ankle case

Question 1

epidemiology of ankle sprain

Answer 1

• most common ankle joint injury
• lateral ligament most common
• indoor sports e.g., basketball carry greatest risk

Question 2

aetiology of ankle sprain

Answer 2

• fall that causes ankle to twist
• exercising on uneven surfaces
• previous history of sprain
• another person stepping or landing on foot
• rapid shift of body mass over the weight bearing foot

Question 3

which ligament is most commonly injured in ankle sprain and how?

Answer 3

• anterior talofibular ligament
• when plantarflexed foot is forcefully inverted

Question 4

which ligaments are least likely to get injured?

Answer 4

• calcaneofibular
• posterior talofibular

Question 5

how do medial sprains occur?

Answer 5

• by forceful pronation and rotation movements of the hind foot

Question 6

what are the symptoms of a sprained ankle?

Answer 6

• pain
• tenderness
• bruising
• swelling
• limited ROM
• instability

Question 7

which special tests can be conducted for an ankle sprain?

Answer 7

• anterior drawer test
• talar tilt
• squeeze test

Question 8

how is the anterior drawer test conducted?

Answer 8

• patient placed in prone position with ankle extending beyond bed
• talofibular head stabilised
• heel held and anterior force applied
• positive result: excessive anterior movement of foot and dimpling of skin beside Achilles tendon

Question 9

how is the talar tilt conducted?

Answer 9

• patient seated
• foot positioned in 10-20 degrees plantarflexion
• distal leg stabilised and hind foot inverted
• positive result: significant inversion as compared to other foot

Question 10

how is the squeeze test conducted?

Answer 10

• compression of proximal fibula against tibia
  positive = pain occurs indicating fracture/ diastasis

Question 11

what are the classifications of ankle sprain

Answer 11

grade I- slight stretching and damage to the ligament
grade II- partial tear of ligament
grade III- complete rupture of ligament

Question 12

classifications without imaging

Answer 12

grade I- mild impairment with minimal swelling and little impact on function
grade II- moderate impairment with moderate pain, swelling and tenderness
- decreased ROM and stability
grade III- severe impairment with significant swelling, loss of function+ instability

Question 13

how should a potential ankle sprain be assessed?

Answer 13

• take medical history
• observe gait, deformity, mal- alignment and swelling
• take note of tenderness
• assess passive and active ROM

Question 14

what is the goal of treatment of an ankle sprain?

Answer 14

• decrease pain and swelling
• protect ligament from further injury
• restore function and stability

Question 15

what is the common treatment protocol for an ankle sprain?

Answer 15

• PRICE
• protection through crutches, brace or tape

Question 16

what are the three stages of recovery?

Answer 16

• inflammatory phase
• proliferative phase
• remodelling phase

Question 17

describe the inflammatory phase treatment

Answer 17

• reduce pain and swelling via PRICE and NSAID’s
• provide support for joint

Question 18

describe the proliferative phase treatment

Answer 18

• improve weight bearing
• increase ROM
• prevent further injury
• brace/ tape can be used to reduce injury

Question 19

what is the remodelling phase treatment ?

Answer 19

• improves muscle strength, active stability, motion and mobility
• use of static and dynamic exercises

Question 20

which tests should be carried out to determine if you can return to normal activities?

Answer 20

• knee to wall test
• lower limb strength
• static balance test
• dynamic balance test
• agility test