Ankle Joint Stability

Depends on both joint congruency and supporting ligaments.

Anterior talofibular, calcaneofibular, and posterior talofibular ligaments

Lateral ankle ligaments responsible for preventing inversion and internal rotation.

Superficial and deep deltoid ligaments

Prevent eversion and external rotation

Anterior, posterior, and transverse tibiofibular, and interosseous ligaments. (Syndesmotic ligaments) Maintain stability between the distal fibular and tibia.

Lateral Ankle Ligaments

Lateral ankle ligaments are the most commonly injured. Anterior talofibular:

under greatest tension when the foot is extended

limits anterior shift (AS) of the talus or posterior shift (PS) of the tibiafibula. limits internal rotation (IR) of the talus or external rotation (ER) of the fibula

Lateral Ankle Ligaments

Posterior talofibular:

under greatest tension when the foot is lifted

limits PS of the talus or AS of the tibia-fibula

limits ER of the talus or IR of the fibula

Lateral Ankle Ligaments

Calcaneofibular
Works synergistically with the anterior talofibular to resist ankle inversion forces.

Under greatest tension when the foot is lifted.

Spans both t lateral ankle joint and lateral subtalar joint, increase subtalar joint stability.

Deltoid
The strongest ankle ligament. Acts to resist eversion, external rotation, and extension of the ankle joint. Prevents lateral talar shift and external rotation

Joint Congruency

During weight-bearing/physical load, articular surface congruency is more important to ankle stability than ligament support. In a loaded state, articular surfaces provided 30% of rotation stability and 100% of resistance to inversion/eversion.

Increases the force to cause ankle inversion (by 91%) and eversion (80%).

Loading the ankle results in decreased range of motion, but increased stability.

Injuries to Ankle Ligaments of landing Injury occurs during periods

or falling, when the ankle is extended and inverted.

The anterior talofibular ligament is the

the most commonly sprained ankle ligament.

This is in part because it is the

weakest of the ankle ligaments, and because of the mechanism of injury.

Kinetics of the Ankle Joint

The ankle joint experiences forces during gait that are equal to or greater than the hip and knee joints. When standing on one leg, on tiptoe, the joint reactive force is approximately 2.1 times body weight, while the Achilles tendon force reaches approximately 1.2 times body weight.

Ankle Load Distribution

Ankle has a large load-bearing surface area (11-13 cm2)

This leads to lower stresses across the joint than the knee or hip.

77-90% of the load during weight-bearing is supported by the tibial plafond and talar dome.

The rest is supported by the medial and lateral talar facets.

As the ankle is inverted, the medial talar facet is loaded more, while eversion increases the load on the lateral talar facet. When the foot is lifted, total talar contact is greatest and the average high presssure is lowest.

Dynamics

The main compressive force across the normal ankle during gait is produced by contraction of the gastrocnemius and soleus muscles.

A compressive force of 4-5 times body weight occurs before toe lift during gait, caused by contraction of the posterior calf muscles.
While walking, faster paces show lower compressive forces than slower paces. While running, however, ankle forces may be as high as 13 times body weight.

Effects of Poor Choices in Ladies Footwear on Ankle Biomechanics

88% of women with foot pain wear shoes that were on average 1.2 cm narrower than their foot. 1.9 cm heel increases forefoot pressure by 22%

5 cm heel increases pressure by 57% 8.3 cm heel increases pressure by 76%

Elevation of the heel may also decrease Achilles contracture, limit ankle dorsiflexion, and alter gait.