The ankle mortise is a highly congruent hinge joint where the wider anterior talus talar dome fits precisely into the bony mortise in dorsiflexion, making the ankle most stable in this position. In plantarflexion, the narrower posterior dome enters the mortise with relative laxity, explaining why lateral ankle sprains occur in plantarflexion. The fibula bears 15 to 20 percent of axial load and its integrity is critical for mortise stability.
The ATFL is the most commonly injured ligament in the body, torn in almost every lateral ankle sprain. The Ottawa Ankle Rules guide radiograph ordering, with tenderness at the posterior malleolar tip or inability to weight bear indicating fracture risk. High ankle sprains (syndesmotic injuries) are less common but more debilitating than standard lateral sprains, requiring longer rehabilitation and occasionally surgical stabilisation. Ankle osteoarthritis is most commonly post-traumatic, unlike hip and knee arthritis which are primarily primary osteoarthritis.
ATFL tear from plantarflexion-inversion injury, the most common ligamentous injury in sport, managed with RICE in the acute phase and progressive functional rehabilitation.
High ankle sprain disrupting the distal tibiofibular syndesmosis producing instability requiring prolonged rehabilitation or surgical fixation with screw or suture button.
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