This definitive text pulls together up-to-date research on medical issues related to the unstable ankle and features contributions from an array of leading physicians and rehabilitation professionals. Edited by two orthopedic surgeons who are internationally respected specialists on sport-related and ankle injuries, The Unstable Ankle may be the most comprehensive book available on the subject.

Editors Nyska and Mann present the latest knowledge on ankle instability with emphasis on conservative treatment and preventive measures. The books 35 chapters provide valuable information on the causes of ankle instability, evaluation and diagnostic procedures, surgical interventions, rehabilitation, and prevention.

Complete and practical, The Unstable Ankle addresses ankle instability problems in a variety of patient populations, including children and adolescents. Special consideration is given to at-risk individuals in selected sports and occupations.

Physicians and other medical team members who work with ankle problems will gain a better understanding of when conservative treatment is appropriate"which is most of the time"and how to rehabilitate at the lowest possible physical, emotional, and financial cost to patients. When surgical intervention is required, this text will guide professionals on the appropriate application of techniques.

The book thoroughly discusses the role of physical therapists and other allied health professionals in treatment of ankle instability. Appropriate exercises for different degrees of instability with different etiologies are described in detail.

This important text includes the following features:

 Three sections dealing with the structure and function of the ankle, prevention of injury, acute ankle sprains, chronic ankle instability, staging, treatment, and evaluation

 Liberal illustrations"236 in total"that eliminate ambiguity and add to the clarity of the information presented

 Step-by-step procedural descriptions of four operations and extensive discussion of arthroscopic reconstruction

This authoritative text will build the confidence of the entire medical team and help members work together to diagnose, treat, and prevent ankle instability with the patients best interests in mind.

Contents

Part I. General Considerations
Chapter 1. Epidemiology of Ankle Sprain

Charles Milgrom

Incidence of Ankle Sprains

Affecting Factors

Outcome and Prognosis

Economic and Social Impact

Direction of Future Research
Chapter 2. Anatomy of the Ankle and Talar Joints

Moira O`Brien and Elisha Freund

The Ankle Joint

The Talar Joints
Chapter 3. Biomechanics of the Ankle Joint Complex and the Shoe

Benno M. Nigg and Beat Hinterman

Movement

Movement Transfer Between Foot and Leg

Forces

Shoes
Chapter 4. Biomechanics of Ligaments in Ankle Instability

Beat Hinterman

Morphological Aspects of Ligaments, Ligament Injury, and Ligament Healing

Mechanical Characteristics of the Ankle Ligaments

Conclusions and Clinical Implications
Chapter 5. Proprioception of the Ankle Joint

Rƒ¼diger Reer and Jƒ¶rg Jerosch

Basic Knowledge

Prophylaxis and Rehabilitation

Diagnostics

Summary

Part II. Primary Evaluation
Chapter 6. Mechanics of Injury, Clinical Presentation, and Staging

Gideon Mann, Meir Nyska, Naama Constantini, Y. Matan, Per RenstrĦm, and Scott Lynch

Mechanism of Injury

Clinical Presentation and Staging
Chapter 7. Scoring Systems Evaluating Ankle Function

Gideon Mann, Meir Nyska, and Y. Matan

Function and Desirable Characteristics

Various Scoring Systems
Chapter 8. Diagnostic Aspects of Chronic Ankle Instability

Beat Hinterman

The Problem

Examination

Conclusions

Part III. Diagnostic Approaches to Ankle Sprain
Chapter 9. Radiographic Assessment of Acute Ankle and Hindfoot Injuries

Ehud Rath and Ilan Shelef

Ankle Injuries" Indications and Radiographs Interpretation

Technical Notes

Radiographs of Specific Injuries
Chapter 10. Imaging of Ankle Injuries

Yaakov Applbaum

Techniques

Ligament Injuries

Tendon Injuries

Osseous Lesions

Summary
Chapter 11. The Role of Arthroscopy in Chronic Ankle Sprains

Wolf-Ruediger Dingels

Anatomy and Pathophysiology

Diagnostics

Classification of Sprains

Part IV. Complications of Ankle Sprain
Chapter 12. Chronic Ankle Instability, Mechanical and Functional

Gideon Mann, Meir Nyska, A. Finsterbush, Naama Constantini, and Joseph Lowe

Introduction

Possible Causes of Instability

Diagnosis
Chapter 13. Osteochondral Fractures of the Talus

Chaim Zinman, Meir Nyska, and Gideon Mann

Pathology and Etiology

Clinical Presentation, Diagnosis, and Classification

Treatment
Chapter 14. Sinus Tarsi Syndrome

Meir Nyska, Gideon Mann, and Cobi Lidor

Anatomy

Biomechanics

Histopathology

Diagnosis

Treatment
Chapter 15. Tendon Injuries in Acute Ankle Sprain

Lew C. Schon and Claude D. Anderson

Peroneal Tendons

Posterior Tibial Tendon

Anterior Tibial Tendon

Achilles Tendon

Conclusion
Chapter 16. Posterior Ankle Impingement

C. Niek van Dijk, Otto Stibbe, and R.K. Marti

Anatomy

Etiology

Diagnosis

Therapy

Methods and Results

Conclusion
Chapter 17. Fractures of the Fifth Metatarsal

Frank Spaas and Marc Martens

General Issues

Metatarsal Neck Fractures

Metatarsal Head Fractures

Metatarsal Base Fractures
Chapter 18. The Subtalar Joint

Elisha Freund, Meir Nyska, and Gideon Mann

Anatomy

Motion

Assessment

Causes of Instability

Treatment
Chapter 19. Midfoot Sprain

Meir Nyska and Gideon Mann

Anatomy and Pathophysiology

Incidence

Assessment

Injury of the Lateral Midfoot

Injury to Medial Midfoot

Conclusion

Part V. Conservative Treatment
Chapter 20. Management of Acute Ankle Sprain

Per Renstrom and Scott A. Lynch

Grades of Injury

Conservative Versus Surgical Treatment

Four Basic Phases of Treatment and Rehabilitation

Functional Treatment Protocol

Supportive Treatment Modalities

Surgery

Conclusions
Chapter 21. Rehabilitation of the Acute Lateral Ankle Sprain

Deborah Cozen and Richard Ferkel

The Four-Phase Rehabilitation Program

Keys to Successful Return to Activity

Closed Kinetic Chain Rehabilitation Exercises

Therapeutic Modalities

Case Studies
Chapter 22. Proprioceptive Retraining for Chronic Ankle Instability

David Mencher

Proprioception in Ankle Sprains

Principles of Proprioceptive Retraining

Protocol for Proprioceptive Retraining of Chronic Ankle Instability

Conclusion

Further Thoughts on Proprioceptive Training as a Therapeutic Measure
Chapter 23. Return to Sport After Delayed Reconstruction for Ankle Instability

Steven I. Subotnick

Types of Instability

Rehabilitation and Return to Sport

Postoperative pain

Nontraditional Accessories to Treatment
Chapter 24. Functional Testing As the Basis for Ankle Rehabilitation Progression

George J. Davies, J.W. Matheson, and Steven Subotnick

Rationale and Definition

History and Subjective Examination

Summary

Part VI. Surgical Treatment
Chapter 25. Overview of the Operative Treatment of Ankle Instability

Meir Nyska and Gideon Mann

Indications for Operative Treatment

Anatomic and Nonanatomic Surgical Procedures

Summary and Conclusions
Chapter 26. Watson Jones Operation for Ankle Instability

Moshe (Perry) Pritsch and M. Salai

Surgical Technique

Personal Experience

Complications
Chapter 27. Lateral Chronic Instability of the Ankle: Christman-Snook Technique

Alberto Macklin Vadell

Surgical Anatomy and Biomechanics

Diagnosis

Treatment

Conclusions
Chapter 28. Ankle Ligament Reconstruction: The BrostrĦm Procedure

Roger A. Mann and Jeffrey A. Mann

Decision Making

Modified BrostrĦm Procedure for Ankle Ligament Reconstruction

Complications
Chapter 29. The Williams Procedure

Gideon Mann, E. London, and Meir Nyska

Operative Technique

Post Operative Management

Clinical Follow-Up
Chapter 30. Arthroscopic Reconstruction of the Unstable Ankle

Charles Southerland

Role of Arthroscopy

Practical Applications of Ankle Anatomy

Mechanism of Injury

Operating Room Set-Up and Surgical Technique

Postoperative Treatment

Experience and Follow-Up

Summary
Chapter 31. Arthroscopy and the Injured Ankle

Wolf-Ruediger Dingels

Acute Arthroscopy

Arthroscopy for Complications of Chronic Ankle Sprain

Part VII. Additional Issues
Chapter 32. Ankle Sprain in Children and Adolescents

Eliezer Trepman, A. Ross Outerbridge, and Lyle J. Micheli

Pediatric Differences

Mechanisms of Injury

Evaluation

Specific Conditions
Chapter 33. Prevention of Acute Ankle Ligament Sprains in Sport

Martin P. Schwellnus

Extrinsic Risk Factors for Ankle Sprains In Sport

Intrinsic Risk Factors

Summary and Practical Application
Chapter 34. Preventing Ankle Injuries in Parachuting

John B. Ryan

Parachuting Apparatus and Technique

Incidence and Mechanism of Injuries

Prevention of Ankle Injuries
Chapter 35. Preventive Effects of an On-Shoe Brace on Ankle Sprains in Infantry

Gideon Mann, G. Kahn, M. Suderer, A. Zeer, N. Constantini, and Meir Nyska

Materials and Methods

Statistical Analysis

Results

Discussion

Conclusions

Audiences

Reference for sports medicine specialists, orthopedic surgeons, podiatrists, physiatrists, and sports chiropractors.

Meir Nyska, MD, has been a senior member in the department of orthopedic surgery at Hadassah University Medical Center in Jerusalem since 1992. He has lectured in medical schools since 1983. He earned his medical degree from the Hebrew University Hadassah Medical School. Dr. Nyska is a member of the Israeli Association of Orthopedic Surgery. He is a well-respected authority in the field and has been widely published. He was a founder and former president of the Israel Foot and Ankle Society, and he currently chairs the department of orthopedic surgery at a major public hospital

Gideon Mann, MD, is the director of the Sports Injuries Unit at Meir Hospital, Kfar Saba, Israel. He has been a senior orthopedic surgeon at Wingate Institute and Hadassah University Hospital since 1990. He has lectured on arthroscopy, sport injuries, and related topics. Dr. Mann has published articles in international journals for more than 25 years. He earned his medical degree from Hebrew University Hadassah Medical School in Jerusalem in 1974. He is a former chair of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Committee, a former member of its board of directors, and president of the Israel Society of Sport Medicine from 1989 to 1999.