of ankle pain Preparation for surgical treatment Preparing for ankle MRI procedure The patient can use special disposable clothing or be in his own clothing during the procedure if it is loose and does not have metal fittings. Food intake during MRI of the ankle joint is not regulated, but it is better to refrain from eating several hours before the study if a study with contrast is planned. If contrast is planned, the MRI technician needs information about the presence of an allergy to the contrast agent or bronchial asthma. The contrast agent most commonly used for MRI examinations contains a metallic substance (gadolinium). And although gadolinium very rarely leads to complications, unlike the contrast with iodine content (which is used in CT studies), nevertheless, its administration is undesirable in the presence of serious somatic diseases, especially chronic kidney disease.If MRI of the spine is performed for women, then information about the presence of pregnancy is needed. And although long-term studies have not shown harmful effects on the fetus, it is nevertheless not recommended to undergo MRI for pregnant women, especially in the first trimester. Conducting MRI with contrast is possible only in exceptional cases, according to clinical indications. In the presence of claustrophobia, MRI is recommended to be performed on open-type devices. Sedation is imperative for young children on an MRI scan so that the child can lie still during the exam.Sedation is performed by an anesthesiologist. All objects containing metal must be removed prior to MRI. These are items such as: Jewelry, watches, credit cards and hearing aids that can be damaged Pins, hairpins, metal zippers and similar metal objects that may distort the MRI image Removable dentures with the presence of metal Pens, pocket knives and glasses Body piercing MRI is contraindicated if the patient has implants or implanted electronic devices: Cochlear Implants Certain types of clips used on cerebral aneurysms Certain types of metal coils placed within blood vessels (stents) Artificial heart valves Implanted infusion pumps Implanted electronic devices, including defibrillator, pacemaker Endoprostheses of joints (with metal content) Implanted nerve stimulators Metal posts, screws, plates, stents or surgical staples Metal parts in the human body (such as bullets or shrapnel), as the strong magnetic field can displace metal objects and damage tissue.And therefore, in such cases, it is necessary to conduct an X-ray before the MRI examination. Parents accompanying children must also remove all metal objects and report the presence of objects containing metal in the body. Ankle MRI Procedure A traditional MRI machine (closed type) is a large cylindrical tube surrounded by a magnet. During the examination, the patient lies on a movable table that moves to the center of the magnet.There are also open-type MRI machines, where the magnet does not completely surround the patient, but is open at the sides. Investigations on devices of open type (and they are mostly low-field) are useful for the study of patients with claustrophobia or overweight. Recently, devices of the open type with a high field (1 or more Tesla) have appeared, which allow obtaining a high-quality image, in contrast to the main models of open MRI, where the magnetic field is low and the image is of lower quality. When performing MRI of the ankle joint, the coil is installed on the ankle joint. During the procedure, the patient must lie motionless for a certain time (on average 30-40 minutes). When examining with contrast, the exam duration will be longer. The MRI procedure is completely painless and, nevertheless, some patients may feel warmth in the area being examined, which is a normal tissue reaction to a magnetic field.As a rule, the patient is alone in the MRI machine during the examination, but there is two-way audio communication between the radiologist and the patient, and the doctor sees the patient. After undergoing the MRI procedure, the patient does not need time to adapt. Recently, it became possible to conduct MRI of the ankle joint on small devices, in which only the joint is examined and the whole body is not in a magnetic field, especially in such devices the magnetic field is powerful enough and allows you to obtain high-quality images. Benefits and risks Benefits MRI is a non-invasive imaging technique that does not use ionizing radiation. MRI is a very valuable method for diagnosing a wide range of conditions, including diseases and injuries of tendons, ligaments, muscles, cartilage and bone pathology. MRI can help determine which patients with ankle injury require surgical treatment. MRI can help diagnose a bone fracture when X-rays and other imaging techniques cannot verify the diagnosis. MRI detects abnormalities that may not be visible with other imaging techniques. Risks MRI presents little or no danger to the average patient when appropriate safety precautions are followed. Risks of over-sedation exist if sedation is used. Although a strong magnetic field is not harmful in and of itself, implanted medical devices that contain metal may deteriorate or malfunction during an MRI procedure. There is a very small risk of an allergic reaction if a contrast agent is injected. These reactions are usually mild and can be easily controlled with medication. Nephrogenic systemic fibrosis is now a recognized, but rare, complication of MRI with contrast and is believed to result from injections of high doses of gadolinium, which is the basis of contrast medium, in patients with very poor renal function. Careful assessment of renal function prior to contrast administration minimizes the risk of this very serious complication. Manufacturers of intravenous contrast agents recommend that breastfeeding mothers do not breastfeed their baby for 24 to 48 hours after an MRI scan with contrast. Restrictions for MRI of the ankle High image quality can only be obtained if the patient lies still during the examination. If the patient is large, then the study is best done on an open-type MRI. MRI examination of the ankle joint is best performed on a high-field (closed type) device, since the image quality is better than on low-field devices, especially if visualization of ligaments and tendons is required. In some cases, when it is necessary to obtain a detailed image of bone tissue, MSCT can be performed, which is better than MRI at visualizing bone tissue. Ask question Rehabilitation program after ACL plasty Preoperative Recovery Phase On the eve of the operation, the injured knee joint must be kept at rest. For this, fixing orthopedic products (brace, splint) are used.Continuous use of immobilizing straps should be limited to avoid atrophy of the quadriceps femoris. It is also extremely important to reduce the swelling of the injured knee joint, and, if possible, restore the range of motion in the joint. By the time of the operation, the patient needs to develop a correct gait. It is allowed to transfer body weight to the injured leg if it does not cause pain. It is recommended to take non-steroidal anti-inflammatory drugs (Nurofen, Ibuprofen, Nais).Duration of use: 7 – 10 days after injury. It is necessary to achieve full extension in the knee joint by performing the following exercises: 1) Passive knee extension. Sitting on a chair, place your foot on the edge of the stool or chair. Relax your thigh muscles. Allow the knee joint to bend under its own weight. 2) Heel support: Place the foot on the rolled up towel. Allow your leg to relax in an extension position. 3-4 times a day for 10-15 minutes. See figure 1 Figure 1. Heel support using a rolled towel. 3) Passive leg extension. Lie face down with your feet at the edge of the table. Allow your legs to fully extend. Figure 2. Passive leg extension. The knee should be outside the edge of the table. Flexion movements in the knee joint: 1) Passive flexion in the knee joints: Sit on the edge of a table and allow the knee to bend under the influence of gravity. 2) Use a wall slide to increase the flexion. Lie on your back with your injured leg on the wall and let your leg slide down the wall while bending your knee, using the other leg to apply downward pressure. Figure 3. Sliding on the wall 3) Sliding the heel on the table; used to obtain final flexion in the knee joint. Pull your heel towards your buttocks, bending your knee.Keep it in this position for 5 seconds. Straighten your leg by moving your heel down. Keep it extended for 5 seconds. Figure 4. Sliding heel on the table Grasp your leg with both hands, pulling your heel towards your buttocks. Figure 5. Sliding the heel on the table using the hands Recovery of muscle strength As soon as the angle of flexion in the knee joint is reached – 100 degrees, you can begin work to restore muscle strength: 1) Exercise bike. Use an exercise bike twice a day for 10 to 20 minutes. See figure 6 Figure 6. Exercise bike helps restore muscle strength. 2) Swimming is also a very valuable procedure that can be useful in this phase of the treatment to restore muscle strength and to maintain range of motion in the joint. 3) Low-impact simulators can also be used for preoperative preparation This preoperative rehabilitation program should continue until you achieve full range of motion and muscle strength in the lower extremities (you must walk without limping). Prepare mentally It is necessary to determine what you expect from the operation Discuss postoperative rehabilitation methods with your doctor in advance Make arrangements with family and / or friends for help during postoperative care Read and work through all postoperative rehabilitation steps After Operation: In the operating room, you will be immobilized with a brace or a plaster cast for rest in the knee extension position. In the ward, an ice pack is applied to the knee joint, which will subsequently reduce pain and swelling in the postoperative period. Postoperative knee immobilization is very important as it helps control pain and swelling in the joint area. Checkout: Produced within 4 to 12 days after the operation. Arrange transportation to your home in advance. Driving is not permitted during this stage. Postoperative rehabilitation (Day 1 – 14) 1) Watch for swelling.Place the limb in an elevated position. It is possible to apply cold to the knee joint. It is allowed to get up, walk, but bed rest must be observed the rest of the time. 2) Do not sit for a long time with the leg down, as this will cause significant swelling of the knee joint and the entire limb. If you have to sit for a long time, an elevated position of the operated limb is necessary (put in front of you on a chair) 3) It is necessary to take anti-inflammatory and analgesic drugs to relieve pain. 4) As soon as the pain and swelling have subsided, you can start walking with crutches. It is not recommended to transfer body weight to the injured leg. This can cause swelling. The brace must be worn for up to 6 weeks from the date of surgery. Flexion angle in the orthosis for this period: 0-10 ° Early development of movements and joint extension 1) Passive knee extension using rolled towel. The towel should be large enough to lift the shin and thigh off the table.See figure 1. Remove the knee brace every 2 to 3 hours for exercise Allow the knee to fully extend passively for 10 to 15 minutes. In this case, it is necessary to completely relax the muscles of the thigh and lower leg. This exercise can also be done while sitting in a chair. While holding the heel with your healthy foot, you must try to fully extend the knee joint. 2) Active extension can be done with the good leg.Excessive overextension of the joint must be avoided. See Figure 7: Figure 7. Use your good leg to extend the knee joint Exercises affecting the quadriceps muscle of the thigh 1) Isometric contractions of the thigh muscles should begin as early as possible Do 10 exercises 3 times a day. Each contraction should last about 6 seconds. This exercise helps prevent atrophy and contracture of the quadriceps muscle, reduce swelling and the amount of fluid in the knee joint. 2) Begin the straight leg raises in the brace (10 exercises, 3 times a day). Do these exercises while lying down. This exercise is performed sequentially by contracting the quadriceps femoris first with full knee extension. The contraction of the quadriceps “closes” the knee joint and prevents excessive stress on the installed graft. The leg remains extended and lifted at an angle of approximately 45-60 degrees and held for about 6 seconds. The leg is then slowly lowered back onto the bed. Muscles relax. DON’T FORGET TO RELAX YOUR MUSCLES EVERY TIME WHEN THE LEG IS LOWERED This exercise can be performed without a brace when the patient is able to lift the operated leg. Once you feel confident, this exercise can be performed in a sitting position. See Figure 9 Figure 9. Raising a straight leg (left in the prone position), in a sitting position (right) For patients who have had ACL reconstruction using inner thigh tendons , it is very important to avoid over-stretching the hamstrings for the first 6 weeks after surgery. The hamstring muscles take approximately 6 weeks to recover; their excessive stress during this period can lead to persistent pain in this area in the long term. Inadvertent muscle overstretching usually occurs with excessive bending forward and when putting on socks or shoes, or lifting objects from the floor. Postoperative rehabilitation (3-4 weeks) Full joint extension 1) Continue with full, passive joint extension.You also need active flexion, active extension, isometric exercises for the quadriceps muscle, and raising the straight leg. 2) Flexion in the knee joint up to 60 degrees Muscle Strength Recovery: 1) Partial squat squat. Feet shoulder-width apart with feet slightly turned outwards Use a table for support, slowly squat down and stand up. Hold in extreme positions for 6 seconds. Exercise 10 squats 3 times a day. Figure 10. Partial squats using a support table. 2) Toe lift. Using a table to support, slowly lift your heel off the floor. Hold for 6 seconds, then slowly lower yourself onto your heels. Do the exercise 3 times a day, 10 lifts. Figure 11.Finger lift 3) Continue to use the brace while walking, even if you have developed sufficient muscle strength. This will protect your graft. 4) Walk with crutches with full body weight on your leg. It is necessary to work out a normal gait with a roll of the foot. 5) You can continue to use the exercise bike, which is an excellent way to restore strength to your quadriceps. See figure 6 The distance to the pedal should be such that the knee joint is in a slightly flexed position. There should be no resistance. Maintain good posture at all times. Once your pedaling ability improves, you can start increasing the resistance (approximately 5-6 weeks). Your goal is to slowly increase your time on the machine (starting at 5 minutes, gradually increasing to 20 minutes) Resistance should be increased in such a way that by the end of the exercise you feel tired in the muscles. THE BIKE IS ONE OF THE SAFE TRAINING MACHINES YOU CAN USE TO REHABILITATE YOUR KNE. THERE ARE NO RESTRICTIONS. Postoperative rehabilitation (5-6 weeks) 1) Passive flexion (flexion) of the knee joint up to 90 degrees. (See Figure 8 below) Sit on the edge of a bed or table and allow the knee to bend passively, the opposite leg used to dose the amount of flexion in the joint. This exercise should be done 4 to 6 times a day for 10 minutes. It is very important to achieve at least 90 degrees of passive flexion 35 to 40 days after surgery. Figure 8. Passive gravity flexion allows the knee to bend up to 90 degrees 2) It is necessary to add the exercise – “sliding on the wall” (see figure 3) and pulling up the heels with the hands in the prone position to increase your range of motion in the joint. 3) Continue isometric exercises for the quadriceps and straight leg raises (see Figure 9). 4) Squats, toe raises (see figure 10 and figure 11). 5) If you are attached to a fitness center or gym, you can start using the following machines: Exercise bike. Lesson time is up to 15-20 minutes a day. Elliptical stepper. The time of classes is 15 – 20 minutes a day. LegPress Strength Machine.Flexion range 90 – 0. (See Figure 12) 90 110 Figure 12. LegPress Strength Machine. Flexion range 90 – 0 Hip Trainer. It can be used at 8-10 weeks if the ACL has been restored from the tendons of the posterior thigh. Exercise equipment for the upper shoulder girdle. Swimming: pool walking, pedal boats, water jogging. Diving and swimming at speed are not allowed. Postoperative rehabilitation (7-8 weeks) 1) Expected range of motion should be from full extension to 125 degrees.Begin flexing with a load. 2) Continue with all previously described exercises. 3) Exercises to maintain body balance (helps to restore spatial sensitivity of the knee joint) Postoperative rehabilitation (9-12) By 9-12 weeks, the range of motion in the knee joint should be complete. 1) Continue with all previously described exercises. 2) Exercises on the machine for the muscles of the back of the thigh.Relate the load to the pain. If pain occurs, reduce the load. 3) Continue exercises to restore body balance. 4) Continue your activity in the swimming pool. 5) Start exercising on the treadmill. MOUNTAIN BIKE RIDING OR CLIMBING IS FORBIDDEN! Postoperative rehabilitation (12-20 weeks) 1) Increase exercise intensity from week 12. 2) Start running, gradually increase the duration and distance 3) Wearing a soft knee pad is recommended while running. Postoperative rehabilitation (6 months) This is the earliest date when you can return to full sports activity. To resume sports loads, you need: Restore quadriceps muscle strength to at least 80% of a healthy leg Restore muscle strength of the posterior thigh group to at least 80% of a healthy leg Restore full range of motion in the joint No edema Satisfactory joint stability Complete the rehabilitation program . Leave a Reply Cancel reply Your email address will not be published. Required fields are marked * Comment * Name * Email * Website