Ankle

Question 1

Acute Phase Interventions for Ankle (4 items)

Level of Evidence

Answer 1

Evidence Level B

1 - Active mobilization (muscle energy)

2 - Oscillatory graded

3 - Strain-counterstrain

4 - Manual lymph drainage

Question 2

Manual therapy

Location to apply soft tissue to the gastrocnemius

Answer 2

Pressure applied to posterior medial tibia

Question 3

Manual therapy to the Soleus

Answer 3

Medial portion of the posterior tibia.

Question 4

Manipulation for patients with lateral and lateral mid-foot symptoms

Answer 4

Tarsal Manipulation

Plantar Flexion / Inversion

Later in rehab phase

Cuboid Manipulation

Follow with heel raises.

Question 5

Tenderness in what area of the foot is a contraindication for joint mobilization?

Involving what bones?

Answer 5

Mid-foot tenderness involving cuboid and navicular.

Need for plain films per Ottawa Rules for the Ankle.

X-rays are important at this point.

Question 6

Appropriate manual technique to gain ankle DF in Progressive loading phase/ Sensorimotor training

Answer 6

Talocrural long axis distraction (manipulation)

Question 7

Cuboid Whip is indicated in which situation and in which phase

Answer 7

Residual tenderness and lack of dorsal mobility of the cuboid bone.

Pain is present with heel-raise movements.

Question 8

Best exercises for Acute phase

Evidence Level

Answer 8

Active range of motion

Seated exercises

Hip and trunk exercises (example bridging and trunk progression)

(Evidence Level A)

Question 9

What are “foot tripod” exercises used for?

Answer 9

Core of the foot

Fibularis Muscle

Question 10

Exercise for lateral ankle sprains in Post Acute Phase Intervention

What is the level of evidence?

Answer 10

D - Conflicting evidence

F - Expert Opinion

Question 11

Post Acute Phase

What should you watch for during exercises?

Answer 11

No reproduction of symptoms during or after the exercise.

No swelling should be seen.

Question 12

Progression from ankle tripod

Answer 12

8:16

Squat/Lunges/Heel raises

Question 13

What should watch for during a calf stretch and how to solve that problem?

Answer 13

Watch for navicular drop.

Solve that by using a little roll under the forefoot.

Question 14

What are the best exercises for balance deficits during

“Progressive Loading/Sensorimotor Training” phase?

Answer 14

Dynamic exercises conducted on single limb

Question 15

What should be the advice in regards to weight bearing during acute protected phase?

Answer 15

Progressively weight bear with assistance of external supports.

Crutches and other devices.

Casting and braces can be used.

Question 16

Ankle taping

Answer 16

Open basket weave

Lateral ankle support

Question 17

Is therapeutic ultrasound recommended on ankle sprains?

Answer 17

The evidence suggests it has a placebo effect only.

Question 18

What modalities should be use for ankle sprains and their level of evidence?

Answer 18

Level A - Cryotherapy / No Ultrasound

Level D - Electrotherapy/low level laser therapy

Level C - Shortwave diathermy

Question 19

Which patients are more likely to benefit from manual therapy with ankle pain?

Answer 19

Patients with:

• Worse symptoms with standing
• Worse symptoms in the evening
• Navicular drop more than 5mm
• Hypomobility of the talucrural joint

Question 20

What are the 4 times of applications of CPGs

Answer 20

1 - Risk factors

2 - Differential diagnosis

3 - Intervention (Clinically effective interventions and patient subgrouping)

4 - Prognosis

Question 21

What are 5 risk factors for ankle injuries?

Answer 21

1 - Hx of previous injury

2 - No external support

3 - No warm ups (static or dynamic)

4 - No normal ankle DF ROM

5 - No participation in balance/proprioception program

Question 22

What is the difference between the acute and chronic ankle sprain presentation?

Answer 22

Acute: Pain and swelling

Chronic: Instability

Question 23

What is a grade A functional measure for ankle assessment?

Answer 23

FAAM - Foot and ankle ability measure