ANkle and foot

Question 1

Describe the anatomy of the ankle

Answer 1

The ankle joint is the articulation of the tibia and fibula with the talus. The dome of the talus fits into the mortise formed by the medial mal, horizontal articular surface of the tibia (plafond) and the lateral malleolus.

Three set of ligaments strengthen the ankle joint. The syndesmotic ligaments, lateral collateral, and medial collateral ligaments.

The flexor retinaculum tethers the tendons of the tib posterior, digitorum longus, and flexor hallucis muscles behind the medial mal/

THe peroneal retinaculum and tendon sheath tether the fibularus longus and brevus behind the medial mal.

The extensor retinaculum tethers the tendons of the tib anterior, extensor digitorum long, extensor hallucic longus and peroneaus tertius over the anterior apsect.

Posterialy lie the achilles and plantaris tendons.

Question 2

Discuss radiological testing of the ankle joint

Answer 2

The AP, lateral and mortise vies constitute the standard three view XR series.

Trace the mortise

• trace around the mortise and talar dome
• check the joint space is uniform - if one side looks widened check for a farcture
• ensure the talar dome surface is smooth
• Access the interosseous ligament
  1) 1 cm proximal to the tib plafond the distance between the tib and fib should be les than 6mm
  2) if greater consider tear or rupture of anlkle ligaments and loof for a fracutre.

LATERAL

• assess bohlers angle: two tangent lines drawn across the anterior and posterior b orders fo the calcaneous form an angle between 20-40 degrees
• if <20 degrees consider a calcneal fracture

Question 3

Describe ottawa ankle and foot rule

Answer 3

ANKLE
Pain in the malleolar region with any of the following findings
1) bone tenderness of the posterior edge of the distal 6cm or tip of the lat mal
2)bone tenderness of the posterior edge of the distal 6cm or tip of the med mal
3) inability to weight bear - for at least 4 steps immediatly after and in the ED

FOOT
Pain in the midfoot region with any of the following
1) bone tenderness at the navicular bone
2) bone tenderness at the base of the fifth
3) inability to weight bear

Sensitivity approaching 100%