Transcript Ankle Evaluation

Ankle Evaluation
History
• How did this injury occur?
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– Mechanism of injury
When?
Where does it hurt?
Did you hear any sounds or feel a pop?
Any previous Hx?
Pain Levels and types of pain
Training Methods
Did you continue activity?
Shoe type/playing surface
Brace/taped?
Observation
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Obvious deformities
Discoloration/ecchymosis
Swelling
Muscle Atrophy / bilateral symmetry
Foot abnormalities
– Toes, arches, callous formation
• Gait / Shoe wear patterns
Bony Palpation
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Fibula
Tibia
Talus
Navicular
Phalanges
Cuboid
• Cuneiforms
• Metatarsals
• Base of the 5th
metatarsal
• Lateral Malleolus
• Medial Malleolus
• Calcaneous
Soft Tissue
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Gastrocnemius
Soleus
Tibialis Anterior
Posterior Tibialis
Fibularis (formally known as the Peroneals)
– Longus
– Brevis
– Tertius
Ligaments/Tendons
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Anterior Talofibular
Calcaneofibular
Posterior Talofibular
Deltoid
Posterior Tibiofibular
Anterior Tibiofibular
Achilles Tendon
Bursa
• Retrocalcaneal bursa
Range of Motion
• Passive ROM
• Active ROM
• Resistive ROM
Dermatomes
• L1 – S2
Special Tests
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Anterior Drawer
Talar Tilt
Side to Side Test
Thompson Test
Tap or Percussion Test
Compression Test
Equinas Deformity
Functional Testing
Anterior Drawer
• Position
– Seated with knee flexed to 90
– Involved foot is slightly plantar flexed
• Action
– Stabilize the Tibia and Fibula
– Apply an anterior force to the
Calcaneus and Talus
• Positive Finding
– Anterior translation of the talus
– Opening up of the joint
– Positive for Anterior Talofibular
ligament sprain
Talar Tilt
• Position
– Seated
– Stabilize the distal Tibia
– Grasping Talus
• Action
– Start in Anatomical
Position
– Tilts Talus into
Inversion
• Positive Findings
– Increase Inversion on
affected side
– Positive for a tear of
the Calcaneofibular
Ligament
Thompson Test
• Position
– Prone
– Heels hanging off table
• Action
– Gastrocnemius – Soleus
complex relaxed
– Squeeze the belly of the
muscle
• Positive Findings
– Normal: foot plantar flexion
– Positive: absence of plantar
flexion upon squeezing
– Rupture of Achilles Tendon
Tap or Percussion Test
• Position
– Lying Supine
– Foot off Table
• Action
– Examiner puts ankle in max Dorsiflexion
– Apply firm tap to heel
• Positive Findings
– Pain @ site of injury indicative of a fx
– Vibration of tapping along the long axis
of the bones will exaggerate pain @ the
fx site
Side to Side Test
• Position
– Supine
– Foot in max Dorsiflexion
– Stabilize Tibia and Fibula
• Action
– Cupping the Calcaneous
– Move side to side within the joint
• Positive Findings
– Opening of the Tibiofibular joint or pain in the
Anterior or Posterior Tibiofibular ligament
– Positive for “high ankle sprain” or a sprain of the
Anterior Tibiofibular Ligament
Compression Test
• Position
– Lying Supine (may be seated)
– Ankle/Foot off of the table
– Examiner notes location of pain
• Action
– Squeezes Tibia and Fibula away from painful
area
• Positive Findings
– Pain @ site indicative of a Fx
– Compressing two bones together may
exaggerate the pain @ Fx site
• Special Considerations
– Avoid if obvious deformity is present
– NOT EXCLUSIVE of a Fx
Equinas Deformity
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Congenital
Casting or crutching
High Heeled shoes
Diabetes
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Heel lifts
Splints
Orthotics
Physical therapy
Surgery
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