Acute Foot and Ankle

Question 1

What basketball player was out playing and landed on someone else’s foot, he said he “ went over it”. What could this mean in clinical language?

Answer 1

Went over, usually means inversion

Question 2

The athlete heard a pop… what could this mean?

Answer 2

May have been a tissue fail

Question 3

The athlete points to the lateral side of his ankle and said it hurts “ here”. What could have happened to that side?

Answer 3

Possibly too much inversion, may be ripped some thing on lateral side, ~ distal to lateral malleolus

Question 4

If the athlete has bruising, what could this mean from a clinical perspective?

Answer 4

Must have damage some thing that has blood supply to it
- The amount of bruising can be very variable between different people

Question 5

Is an athlete has swelling, wrapping around the malleolus and starting to move into the heel region in the lateral side, what could this mean from a clinical perspective? Why does this occur in the first place?

Answer 5

• probably asked for help a lot later than the injury happened
• likely had three days of inflammatory phase
• Probably walked on it, etc.

GRAVITY is draining fluid down if the foot isn’t rested and elevated ( in severe cases, it can move into toes and make toe “sausages” XD)

Question 6

If something on the lateral side of the foot/ankle is damaged, what structures could have been impacted?

Include bones, ligaments, tendons

Answer 6

5 Bones
- talus, fibula, calcaneus, cuboid, metatarsals

3 Ligaments
- Talofibular (ANT), talofibular (POS), calcaneofibular

2 Tendons
- Peroneus longus, peroneus brevis

Question 7

Describe the difference between a sprain and a strain

Answer 7

• a SPRAIN enters a bands of tissue that connect 2 bones together (aka ligaments)
• a STRAIN involves an injury to a muscle or to the band of tissue that attaches a muscle to a bone

Question 8

A ligament can stop you until it fails… what are the three grades of ligament damage?

Answer 8

Mild, moderate, severe

Question 9

Describe a mild ligament tear

Answer 9

Tearing of only a few of the ligament fibres

Question 10

Describe a moderate ligament tear

Answer 10

A more severe partial, tearing of the ligament

Question 11

Describe a severe ligament tear

Answer 11

Complete tear of the ligament (80/90+ fibres), every/almost all fibres failed

Question 12

What kind of ligament tear doesn’t usually have bruising?

Answer 12

Mild

Question 13

What type of ligament tear(s) will see bruising?

Answer 13

Moderate and severe
- Blood vessels, not OK

Question 14

What factors of their story are important to consider before establishing the injury/ which parts of the story, but you need to translate into clinical language?

Answer 14

• WHAT IS THEIR STORY IN GENERAL: “layman’s” way of explaining what/when of the injury
• SOUND OR SENSATION: look for descriptions of “pop” that was felt or heard
• PAIN DISTRIBUTION: where does it hurt? Up to you to determine what “that side” or “here” means
• SWELLING/BRUISING DISTRIBUTION
• WEIGHT BEARING STATUS

Question 15

What are the three types of weight-bearing status you can see in patients?

Answer 15

NWM (non weight bearing)
PWB (partial weight bearing)
FWB (full weight bearing)

Question 16

Describe a high ankle sprain, explaining how it might happen, and how it impacts gait/weight-bearing status

Answer 16

• acute injury: usually in position with heavy load on ankle
• changes position quickly (cleats/skate sticking to the ground), when the foot turns away/changes direction they feel pain
• There’s usually limit walking abilities/weight-bearing more so than low ankle sprains
  = tells us that the injury is on a WEIGHT-BEARING STRUCTURE

Question 17

Which ligament and tendon might be involved in a high ankle sprain?

Answer 17

Inferior/distal tibiofibular ligament(creates a mortis for talus to sit in)
Extensor digitorum longus (similar pain location)

Question 18

In terms of movement, and it’s effect on the affected structures, how many high ankle sprains happen?

Answer 18

• Dorsiflexion puts the widest part of the talus in and stretches ligament
• Additional rotation forces fibula away from tibia and opens joint

Question 19

What’s another name for a high ankle sprain?

Answer 19

Syndesmotic sprain

Question 20

Where does swelling and bruising occur during high ankle sprains?

Answer 20

• swelling is typically localized where ankle meets low leg
• as it becomes more severe, swelling will spread more
• bruising happens in same place as swelling

Question 21

A soccer player hurt his toe when he fell at practice. His toe was forced into hyperflexion and foot into plantarflexion. What is this called? What structure may have been damaged?

Answer 21

TURF TOE!

• MTP joint forced into hyperextension
• Something failed on the plantar side, think about what gets pulled apart

Which tendon travels along planter side of MTP joint ? FLEXOR HALLICUS LONGUS (FHL)

Question 22

Lateral ankle sprains, high ankle sprains, and turf toe are all…

Answer 22

Acute injuries

Question 23

Which 4 ROM should you test when evaluating an ankle injury? Include average rom values.

Answer 23

DF (20), PF (55), INV (20) , EV (15)

Question 24

What 4 ROM should you test when evaluating a toe injury?

Answer 24

Toe flexion, toe extension, DF, PF *Key structures that cross toe also cross ankle

Question 25

Pain is most likely to show up when (3 things):

Answer 25

A) injured muscle contracts
B) injured tissue is pulled apart
C) injured joint surface is compressed

Question 26

What is the relative risk of recurrent sprains with a brace?

Answer 26

0.30

Question 27

What is the relative risk of first time sprains with a brace?

Answer 27

0.69

Question 28

In lecture it was mentioned that soft tissue injuries meed PEACE and LOVE. What does the acronym PEACE stand for here?

Answer 28

Protect
Elevate
Avoid
Compress
Elevate