Ankle Flashcards
1st degree ankle sprain
Stretching or minor tearing of ligament and fibers Minimal pain Mild swelling Mild ecchymosis Full ROM Mild point tenderness Stable joint Ability to bear weight RICE, active ROM exercises Non-weight bearing activity (swim, bike) Return to sports in 2-3 weeks recurrent
2nd degree ankle sprain
Partial tearing of ligament fibers
Mild to moderate pain
Moderate swelling
Moderate ecchymosis
Painful, slightly limited ROM
Point tenderness over joint
Mild joint laxity with stress
Painful to bear weight (can do it though)
RICE, active ROM exercises as tol.
Partial weight bearing as tolerated , gradual progress to full
Return to sports in 4-8 weeks with ankle support
Recurrent sprains, jt instability, traumatic arthritis
3rd degree ankle sprain
Complete tearing of ligament fibers Severe Significant Severe ecchymosis Loss of function Severe pain (difficult examination) Abnormal joint movement Inability to bear weight Referral to Ortho (surgery perhaps? Cast for 4-6 weeks, no weight bearing, gradual progression to full Rehab b/g returning to sports Persistent instability, traumatic arthritis
syndesmosis Injury
high ankle external rotation stress test (+ if pain) squeeze test (+ if pain)- tibia and fibia squeeze on calf side to side test (assess endpoint) tibiofibular clear spaace >5mm = injury on xray
Squeeze test
for high ankle sprain
(+ if pain)- tibia and fibia squeeze on calf
Thompson s Test
Achilles rupture/injury
foot not move on squeeze of calf=tear
Plantar Fascititis
medial/distal calcusnus
Morton’s Neuroma
Irritation of interdigital nerve between the metatarsal heads and beneath the overlying transverse ligament
“ feel like walking on pebbles”
see if reproduces pain on palpation- Mulders sign
Mudler’s sign
test for mortons neuroma
palpate interdigit- + if pain
Metatarsal Stress Fx
pain at MTP joint
+ with forced flexion of toes at MTP joint i.e. soccer players
Ottawa Rules
Reported sensitivity of 100% in detecting fractures of the ankle and mid-foot in adults.
Reduces use of radiographs by 30%.
Does not apply if syndesmosis injury is suspected.
Initially not used in children/adolescents but some argue for use in children >5yrs.
-within 10 days of injury, bone tenderness in posterior half of lower 6cm of fibula/tibia or unable to bear weight right after injury
-bone tender over navicular bone, base of 5th metatarsal
CT or MRI
r/o talar dome lesions
ankle inuries involving crepitus, cathcing or locking (displaced osteochondral fragment)
MRI
syndesmosis sprians, peroneal tendon involvement, tf syndesmosis ligament
Xray
malleolar fx, talar dome fx, distruption of ankle syndesmosis, tarsal navicular stress fx
forefoot injury - conservative
metatarsal fx- stress and acute mortons neuroma metatarsalgia 1st MTP joint sprain (turf toe) Hallux Valgus Hallux Rigidis
