Quick Questions in Ankle Sprains

Patrick O. McKeon, PhD, ATC, CSCS is an Assistant Professor in the Department of Exercise and Sport Sciences at Ithaca College and serves as the Clinical Education Coordinator for the Athletic Training Education program. Prior to coming to Ithaca College, Dr. McKeon served as an Assistant Professor within the Post-Professional Athletic Training program and the Rehabilitation Sciences Doctoral program at the University of Kentucky. He earned his bachelor of science degree in Athletic Training from Springfield College, his master of science in Sports Health Care from the Arizona School of Health Sciences, and his doctorate of philosophy in Sports Medicine from the University of Virginia. Dr. McKeon’s research interests include understanding and enhancing recognition, prevention, and rehabilitation strategies for ankle instability. He incorporates a holistic research perspective, which combines patient-, clinician-, and laboratory-oriented outcomes to capture the broad spectrum of functional issues related to this clinical phenomenon. Erik A. Wikstrom, PhD, ATC, FACSM is an Associate Professor in the Department of Kinesiology and the Co-Director of the Biodynamics Research Laboratory at UNC Charlotte. Prior to coming to UNC Charlotte, Dr. Wikstrom served as the Director of Undergraduate Athletic Training in the College of Health and Human Performance at the University of Florida. Dr. Wikstrom earned his bachelor of science degree in Athletic Training/Sports Medicine from Roanoke College and both his master of science degree in Exercise Science and his doctorate of philosophy in Health and Human Performance from the University of Florida. Dr. Wikstrom’s research focuses on the interactions between musculoskeletal biomechanics and sensorimotor control of the lower extremity following injury, with particular emphasis on the coordination of balance in those with ankle joint pathologies.

Dedication Acknowledgments About the Editors Contributing Authors Preface Introduction Section I Risk and Risk Reduction of Ankle Sprains Question 1 Why Are Lateral Ankle Sprains so Common in Sports and Physical Activity?Erik A. Wikstrom, PhD, ATC, FACSM and Patrick O. McKeon, PhD, ATC, CSCS Question 2 How Does the Incidence of Lateral Ankle Sprains Differ Across Sports and Physical Activities?Jennifer M. Medina McKeon, PhD, ATC, CSCS and Thomas L. Pommering, DO, FAAFP Question 3 What Are the Most Common Modifiable Risk Factors for Lateral Ankle Sprains?Tine Willems, PhD, PT Question 4 What Are the Most Common Nonmodifiable Risk Factors for Lateral Ankle Sprains?Kenneth L. Cameron,PhD, MPH, ATC, CSCS; Brian R. Waterman, MD; and Brett D. Owens, MD Question 5 What Are the Contributing Factors for Recurrent Ankle Sprains and/or Chronic Ankle Instability?Lisa Chinn, PhD, AT Question 6 What Effect Does Prophylactic Bracing and/or Taping Have on Reducing Lateral Ankle Sprain Risk?Timothy A. McGuine, PhD, ATC Question 7 To What Extent Does Ankle Bracing or Taping Impair Functional Performance?Mitchell L. Cordova, PhD, ATC, FNATA, FACSM Question 8 What Types of Preventive Exercises Could Help Reduce an Athlete's Risk of Suffering a Lateral Ankle Sprain?Evert Verhagen, PhD, FECSS Question 9 What Is the Comparative Cost-Effectiveness of Lateral Ankle Sprain Prevention Strategies?Luke Donovan, PhD, ATC and Jay Hertel, PhD, ATC Section II Diagnosis Question 10 How and Why Are Ankle Sprains Graded?Matthew Stewart, PT, FACP Question 11 What Are the Differences in Key Clinical Features Among Syndesmotic, Medial, and Lateral Ankle Sprains?Thomas W. Kaminski, PhD, ATC, FNATA, FACSM and Eric Nussbaum, MEd, ATC, LAT Question 12 What Are the Most Useful Clinical Tests to Accurately Diagnose Syndesmotic and Medial Ankle Sprains?Eric Nussbaum, MEd, ATC, LAT and James C. Sullivan, DPM, ATC, FACFAS Question 13 What Are the Most Useful Clinical Tests for Accurately Diagnosing Acute Lateral Ankle Sprains?Cathleen N. Brown, PhD, ATC; Adam B. Rosen, PhD, ATC; and Jupil Ko, MS, ATC Question 14 How Well Do the Ottawa Ankle and Foot Rules Help to Accurately Rule Out Ankle Fracture?Jeffrey D. Tiemstra, MD, FAAFP Question 15 What Are the Concomitant Injuries That Occur With a Lateral Ankle Sprain?J. Ty Hopkins, PhD, ATC, FNATA, FACSM Question 16 What Criteria Should Be Used to Diagnose a Patient With Chronic Ankle Instability?Eamonn Delahunt, PhD, BSc (Physiotherapy), SMISCP; Brian Caulfield, PhD, M MedSc, B Physio, MISCP; and Cailbhe Doherty, BSc (Physiotherapy) Question 17 What Functional Tests Best Identify Functional Impairments Following a Lateral Ankle Sprain?Carrie Docherty, PhD, ATC, FNATA Question 18 What Diagnostic Imaging Techniques Are Used to Further Evaluate Syndesmotic, Medial, and Lateral Ankle Sprains?Leah H. Portnow, MD; Joseph Surace, DO; Tennyson Maliro, MD; and Javier Beltran, MD Question 19 What Are Important Diagnostic Considerations for the Pediatric Ankle?Claire E. Hiller, PhD, MAppSc, BAppSc (Physio) and Joshua Burns, PhD, BAppSc (Pod)(Hons) Section III Treatment and Rehabilitation Question 20 Should I Immobilize and Restrict Weight Bearing for an Acute Ankle Sprain and, if so, With What and for How Long?Tricia Hubbard-Turner, PhD, ATC, FACSM Question 21 What Is the Most Important Immediate Treatment Following an Ankle Sprain?Michael G. Dolan, MA, ATC, CSCS Question 22 What Are the Most Important Components to Include in a Rehabilitation Program Following an Ankle Sprain?Scott E. Ross, PhD, LAT, ATC, FNATA and Brent L. Arnold, PhD, ATC, FNATA Question 23 What Treatments Are Most Effective for Increasing Dorsiflexion During the Rehabilitation Process, and How Long Should I Expect Dorsiflexion Deficits to Be Present in My Patient? 1Patrick O. McKeon, PhD, ATC, CSCS and Erik A. Wikstrom, PhD, ATC, FACSM Question 24 What Is Cuboid Syndrome Following Traumatic Lateral Ankle Sprain, and How Should It Be Treated?Helene Simpson, MSc Physiotherapy Question 25 What Criteria Should I Use to Return an Athlete to Sport After an Acute Lateral Ankle Sprain?Chris M. Bleakley, PhD, BSc and Philip Glasgow, PhD, BSc Question 26 How Effective Are Foot Orthotics in Treating Impairments Associated With Ankle Sprains?Caitlin Whale, MS, LAT, ATC and Carl G. Mattacola, PhD, ATC, FNATA Question 27 To What Extent Does Intrinsic Foot Muscle Strengthening Enhance Rehabilitation Outcomes for Ankle Sprains?François Fourchet, PT, PhD; Darren James, PhD; and Patrick O. McKeon, PhD, ATC, CSCS Question 28 How Should I Design a Rehabilitation Program for Chronic Ankle Instability, and How Long Should It Last?Eric Eils, Prof. Dr. rer. medic. habil. Question 29 What Is the Role of Proximal Strength and Neuromuscular Training in Ankle Rehabilitation?Phillip Gribble, PhD, ATC, FNATA and Masafumi Terada, PhD, ATC Question 30 To What Extent Should I Use Manipulative Therapies to Treat Ankle Sprains and Chronic Ankle Instability?Matthew C. Hoch, PhD, ATC and Bill Vicenzino, PhD Question 31 What Physical and Pharmacological Agents Are Useful When Treating Ankle Sprains?Chris M. Bleakley, PhD, BSc Question 32 How Much Should I Be Concerned About Persistent Laxity Associated With the Lateral Ankle Ligaments?John E. Kovaleski, PhD, ATC Question 33 What Should Be Considered When Rehabilitating a Pediatric Ankle Sprain?Claire E. Hiller, PhD, MAppSc, BAppSc (Physio) and Joshua Burns, PhD, BAppSc (Pod)(Hons) Question 34 What Are the Most Appropriate Patient-Oriented Outcome Measures to Use for Gauging Disability and Functional Recovery During Rehabilitation Following Ankle Sprain?Todd A. Evans, PhD, ATC and Kelli R. Snyder, EdD, ATC Section IV Surgical Considerations Question 35 When Should I Refer My Patient With an Ankle Problem to an Orthopedic Surgeon?Kelli Frye Pugh, MS, ATC, LMT Question 36 Which Surgical Technique Produces the Best Clinical Outcomes in Lateral Ankle Sprains?Chad M. Ferguson, MD and J. Kent Ellington, MD, MS Question 37 What Are the Key Rehabilitation Considerations for Producing the Best Clinical Outcomes Following Lateral Ankle Reconstruction?Michael Johnson, PT, DSc, OCS, SCS; Brett D. Owens, MD; and Kenneth L. Cameron, PhD, MPH, ATC, CSCS Question 38 What Are the Surgical and Rehabilitative Treatment Options for an Athlete With a Combined Syndesmotic and Lateral Ankle Sprain?Kevin D. Phelps, MD and J. Kent Ellington, MD, MS Question 39 What Are the Surgical and Rehabilitative Treatment Options for an Ankle Sprain With a Chondral Defect?J. Kent Ellington, MD, MS and Matthew S. Wilson, MD Financial Disclosures Index