A lateral ligament injury or varus injury is probably one of the most common sports injuries that physical therapists see, especially in jumping sports such as basketball volleyball. They are usually the result of forced plantarflexion/varus movements in which the ligamentous complex Tears of varying degrees on the outside of the ankle. Inversion injuries are also more common than valgus injuries due to the relative instability of the lateral joint and the weaker lateral ligament compared to the medial ligament. Although a sprained ankle is a relatively benign Injuries they are not always well managed. Inadequate rehabilitation can lead to chronically painful ankles, reduced functional capacity and increased likelihood of re-injury. Care should also be taken to avoid missing less common causes of ankle pain; small fractures around the ankle and Pulled or ruptured muscles around the foot (eg, Pott’s fracture) and ankle (eg, peroneal tibialis anterior of the calf).
Clinically Relevant Anatomy
The ankle contains three joints. The talocrural joint or ankle joint is a hinge joint formed between the lower surface of the tibia and the upper surface of the talus. The medial and lateral ankle joints provide additional articulation and stability to the ankle joint. lower tibia The joint is formed by joining the distal parts of the fibula and tibia. The inferior tibiofibular joint is supported by the inferior tibiofibular ligament, or syndesmosis. The subtalar joint between the talus and calcaneus is divided into an anterior joint and a posterior joint, consisting of sinus tarsi. The lateral ligament is made up of three parts: the anterior talofibular ligament, which runs from the tip of the fibula in a flat ribbon across the lateral neck of the talus; the calcaneofibular ligament, a cord-like structure that points backward; and the posterior The talofibular ligament, which runs posteriorly from the fibula to the talus .
Injury Mechanism/Pathological Process
A Pott fracture is a fracture that affects one or both ankle joints. During activities such as jumping landings (volleyball basketball) or turning the ankle, a certain amount of stress is placed on the tibia and fibula and the ankle joint. When this stress is traumatic and beyond what Bones that can withstand possible fractures of the medial or posterior malleolus. Activities that involve sudden changes in direction, such as soccer and rugby, can also cause fractures around the ankle joint. When this happens, the condition is called a Pott’s fracture. Porter’s Fracture It usually occurs with other injuries, such as inversion injuries, ankle dislocations, or other fractures of the ankle or lower leg. Pott fractures can vary in location, severity and type, including displaced fractures, undisplaced fractures, bilateral malleolus fractures or compound fracture. It is clinically difficult to distinguish fractures from moderate to severe ligament sprains. Both conditions can result from an inversion injury with severe pain and varying degrees of swelling and disability.
Patients with a Pott’s fracture often experience sudden, sharp, severe pain around the ankle or lower leg immediately after the injury. The pain is located on the front, inside, or outside of the ankle or lower leg. Patients may also hear a “cracking” sound. Due to the pain, the patient limps to protect the wound. In severe cases, weight bearing may not be possible. People with a Pott fracture often experience swelling, bruising, and pain when the affected bone area is touched firmly. Pain may also increase during certain movements of the foot or ankle or when trying to stand or walk. When it is a displaced fracture, significant deformity may be present. Disabilities such as flat feet were also common in Pott’s fracture case. And the reason for that was because of a guy who had a Porter’s fracture. This is because in many cases The foot of a person with a Pott fracture is at a right angle in an everted position, and the muscles that support the arch are stretched, so a person with a Pott fracture walks in this wrong posture and develops a flat foot.
When diagnosing a Pott fracture, a detailed patient history is required, and an increase in leg diameter at the level of the ankle suggests a fracture of the fibula (Keen sign Pott fracture). The diagnosis of a Pott’s fracture can be confirmed by X-rays. Once diagnosed, often Standard schemes for classifying fractures using the Lauge-Hansen classification based on the mechanism of injury rotation or the Danis-Weber classification system, which takes into account the location of the distal fibula fracture relative to the syndesmosis of the ankle United .
There are many outcome measures available when evaluating ankle fractures. Some are designed to measure functional limitations, while others rely on patient-reported outcome measures that focus on activities in which patients report pain and other functional outcomes of their daily lives. 
- Clinical Demerit Points
- Maryland Foot Score
- Walking speed
- The time it takes to climb a certain number of stairs
- 36-item Short-Form Health Survey (SF-36)
- Short Musculoskeletal Functional Assessment (SMFA)
- Ankle Fracture Outcomes for Rehabilitation Measures (A-FORM)
- Olerud and Molander (O&M) Questionnaire
- Lower Extremity Functional Scale (LEFS)
Also, see Outcome Measures Database
Management / Interventions
One of the most important components of recovery after a Pott fracture is for the patient to rest adequately from any activity that increases pain. Activities that put a lot of stress through the ankles, especially heavy-weight bearing, should also be avoided Activities such as running, jumping, standing, or walking.
Displaced Pott fractures, in which the anatomical relationship of the ankle bones have been disrupted, require surgical fixation . A boot or plaster cast and/or crutches are used for several weeks after surgery.
Nondisplaced treated fractures may involve a cast and use of crutches, followed by protective boots or braces for several weeks.
Patients with Pott fractures should perform pain-free flexibility enhancement and balance exercises during their rehabilitation to ensure optimal results. Physiotherapists can use techniques such as massage and joint mobilization to ensure optimal range of motion and flexibility. The goal of massage is to combat the formation of heterotopic ossification . This is the process by which bone tissue forms on the outside of the bone. Treatment may also include electrotherapy taping and bracing exercises to improve strength flexibility and balance, Spa . Achilles tendon lengthening  has been shown to treat complex Pott fractures. This tendon can be lengthened or stretched by passive dorsiflexion of the foot while the leg/knee is straight .
There are many other situations and injuries that can mimic a Pott fracture in the absence of an apparent sudden injury. The following are examples of other ankle conditions:
- Acute Compartment Syndrome
- Lateral Ankle Ligament Tear
- Deep Vein Thrombosis
- Syndesmotic Disruption
- Rheumatoid Arthritis
- Talar Fracture
In the most severe cases of Pott’s tumor, patients often make a complete recovery with appropriate treatment. Functional or athletic recovery can usually take place over a period of several weeks to several months.
- Khan K, Bruker P. Ankle acute injuries. Encyclopaedia of sports medicine and science. TD Fahey (Ed). Internet society for sports science: http://sportsci. org. 7th March. 1998 Mar.
- Goldblatt, D. , Treatment Of Pott’s Fracture, department of traumatic surgery of the New York postgraduate hospital, New YorkfckLR
- Tartaglione JP, Rosenbaum AJ, Abousayed M, DiPreta JA. Classifications in brief: Lauge-Hansen classification of ankle fractures.
- Ng R, Broughton N, Williams C. Measuring recovery after ankle fractures: a systematic review of the psychometric properties of scoring systems. The Journal of Foot and Ankle Surgery. 2018 Jan 1;57(1):149-54.
- Heath HH, Selby CD. XV. The Open Method in the Treatment of Pott’s Fracture of the Leg. Annals of Surgery. 1908 Jan;47(1):98.
- Samuel L Stover, MD., reviewed without changes by C.T. Huang, MD., Spinal Cord Injury Formation Network, HETEROTOPIC OSSIFICATION, University of Alabama, Birmingham, 1997, reviewed 2009fckLRLevel of evidence : 1A
- PhysioAdvisor, take control of your injury, Pott’s Fracture, 2008, (http://www.physioadvisor.com.au/13320350/potts-fracture-broken-ankle-physioadvisor.htm)fckLR
- Dowd CN. Lengthening of the Tendo Achillis in the Treatment of Complicated Pott’s Fracture. Annals of Surgery. 1918 Sep;68(3):330.
- nabil ebraheimAnkle fracture / Fractures and its repair- Everything You Need To Know – Dr. Nabil Ebraheimhttps://www.youtube.com/watch?v=sKIyBsiI1Z4&feature=emb_logo
- AudiopediaBimalleolar fracture Available from https://www.youtube.com/watch?v=-AqaeDYGmJs&feature=emb_logo