Acute Ankle Conditions

Question 1

What is a Grade 1 acute ankle sprain?

Answer 1

mild stretching of the LCL of the foot

no joint instability is noted

Question 2

what is a Grade 2 acute ankle sprain?

Answer 2

involves a ligament tear or partial rupture (usually ATFL)

mild instability noted

Question 3

what is a Grade 3 acute ankle sprain?

Answer 3

complete disruption of the LCL complex AND instability of the ankle joint is seen

Question 4

When completing an ankle exam after an acute injury, how should the physical exam be performed?

Answer 4

in a systematic and reproducible fashion, from proximal to distal.

Question 5

why do you palpate the proximal fibula in an ankle exam after an acute injury?

Answer 5

to rule out a Maisonneauve fx

Question 6

how do you evaluate the ankle syndesmosis?

Answer 6

external rotation and medial-to-lateral squeeze tests

Question 7

the talar tilt test evaluates the integrity of what ligament?

Answer 7

CFL

Question 8

explain how to perform the external rotation test to evaluate the syndesmosis.

Answer 8

stabilize the leg with one hand.
externally rotate the foot on the leg with the other hand.
if significant pain ensues, this is a positive finding.

Question 9

explain how to perform the medial-to-lateral squeeze test to evaluate the syndesmosis.

Answer 9

the tibia and fibula are compressed together about 3cm proximal to the ankle joint. if pain ensues distally, this is considered a positive test.

Question 10

explain how you would perform the talar tilt test.

Answer 10

hold the leg locked from side to side and invert the heel. can be performed under AP radiograph so that the angle btwn the tibia and talus can be measured. a difference of 5-15 deg btwn limbs is a significant disruption.

Question 11

what are the Ottawa ankle rules for obtaining radiographs?

Answer 11

ankle radiographs are necessary if:

1. pain at tip of medial malleolus
2. pain at tip of lateral malleolus
3. or inability to bear weight immediately / walk 4 steps in the ED

foot radiographs necessary if:

1. bony tenderness at th navicular
2. bony tenderness at base of 5th met
3. or inability to bear weight immediately / walk 4 steps in the ED

Question 12

how long does it take for ligaments of the ankle to heal?

Answer 12

6 weeks to 3 months

Question 13

when evaluating for deltoid injury, a medial clear space of how much is considered abnormal?

Answer 13

> 4mm

Question 14

What is the function of deltoid ligament ?

Answer 14

(prohibits abduction and eversion )
superficial deltoid- resists hindfood eversion
deep deltoid- prevents external rotation of the talus

Question 15

what is the angular relationship between the CFL and ATFL?

Answer 15

104 deg

this is important to remember during reconstructive porcedures

Question 16

what is the superficial part of the deltoid ligament?

Answer 16

tibiocalcaneal
tibionavicular
posterior tibiotalar

Question 17

what is the deep part of the deltoid ligament?

Answer 17

anterior tibiotalar

Question 18

the inferior transverse ligament is really part of waht ligament?

Answer 18

deep fibers of the PITFL

Question 19

which ligament spans across both talocalcaneal and tibiotalar (ankle joint)?

Answer 19

CFL

Question 20

Which ligament helps to check over-inversion?

Answer 20

cervical lig (anterior talocalcaneal)

Question 21

If you suspect a severe complete sprain of the lateral ankle complex, what test can you order if MRI is unavailable?

Answer 21

arthrogram

Question 22

what taping technique is most popular after an acute ankle sprain?

Answer 22

open basket weave technique

Question 23

The classic article by Ramsey and Hamilton showed that if the talus is displaced by 1mm laterally, how much tibiotalar contact do you lose? Why is this important?

Answer 23

a. 42% decrease in tibiotalar contact area when talus is displaced 1mm laterally
b. Shows that if talus isn’t reduced back into the mortise, gross instability occurs  post-traumatic arthritis

Question 24

Why do you perform the external rotation test when evaluating for a syndesmotic injury?

Answer 24

because it is the external motion of the talus that usually causes syndesmotic injuries

Question 25

What is another name for the AITFL?

Answer 25

Bassett ligament

Question 26

What is the Chrisman-snook procedure?

Answer 26

splits the PB tendon to reconstruct the ATFL and CFL; is considered non-anatomic reconstruction though

Question 27

Which ligament is extra-capsular?

Answer 27

CFL

Question 28

what is the strongest ligament of the deltoid ligament complex?

Answer 28

posterior talofib

Question 29

Where does the ATFL insert?

Answer 29

(NOT on the talar neck; it is intra-capsular)

it inserts on teh body of the talus just anterior to the articular facet

Question 30

What is the classification system for peroneal tendon dislocation?

Answer 30

Eckert and Davis