Ankle Pathologies Flashcards
Lateral Ankle Sprain: Affected Anatomy
16-40% of all sports injuries are ankle sprains.
ATFL: 65% of cases affect the ATFL
CFL: 20% of cases affect the AFTL+CFL
PTFL: least commonly affected due to placement; only in extreme cases
Lateral Ankle Sprain: Grading System
Grade 1: mild strain, <10% damage
Grade 2: partial ligament tear, 11-49% damage
Grade 3: complete tear, 50% + damage
Lateral Ankle Sprain: Mechanism of Injury
Twisting inwards after planting the foot. Plantarflexion and inversion
Lateral Ankle Sprain: observation
Palpation: pain on ligaments, if the injury is hot the grade is likely higher, pain on lateral malleolus, fluid/swelling
RoM: inversion and eversion limited, plantarflexion and dorsiflexion limited
Strength: Modified Oxford Scale - pain on plantarflexion and dorsiflexion; decrease in RoM but no change in strength; grade on strength
Visual: Inability to weight-bear, swelling around lateral malleolus (bottom of fibular), in grade 2+, there is usually bruising from the lateral aspect of the foot extending to the Peroneal tendons, bruising around the lateral aspect of the foot.
Lateral Ankle Sprain: Functional Ability and Tests
Figure of 8 hop test/balance testing
Single-leg stance/side hop
Talar tilt Test
Anterior Drawer Test
Syndesmosis Injury: Affected Anatomy
Around 20% of ankle ligament injuries and can be difficult to diagnose. Syndesmosis: joint where two bones are held together.
Injury to distal tibiofibular region, usually a traumatic injury, made up of tibia, fibular and four ligaments.
Transverse ligaments, IOL, AITFL, PITFL
Syndesmosis Injury: Grading System
Grade 1: mild injury, some damage to the AITFL, stable syndesmosis, one special test positive
Grade 2: Stable or unstable, special tests are positive, complete disruption of AITFL and IOL
Grade 3: Joint is unstable and there’s widening of the syndesmosis, all clinical tests positive, complete disruption to AITFL, IOL, PITFL, and deltoid ligament avulsion
Grades on injury to ligaments and which ligaments are affected.
Syndesmosis Injury: MoI
Excessive external rotation while the ankle is in maximal dorsiflexion; causing a widening between the tibia and fibula
Syndesmosis Injury: Joint Assessment
Remember to palpate the tibiofemoral joint space. Similar to lateral ankle sprain; tenderness will be more medial than lateral. Specialist joint tests have high sensitivity but low specificity; good ability to identify people with the condition, but aren’t good at ruling it out
Syndesmosis Injury: Special Tests
Syndesmosis Squeeze
External Rotation Stress Test
Deltoid Ligament Strain: Affected Anatomy
Anterior tibiotalar ligament
Posterior tibiotalar ligament
Tibionavicular ligament
Tibiocalcaneal ligament
Only 3-5% of ankle injuries involve the deltoid ligaments; very rare; more complex and can result in chronic ankle stability
Deltoid Ligament Strain: Classification
Type 1: proximal tear or avulsion
Type 2: middle of the ligament, intermediate tear
Type 3: distal tear or avulsion
Refers to anatomical location rather than proportion of damaged fibres
Deltoid Ligament Strain: Observations
Localised pain and swelling, bruising that may spread to the heel, pop or tearing feeling at the time of injury, difficulty walking/weight-bearing, instability at the joint, restricted RoM
Deltoid Ligament Strain: MoI
The opposite of a lateral ankle sprain.
Eversion of the ankle at the subtler joint in an off-balance pronated foot position
Achilles Tendinopathy: Symptoms
Loss of function, pain, swelling
Achilles Tendinopathy
Chronic onset of symptoms due to degeneration or failed healing due to continuous overload and inadequate recovery. Can occur at any point of the tendon but the mid-point is the most common.
Tendons have a very poor blood supply; healing process is difficult to normal tissues.
Achilles Rupture
Most at risk population between 30-50 years old. Most likely tendon to rupture due to it being subjected to high stress, common in contact injuries.
Most ruptures occur at the hypovascular zone where healing is very slow and 90% injuries occur during acceleration or deceleration; a sudden force of plantarflexion
Achilles Rupture Risk Factors
Asymmetry of the tibia (tibiavara)
Insufficient gastrocnemius/soleus flexibility
Caveous foot
Football, basketball and racquet sports at most risk
Plantar Fasciitis
Around 80% of help pain is diagnosed as plantar fasciitis. People with flat foot are at higher risk. Likely due to overuse but the cause is unknown.
Plantar Fasciitis: Symptoms
Stiffness
Worse in the morning
Eases with rest
Dull ache around the foot
Medial Tibial Stress Syndrome (Shin Splints)
Diagnosed through subjective history and objective assessment with almost perfect reliability. Over-use condition affecting the posteromedial tibial border. Likely over-diagnosed; no more than 25%; common in runners and the military. Women and people with high BMI are more at risk.
Shin Splints: Objective Assessment
Palpation is important; if the area is localised >5cm, consider stress fracture.
The area should be large
Shin Splints: CECS (Chronic Exertion Compartment Syndrome)
Fascia around structures gets tight and obstructs blood flow to an area.
Exercise induced
Pain
Numbness
Stress Fractures
Fatigue reaction caused by a sudden increase in load which the body cannot cope with; loading a bone that is already impaired.
Imaging preferred if suspected, but they don’t always show up on scans.
More common in sports involving running and jumping.
Palpation is reliable <5cm
Haglund’s Deformity
Bone growth on the heel near the Achilles tendon.
Caused by tight Achilles tendon, tight narrow shoes, over-training, high arches, genetic predisposition
Extensor Tendinopathy
Tendinopathy affecting the extensor tendons on the foot
Traumatic Fractures
Obvious
Turf Toe
Sprain of the big toe, usually can’t be helped
Bursitis
Inflammation of the bursa
Compartment Syndrome
Increase in pressure inside a muscle restricting blood flow to an area
