Ankle

Question 1

Lateral ligament injury

Answer 1

MOI - PF+inv
Usually injures ATFL or ATFL+CFL
40% risk of developing CAI

Question 2

Grades of ligament injury

Answer 2

Grade 1 - pain and no laxity
Grade 2 - pain with some laxity
Grade 3 - significant laxity and no end feel

Question 3

Lateral lig injury - clinical findings

Answer 3

lateral swelling/effusion (accumulates base of foot d/t gravity)
able to WB
Tests - Ottawa Ankle Rules to exclude #; Anterior drawer (ATFL); talar tilt (CFL)

Question 4

Prognosis of lateral ankle injury

Answer 4

Pain significantly reduces in first 2 weeks but people still having pain 2 years after initial injury

Question 5

Management of Lateral ankle sprain

Answer 5

Day 1:

• apply ice 10-20mins 3x/day
• rest a few hours but load ASAP (<24hrs)

Week 1-8
- load in ADLS - protect with tape/brace

2 mons-1yr

• balance training reduces risk of resprain by 40%
• bracing during sport reduces risk by 80%

Question 6

Medial Lig injury

Answer 6

Less common than lateral
MOI - eversion; often assoc with fracture
LONGER RECOVERY

Question 7

Achilles rupture - basic info?

Answer 7

Young active people 30-40 yrs
M>F 10:1
MOI = forceful eccentric contraction of calves

Question 8

Achilles rupture - clinical findings

Answer 8

Palpable GAP in tendon
+ Thompson test
Reduced/º PF strength?

Question 9

Achilles rupture - PT management

Answer 9

• immob (brace) - first in PF -then neutral
• address ROM, joint stiffness, weakness, short mm, balance, neuromotor control

6 months

Question 10

CAI - how do you dx someone with CAI?

Answer 10

1+ of these signs = CAI
Recurrent sprains
Pain (even > 2 yrs)
Mechanical instability
Perceived instability (ankle 'giving way')
Swelling

40% of people with ankle sprains go on to develop CAI

Question 11

Management of CAI

Answer 11

Multimodal

• strengthening, balance, proprioception
• perturbation during heel strike, increase automaticity ability

Question 12

Sinus Tarsi Syndrome

Answer 12

What is it?
- sinus tarsi located on lateral ankle - a canal that contains fat, BVs, CT, ligaments

MOI

• overuse injury 2º subtalar pronation; can also occur with lat ankle sprain
• worse in AM; PROM eversion/inversion painful

Management:

• ice
• joint mobs
• taping
• strengthening/stretching
• corticosteroid injection

Question 13

Ankle OA

Answer 13

Clinical findings:
- reduced ROM and PAM

Management:

• joint mobs, NSAIDS, strengthening+MC, reduce load, foot wear?
• SURGICAL - arthroscopy, fusion, joint replacement (distal end of tibia is replaced

Question 14

Plantar fascitis

Answer 14

• inflammatoy/degenerative process
• 40-60 yrs
• pain on MEDIAL (vs fat pad pain is on lateral) plantar aspect of heel

PREDISPOSING FACTORS:
weight, supination/pronation, standing on hard surface prolonged time

Question 15

Plantar fascitis management

Answer 15

• corticosteoid injection
• stretching
• NSAIDs
• taping/STW
• healthy weight
• address training load