Ankle History

Question 1

Goals of Ankle History

Answer 1

Determine the following:
•chief complaint (ie, report)
•mechanism of injury
•patient’s occupation
•location and severity of the condition
•which activities/positions aggravate symptoms
•nature and behavior of symptoms
•specific structure at fault
•presence of any systemic conditions

Question 2

Area/Nature/Behavior of Symptoms

Answer 2

• Determine if swelling occured and time of onset
• Snap, crack, or pop at time of injury could indicate
ligamentous injury or fracture
• Report of ankle feeling unstable after trauma also
indicative of ligamentous injury
• Inability to bear weight, severe pain, rapid swelling
indicate serious injury
o e.g. capsular tear, fracture, grade III ligament sprain

Question 3

Neurologic or Systemic Conditions

Rule out Systemic Sources

Answer 3

diabetes mellitus (peripheral neuropathy),
osteomyelitis, gout and pseudogout, sickle cell disease, complex regional pain
syndrom (CRPS)/ or Reflex Sympathetic Dystrophy (RSD), peripheral vascular disease, RA

Question 4

Neurologic or Systemic Conditions

Rule out neurological sources

Answer 4

Nerve root involvement of L4,L5,S1, or S2,

peripheral nerve entrapment, or Morton’s neuroma

Question 5

Warning signs for more insidious conditions:

Answer 5

o immediate and continuous inability to bear weight indicating possible fracture
o nocturnal pain indicating malignancy, hemarthrosis, fracture, or infection
o Gross pain with ankle valgus and distal fibula tenderness indicating possible
fibula fracture
o pain and weakness with resisted eversion indicating possible fracture of fifth
metatarsal bases
o Calf pain, swelling with pitting edema, increased skin temp, superficial venous
dilation, cyanosis, possibly indicating DVT (Deep Vein Thrombosis–requires immediate medical
attention!)
o Warmth or coldness felt in foot. Warmth could indicate tumor in pelvic or lumbar
region. Cold could indicate vascular problem.

Question 6

Mechanism of Injury

Answer 6

Remember patient’s recollection of MOI does not necessarily correspond to structures damaged!
•Determine if injury is traumatic vs insidious onset
•Ankle sprains most often occur when ankle is in PF, inversion, and adduction (ATFL)
•History involving sudden changes in training pattern may indicate overuse injury (increase in intensity, volume, training surface, different shoe type)
oe.g. achilles tendinitis, stress fracture, plantar fasciitis
•Dorsiflexion injury with snapping and pain on lateral aspect of ankle that rapidly diminishes may indicate tear of fibular retinaculum
•In absence of trauma, determine if patient has recently changed activity intensity, training surface, body weight, or shoe wear.

Question 7

Patient’s Occupation

Answer 7

• Effect of injury on patient’s life has large impact on early intervention
• Rigid immobilization for patients requiring painless ambulation for work
• Functional immobilization is more appropriate for patients needing to return to sport

Question 8

Location and severity of pain

Need to know this chart!

Answer 8

1. body diagram and visual analog scale helpful to determine location and severity of pain
2. Determine whether distribution is associated with structure, dermatome, peripheral nerve, or systemic in nature

Question 9

Aggravating Activities/Positions

Answer 9

1. Pain lingering or occurring after activity is suggestive of overuse or chronic injury
2. Pain primarily occurring during activity suggest stress on injured structure

Question 10

Ankle Outcome Measures

Answer 10

Foot and Ankle Disability Index
American Orthopedic Foot and Ankle Score
Foot and Ankle Disability Index Sport
VISA-A questionnaire for Achilles Tendinopathy