Ankle

Question 1

What is pes planus and pes cavus?

Answer 1

Pes Planus (flat feet)
•Loss of longitudinal arch
•Mild valgus deformity of hind foot
•Results in pronation of forefoot and loss of medial arch

Pes Cavus (high arch)
•Accentuation of longitudinal arch
•Secondary to muscle imbalance

Question 2

What is plantar fasciitis?

Answer 2

Defined as a tensile overload of the plantar fascia at its origin causing collagen disarray

Question 3

Lateral ankle sprain

MOI-
S&S-

Answer 3

MOI- jumping and landing 
•ATFL on stretch
•Full weight bearing (FWB)
•Rapid changes in direction
•Uneven surfaces (often as a result of landing on someone else's foot)

S&S- Audible snap, click or tear
•Pain and swelling on lateral side of ankle
•Tenderness on palpation (ToP) of ATFL/PTFL/CFL
•Pain on PF/Inv
•Total absence of pain??

Question 4

Syndesmosis Injury (High Ankle Sprain)

MOI-
S&S-

Answer 4

MOI- *hyper-dorsiflexion and external rotation
*Forces talus to split the inferior tib-fib

S&S- *Pain above the ankle.

• Calf pain.
• Inability to place weight on the leg.

Question 5

POTTS#

MOI-
S&S-

Answer 5

MOI-Similar to a severe ankle sprain

S&S- Similar to Gd 2-3 ligament sprain
•Unable to FWB
•Severe pain
•Palpation: pain localised to bone > ligament

Question 6

What are the Ottawa rules?

Answer 6

A set of guidelines used to reason whether someone presenting with ankle/foot pain should be referred for an X-ray for # diagnosis

Boney tenderness around the lateral malleolus - from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular

Question 7

Talar dome injuries

MOI-
S&S-

Answer 7

MOI- Can occur in association with ankle sprains
•Usually involves compression trauma, i.e. landing plus inversion / rotation

S&S- Ankle range remains restricted
–persistent ankle pain/aching despite appropriate management
–pain can be more diffuse
–tends to increase with activity
–Ongoing swelling, stiffness

Question 8

Tendon Tears/Ruptures

MOI-

Answer 8

MOI- Overstretch followed by immediate muscle contraction

• Immediate onset of pain
• Audible ‘snap’ or ‘pop’
• “Felt like being kicked, hit or shot”
• Limping, or completely unable to weight bear

•Total Rupture:
–palpable gap, bunching of calf muscles

Question 9

What is the difference between tendinitis and tendinopathy?

Answer 9

Tendonitis suggests inflammation

•Tendonopathy suggests degeneration (histological studies have found degenerative changes and absence of inflammatory cells)

Question 10

Achilles Tendinopathy

S&S-

Answer 10

S&S- (with increasing severity of tendinopathy):
•A) pain: on movement which goes away with warm up
•pain will go away but needs longer to warm up.
•constant pain
•B) thickening / swelling over site of tendinopathy

Question 11

What is a Anterior Impingement (footballer’s ankle)

S&S-

Answer 11

Bony spurs (exostoses / osteophytes) form on inferior tibia / superior talus) from repetitive impact in FWB dorsiflexion
Bone or soft tissue gets trapped between the talus and tibia during DF
Signs and symptoms: anterior ankle pain- becomes sharper and more localised, pain worst with activity involving forced DF, DF ROM restricted

Question 12

Posterior Impingement characteristics

Answer 12

Impingement of posterior talus on posterior aspect of tibia in extreme FWB PF
•⇑ posterior tubercle of talus
•Common sports:
➢Ballet dancers
➢Gymnasts