The Unstable Ankle.

Nyska M, Mann G, eds. Champaign, IL 61825-5076, Human Kinetics, 2002, hardcover, 334 pp, illus, ISBN: 0-88011-802-4, $85.

This text provides a comprehensive look at the diagnosis, treatment, and prevention of ankle injuries. The contributors to the text are primarily physicians, with contributions from physical therapists, podiatrists, and a chiropractor as well. The text is divided into 7 parts with a total of 35 chapters. Each of the chapters contain detailed figures and tables to supplement the discussion.

Part I of the text focuses on general considerations concerning the ankle, including anatomy, biomechanics, innervation, and proprioception. Each of the chapters provide generous discussion of the relevant literature on the subject. The chapter on proprioception is exceptionally well done, with an in-depth discussion of the research literature and the implications that proprioception has for ankle injury prevention and rehabilitation.

Part II describes the primary examination and evaluation of ankle sprains, focusing on the clinical presentation and grading systems. In chapter 7, the authors present a thorough discussion of the various ankle injury grading scales. The second section of this chapter deals with the various ankle scoring scales that focus on function and outcome measures. This part concludes with a brief discussion of the examination, with a primary emphasis on imaging studies. Radiographic and arthroscopic images are included to enhance the discussion. Part III continues the discussion of imaging and arthroscopy of the ankle. The authors of chapter 9 provide an excellent discussion of the use of plain-film radiography in the evaluation of the ankle. They also show how to perform the various examination procedures. Relevant references providing evidence for the chosen techniques are included.

Part IV is the largest section of the text and covers complications of ankle sprains. Topics covered include instability of the ankle, fractures of the talus, sinus tarsi syndrome, tendon injuries, posterior ankle impingement, midfoot sprains, and fractures of the fifth metatarsal bone. Chapter 15, which covers tendon injuries, is very well done. The authors describe in detail the injury, clinical findings, and treatment for each of the tendons affected by ankle sprains. They provide a large number of figures, including drawings, photographs, and radiographs of ankle anatomy, dysfunction, and surgical treatment. The chapter on posterior ankle impingement provides one of the best descriptions of the condition that I have seen. The authors lead the reader through etiology, diagnosis, and therapy using excellent radiographs, photographs, and computed tomography images.

Part V covers conservative treatment of the sprained ankle. Chapter 20 starts this section by providing an overview of the sprained ankle, including causes and conservative versus surgical management. This chapter is followed by 2 chapters covering the rehabilitation of acute ankle sprain and chronic ankle sprain, respectively. The chapter on the acutely sprained ankle provides a step-by-step progression of the rehabilitation process, including return-to-activity programs. Specific exercises are described for both open and closed chain activities. This section of the chapter is followed by a discussion of therapeutic modalities commonly used with ankle sprains. The authors provide case studies for the reader that illustrate the use of the various rehabilitation programs. A short chapter on rehabilitation following surgical reconstruction is also included. Part V concludes with a chapter on functional testing for use in ankle rehabilitation progression. The author provides detailed instructions on methods of functional testing for the patient with a sprained ankle using algorithms as the foundation of the progressive rehabilitation program. This chapter is well supported by a review of the relevant literature.

Various surgical techniques for the unstable ankle are addressed in part VI of the text. Each chapter briefly addresses a technique, discussing the indications for surgery, the surgical technique, and rehabilitation following surgery. Although they are brief, each chapter provides the reader with a good understanding of each surgical technique and the indications for their use. The chapters on arthroscopy are presented in more detail and provide the reader with numerous photographs for illustration.

Part VII discusses additional issues related to the unstable ankle. Ankle instability in children and adolescents is presented in detail. The authors discuss the many ankle conditions seen in this age group, the medical treatment, and rehabilitation. The final chapters of the text focus on prevention of ankle sprains using footwear, strapping, and bracing. The discussion of using support in the prevention of ankle sprains provides a significant, in-depth look at the literature.

This text provides the reader with a comprehensive look at the ankle and injuries that lead to instability. The writing is well done and easily understood. I was especially pleased with the review of relevant literature that was provided in each of the chapters. The authors presented an evidence-based discussion of the subject material. I would highly recommend this text to anyone who has an interest in the foot and ankle.

Byron Russell, PT, PhD
Eastern Washington University
Spokane, Wash

Dr Russell is Chair and Assistant Professor
in the Department of Physical Therapy. He
is the department's anatomy instructor.