ankle and foot module 4

Question 1

what are some common ankle ligament sprains?

Answer 1

lateral ankle sprains
medial ankle sprains
syndesmosis injury (high ankle sprain)
chronic ankle instability (CAI)

Question 2

what are some l risk factors for lateral ankle sprains?

Answer 2

women more than men
cutting sports (soccer, basketball)
fatigue in longer sports (soccer second half)

Question 3

are BMI and age conclusive risk factors for lateral ankle sprains?

Answer 3

no

Question 4

how is body function/structure affected by lateral ankle sprains?

Answer 4

tensile loading to lateral ligaments
compression load on medial osseous structures “kissing lesion”
tenderness, swelling, ecchymosis
decreased weight bearing, decreased ROM

Question 5

what are the lateral ligaments commonly sprained?

Answer 5

anterior talofibular ligament (ATFL)
cancaneal fibular ligament (CFL)
posterior talofibular ligament (PTFL)

Question 6

what are 80-90% of all ankle sprains due to?

Answer 6

inversion MOI with the lateral ligaments involved

Question 7

what is the chief complaint with lateral ankle sprains?

Answer 7

difficulty in activity depends on grade of sprain, history of sprains vs functional instability
painful weightbearing and ROM

Question 8

what is the common MOI for lateral ankle sprains?

Answer 8

inversion with a PF foot, traumatic

Question 9

what are the grades of acute ankle sprains?

Answer 9

grade 1 (mild)
grade 2 (moderate)
grade 3 (severe)

Question 10

what is a grade 1 acute ankle sprain?

Answer 10

expect 2 weeks of rehab
mild effusion, no hemorrhage
negative anterior drawer, negative varus laxity
pain with inversion and PF
function: little or no limp, but has trouble with hopping

Question 11

what is a grade 2 acute ankle sprain?

Answer 11

rehab about 3-4 weeks
more swelling, hemorrhage likely present
pos anterior drawer, no varus laxity at neutral
function: limping with walking, unable to raise on toes/hop/run

Question 12

what is a grade 3 acute ankle sprain?

Answer 12

immobilization 1-10 days, and 8-10 weeks of rehab
diffuse swelling, hemorrhage
significant instability, complete tears of ATFL and CF
function: unable to weight bear completely, decreased ROM

Question 13

what are some important differential diagnoses for lateral ankle sprains?

Answer 13

fibularis muscle tear
avulsuion fracture
lis franc fracture/dislocation
subtalar sprain
achilles tendon rupture
lateral talar process and/or anterior process of the calcaneus injury

Question 14

how is the body function/structure affected in a medial ankle sprain?

Answer 14

tensile loading to medial ligaments are rare (deltoid ligament- triangular shaped broad ligament)
decreased weightbearing decreased ROM
10% of ankle sprains are to the medial aspect

Question 15

what are common MOI for medial ankle sprains?

Answer 15

usually due to overexertion of deltoid ligament due to chronic ankle instability
severe trauma resulting in outward twisting of the ankle, which is usually accompanied by a fibula fracture

Question 16

what are some examination findings for medial ankle sprains?

Answer 16

PROM eversion produces cc distal to medial malleolus, AROM ev pain
pain with palpation over deltoid ligament
ligament stability testing-MSR

Question 17

what are some important differential diagnoses for medial ankle sprains?

Answer 17

PTTD
charcot foot
navicular foot
medial malleolus fracture
fibular fracture

Question 18

how do we treat ankle sprains?

Answer 18

75-100% of patients have good to excellent outcomes
most treated non-operative
treatment consists of short period of protection, early ROM and WB
with grade 3 ruptures, casting or removable boot may be added
return to full activity may be in 2-8 weeks

Question 19

how is the body function/structure affected in syndesmosis injuries?

Answer 19

injury to the distal tib-fib joint
disruption of the interosseous membrane
decreased WB, decreased ROM, decreased stair climbing ability due to increased pain with ankle DF
less than 10% ankle sprains are at the distal tib-fib joint

Question 20

what are common MOI for syndesmosis injuries?

Answer 20

trauma- leg rotation upon a planted floor, while the ankle is in a neutral or DF position
forced dorsiflexion

Question 21

what are some chief complaints for syndesmosis injuries?

Answer 21

pain in anterior distal shin
difficulty with ambulation and stair climbing

Question 22

what are some common examinations findings for syndesmosis injuries?

Answer 22

may not be a palpably painful area
decreased ROM (DF>PF)
distal tib-fib joint stress tests- MSR
radiographic stress tests
delayed identification, delayed healing times

Question 23

what is chronic ankle instability (CAI)?

Answer 23

10-30% of lateral ankle sprains will become chronic
frequent sprains, leading to elongated and ineffective tissue stability result in loss of stability, proprioceptive ability can result in CAI
“copers” vs continue with CAI

Question 24

what are some risk factors for CAI?

Answer 24

not using prophylactic bracing
not participating in exercise-balance program
poorer function performance after a lateral ankle sprain, poorer dynamic postural control and lower self-reported function after 6 months
higher BMI in military members

Question 25

when are CAI non surgical?

Answer 25

when it is functional and can be fixed by PT “coper”

Question 26

when are CAI surgical?

Answer 26

when it is mechanical- lengthened beyond patients control

Question 27

what are some important differential diagnoses for CAI?

Answer 27

fibularis tendon pathology
accessory ossicles
tarsal coalition
sinus tarsi syndrome
subtalar sprains with or without instability
spring or bifurcate ligament damage
ankle impingement

Question 28

what technique is the surgical reconstruction for CAI?

Answer 28

bronstorm technique