Ankle Injury

Question 1

Overstretching or overuse of muscles/tendons

Answer 1

Strain

Question 2

Stretching and/or tearing of the ligaments that bind the joint. Occurs as the joint is forced beyond it’s normal ROM.

Answer 2

Sprain

Question 3

Minimal injury of an overstretched ligament resulting in mild pain and edema is a grade ___sprain.

Answer 3

Grade 1

Question 4

An incomplete tear of a ligament and includes some moderate functional impairment, ecchymosis, edema and discomfort with weight bearing is a grade___sprain.

Answer 4

Grade 2

Question 5

A full or complete tear of the ligament with the loss of ligament integrity is a grade___sprain.

Answer 5

Grade 3

Needs referral

Question 6

Talar tilt

Answer 6

examines stability of calcaneofibular ligament

Question 7

Squeeze test

Answer 7

Pain suggests tibiofibular syndesmosis ligamentous injury ie: high ankle sprain.

Question 8

What is the most common ankle injury?

Answer 8

Inversion injuries with plantar flexion
“rolled their ankle”
talofibular and calcaneofibular ligaments

Question 9

Ankle injury physical exam

Answer 9

Inspection (deformity, swelling, pain)
Palpation ROM (compare bilateral)

Question 10

Which of the following patients would you refer to an orthopedic specialist?
A. A 42 year old female with a first time Grade 1 ankle sprain.
B. A 30 year old male who had an eversion ankle injury while playing soccer.
C. A 54 year old male who had a Grade 1 ankle sprain 3 weeks ago and still has residual bruising.
D. A 20 year old female with pain and swelling to the lateral malleolus, limited range of motion of the ankle, and tenderness over the 5th metatarsal.

Answer 10

ANS: B

Question 11

If the patient hears a “pop” followed by immediate swelling and bruising consider…..

Answer 11

fracture of the distal malleoli

Question 12

When is the best time to examine a patient after an injury?

Answer 12

Right away or in 4-5 days due to swelling obstructing the ability to examine.

Question 13

Thompson test

Answer 13

achilles tendon test
Squeeze the calf; great toe of that foot should go down; if it doesn’t, suspect an achilles tendon tear [surgical emergency]

Question 14

How do you treat eversion injuries?

Answer 14

Refer to ortho

Question 15

Ottawa Ankle rules

Answer 15

• X-ray the ankle if
   o Pain near the malleoli, or bony tenderness at the 
      posterior tip of either malleolus
   o Inability to bear weight
   o Severe injury
• X-ray the foot if
   o Pain in the midfoot
   o Inability to bear weight
   o Bony tenderness at the base of the fifth metatarsal

Question 16

What diagnostic test do you do for a fracture?

Answer 16

Plain x-ray

Question 17

What diagnostic test to you do for an occult fracture?

Answer 17

MRI

Question 18

What diagnostic test to you do for a stress fracture?

Answer 18

Nuclear med bone scan

Question 19

What diagnostic test to you do for a metastasis?

Answer 19

Nuclear med bone scan

Question 20

How long does it take for acute pain to resolve?

Answer 20

10-14 days. Compensatory movements start after that.

Question 21

When is plantar fasciitis pain the worst?

Answer 21

First thing in the morning

Question 22

What does Windlass test for?

Answer 22

Plantar fasciitis

dorsiflex the toe

Question 23

Treatment for plantar fasciitis

Answer 23

Stretching (rolling ball on the heel)
Taping to prevent over pronation
NSAIDs

Question 24

What is pes planus and congenital vertical talus (extreme)?

Answer 24

flat foot

Question 25

What is talipes equinovarus

Answer 25

clubfoot

Question 26

What is the treatment for talipes equinovarus?

Answer 26

serial casting and physical therapy

Question 27

Patient history for an ankle injury

Answer 27

• Mechanism of injury (was it an inward/outward twist)
• Crack or pop?
• Able to bear weight?
• Immediate pain or swelling
• Bruising present?
• Previous ankle sprains

Question 28

Ankle injury management

Answer 28

• R-I-C-E
• Crutches if non–weight bearing
• Splint (air cast)
• NSAIDs
• Physical therapy for Grade 2 or 3
• No improvement after 10 days: bone scan if fracture suspected
• X-ray not necessary for sprain

Question 29

When do you refer an ankle injury?

Answer 29

• Eversion injury
• Grade 3 sprain
• No improvement after 2–3 wks or instability
• Neurovascular compromise
• Tendon rupture or subluxation

Question 30

Which of the following is the biggest risk factor for an ankle sprain?

Wear high-heeled shoes
Prior knee sprain
Prior ankle sprain
Playing basketball

Answer 30

Prior ankle sprin

Question 31

Which of the following elements on physical exam would indicate the possibility of ankle fracture and should be evaluated by x-ray?

Ability to bear weight on the affected ankle
Tenderness over medial malleolus
Swelling of affected ankle
Bruising of affected ankle

Answer 31

Tenderness over medial malleolus

Question 32

A school-age child with an acute ankle inversion injury resulting in lateral ankle pain and swelling is most likely to have which of the following injuries?

Sprained anterior talofibular ligament (ATFL)
Sprained deltoid ligament
Muscle strain
Fracture of the growth plate at the distal fibula

Answer 32

Fracture of the growth plate at the distal fibula

Question 33

A 30-year-old male is seen in the office for ankle pain. While playing basketball he jumped and landed on the lateral edge of his foot. He had immediate pain and did not continue playing, but was able to walk after the injury.
P/E : His right ankle has tenderness, swelling, and bruising over the anterior talofibular and calcaneofibular ligaments. There is no bony tenderness.
Which one of the following would be most appropriate at this point?

A) Taping the ankle for future sports participation
B) An elastic compression wrap
C) A lace-up ankle support
D) A radiograph of the ankle
E) A below the knee cast

Answer 33

C) A lace-up ankle support