• Foot and ankle act to support and propel the body.

• During running and jumping, loads well in excess of 10 times the body weight are transmitted through the ankle
and foot. If this loading is excessive or excessively repeated, it can lead to foot and ankle injuries.
• Anatomy – refer to slides 4 to 8
C/F
• Swelling, Tenderness, Bruising, Pain, Inability to put weight on the affected ankle, Skin discoloration, Stiffness.
Tests
• Anterior drawer – tests integrity of anterior talofibular ligament.
• Talar tilt – tests integrity of calcaneofibular ligament
• If only pain – partial rupture, If movement – complete rupture
Imaging
• Bones – X-ray (AP, Lateral, Mortise), CT, 3DCT
• Soft tissues – US and MRI (coronal, saggital)

ANKLE SPRAIN
• 75% of cases it is the lateral ligament complex that is injured, in particular the anterior talofibular and
calcaneofibular ligaments.
• Long fibula – no eversion – less medial sprains.
• Medial ligament injury – associated with fracture or joint injury
• Inversion – lateral ligament sprained ; Eversion – medial ligament sprained
C/F
• Swelling, tenderness, bruising, pain, inability to put weight on ankle, skin discolouration.
Imaging
• X-ray, US
Treatment
• Non-operative – PRICE (Protection, Rest, Ice, compression, elevation), NSAID for pain, for 1-3 weeks.
• Operative – arthroscopic repair or ligament substitution.
o Indication - After 12 weeks. Residual complaints of ankle pain and stiffness, a sensation of instability or
giving way and intermittent swelling are suggestive of cartilage damage or impinging scar tissue within
the ankle.
ANKLE TWISTING WITH LIGAMENT TEARS
• Deltoid ligament tear
o On eversion and external rotation as it is on the medial side
o Associated with either a fracture of the distal end of the fibula or
tearing of the distal tibiofibular ligaments (or both)
o When there is a tear of deltoid ligament or medial malleolar fracture but
no lateral disruption at the ankle, it is important to look for a
fracture or dislocation of the proximal fibula.
o Completely reduced medial joint space - ligament will heal.
The fibular fracture or diastasis (gap) reduced
ORIF if needed
A below-knee cast or support boot is applied for 8 weeks.
• Inferior tibiofibular ligament tear
o If this is torn – partial or complete separation of tibiofibular joint (diastasis)
o Can occur in isolation or associated with fractures of malleoli and rupture of collateral ligaments.
o Partial tear – bracing for 2-3 weeks, physiotherapy and exercises
Complete tear – Internal fixation with transverse syndesmosis screw above the joint, cast for 8 weeks.
MALLEOLAR FRACTURE
• Low energy twisting – inversion/eversion – malleoli fractured
• High energy injury – FFH and RTA – Axial loading – Fracture tibia plafond (talus driven into tibia) / fracture pilon
(refer slides 24,25)
• Danis and Weber classification – for fibular fractures
o Type A - Transverse fracture of the fibula below the level of tibiofibular syndesmosis
o Type B – Oblique fracture of the fibula at the level of tibiofibular syndesmosis
o Type C – Severe injury above the level of syndesmosis. Tibiofibular ligament and part of
interosseous membrane torn.
• TX- Look for swelling, blister, wound, hematoma
o ORIF with syndesmotic screws and plates.
o Cast or boots for 6 weeks
o Open malleolar fracture – span, scan, plan – Open reduction External fixation
TALAR NECK FRACTURE
• Talus is a major weight-bearing bone.
• The superior articular surface carries the greatest load per unit area in the body.
• Vulnerable blood supply – common site for post-traumatic ischemic necrosis.
• Hawkins classification modified by Canale
o Type I – undisplaced
o Type II – displaced + subluxation or dislocation of the subtalar joint
o Type III – displaced + dislocation of the body of the talus from the ankle joint
o Type IV – displaced vertical talar neck fracture + talonavicular joint disruption
• Xray, Ct
• ORIF with screws
FRACTURES OF THE CALCANEUM
• FFH onto one or both heels – calcaneus driven up the talus and is split and crushed
• Associated with injuries of spine, pelvis and hip
• Extra-articular – conservative cast for 6 weeks
• Intra-articular – ORIF
• If Bohler’s angle >40° or <20° - ORIF with plate and screws (refer slide 38)

LISFRANC FRACTURE
• The five tarsometatarsal (TMT) joints form a structural complex that is held intact by the interdigitating joints
and strong ligaments that bind the metatarsal bones to each other and to the tarsal bones of the midfoot.
• There is no ligament between first and second metatarsal
• Lisfranc – disruption that occur at midfoot-forefoot junction – high-energy injury with extensive damage.
(refer slide 40)
• ORIF with screw or boot/cast for 6-8 weeks
FRACTURES OF THE FIFTH METATARSAL BASE
• Forced inversion of foot – pothole injury
• Avulsion of base of fifth metatarsal with pull-off by peroneus brevis tendon or lateral band of plantar fascia.
• Proximal avulsion fractures – symptomatic tx – rest & support with early mobilization and return to function.
Can cast for 6 weeks