Ankle Pathologies Flashcards
Fractures (Traumatic) - SUBJECTIVE
Pott’s Fracture – A fracture affecting one or both malleoli, often due to an inversion injury. Common in high-impact sports like football and rugby. Can be difficult to distinguish from a severe ligament sprain.
Fractures (Avulsion) - SUBJECTIVE
Small bone fragments are pulled off by tendon or ligament forces, commonly occurring at:
- Medial Malleolus – Can occur with excessive eversion injuries.
- Base of the 5th Metatarsal – Linked to the pull of peroneus brevis and tertius tendons.
Fractures (Stress) - SUBJECTIVE
Tibia, 5th Metatarsal, 2nd Metatarsal (March Fracture) – Overuse fractures common in runners and military personnel. Pain worsens with activity and eases with rest.
Fractures - OBJCTIVE
- Palpation
- Observation and functional task, e.g. gait
- Active range of motion
Severs Disease (Calcaneal Apophysitis) - SUBJECTIVE
- Involves inflammation at the growth plate of the calcaneus due to repetitive stress.
- Common in physically active sporty children.
- Pain is localized to the heel, especially after activity.
- Pain on isometric plantarflexion
Severs Disease (Calcaneal Apophysitis) - OBJECTIVE
- Observation and palpation
- Pain on isometric plantarflexion often at the back of the heel.
Anterior Ankle Impingement (footballer’s ankle) - SUBJECTIVE
- MOI - Due to repetitive dorsiflexion trauma, osteophytes form on the anterior tibia or talus, restricting movement and causing pain in activities requiring full dorsiflexion, such as football and ballet
- PMH - Ankle sprains causing reduced proprioception
- SH - Sports that require full dorsiflexion, e.g. footballers, dancers, athletes
Anterior Ankle Impingement (footballer’s ankle) - OBJECTIVE
- Palpation: pain at joint line
- Passive movement: symptomatic in full dorsiflexion
- Active movement: symptomatic in full dorsiflexion
Osteoarthritis - SUBJECTIVE
- Degenerative joint disease with progressive cartilage loss.
- Location of symptoms: most common in 1st MTPJ
- Gradual onset or post trauma
- > 45 years
- Joint pain related to activity and weight-bearing
- Mild swelling
- No morning stiffness lasting longer than 30 mins
- Pain and stiffness increases throughout the day.
Osteoarthritis - OBJECTIVE
- Passive/Accessory motion: non-contractile structures
- Observation: mild effusion, hallux valgus
- Calluses or blisters over bony changes (osteophytes)
- Active range
Rheumatoid Arthritis - SUBJECTIVE
- Chronic inflammatory arthritis, often affecting the foot in up to 90% of cases
- Up to 90% have foot problems
- Location: MTPJ, subtalar, talocrural and mid-tarsal
- Early morning stiffness for longer than 30 mins
- Swelling and heat
- General health as it’s systemic: feeling unwell (malaise), fatigue, low grade fever
- Extra-articular-rheumatoid nodules, vasculitis, pulmonary, fibrosis, carditis, ocular disease
Rheumatoid Arthritis - OBJECTIVE
- Palpation: swelling and temperature
- Observation: swelling
- Passive/accessory range of motion: non-contractile structures
Muscle injuries and tenonitis - SUBJECTIVE
- Rupture - achilles tendon rupture
- Strains - gastrocnemius
- Tendonitis: achilles, peroneal, tibialis posterior, FHL
- Mechanism of injury: sudden (strain/rupture) versus gradual onset (tendonitis)
Muscle injuries and tendonitis - OBJECTIVE
- Muscle testing: contractile tissue
- Palpation to locate pain
- Pain on passive movement in opposite direction
- Pain during isometric contractions if muscular injury.
Shin splints/medial tibial stress syndrome - SUBJECTIVE
- Pain (ache) increase during or after exercise. Reduces with rest. Worse when running on hard, non-compliant surfaces
- Pain located in lower 2/3 of tibia
- High BMI
- SH: athletes who run and jump e.g. netball, tennis, gymnastics
- Training overload
Shin splints/medial tibial stress syndrome - OBJECTIVE
- Palpation: pain on palpation along the posteromedial border of tibia > 5 cm
- Tibialis posterior, flexor digitorum longus and soleus muscles are overloaded.
- Can associate with: pronation, increased ankle plantar flexion and increased hip external rotation
Plantar fasciitis - SUBJECTIVE
- Location of pain: medial heel and midfoot pain
- Worse on standing in the morning and when bare foot
- More common in females
- PMH: obesity
- SH: Prolonged standing/walking
Plantar fasciitis - OBJECTIVE
- Palpation
- Passive DF and toe extension
- Associated with reduced dorsiflexion
Ligament Injuries - SUBJECTIVE
- Mechanism of injury: excessive inversion. “twisted ankle”
- Swelling and bruising
- Difficulty weight-bearing
- X-ray shows no fracture
Ligament Injuries - OBJECTIVE
- Passive movements: inversion reproduces symptoms
- Accessory movements: anterior draw to test instability anteriorly
- Palpation
