Ankle Special Tests

Question 1

Ottawa Ankle Rule

Answer 1

Guideline to reduce costs and increase time effectiveness in ED setting by ruling out ankle/midfoot fractures in non-athletic adult population

Question 2

Ottawa Ankle Rule (Radiography recommend for patients):

Answer 2

i. 55 y.o or older
ii. unable to WB for 4 steps immediately after injury and in the ED/clinic
iii. bone tenderness at medial or lateral malleolus (inferior tip and distal 6 cm)
iv. bone tenderness at base of 5th MT, cuboid, or navicular

Question 3

Arc sign for achilles tendionopathy

Answer 3

1. Patient prone with foot over edge of table
2. Palpate the Achilles tendon 2-6 cm from insertion
   on calcaneus – identify area of thickening/swelling
3. Ask patient to actively PF/DF ankle while keeping
   maintain your hand position on the tendon
4. Does the area of thickening slide with PF/DF?
   a. (-) No – implicates the synovial sheath
   (tenosynovitis)
   b. (+) Yes – implicates the tendon itself
   (tendinopathy

Question 4

Royal London Hospital Test for Achilles Tendinopathy

Answer 4

1. Patient prone with foot over edge of table
2. Palpate the Achilles tendon 2-6 cm from insertion
   on calcaneus – identify area of tenderness
3. Ask the patient to actively DF the ankle and palpate
   again
4. (+) if less tender in DF (tendon on stretch) –
   indicates tendinopathy

Question 5

Anterior drawer test

Answer 5

-assessing for anterior talofibular ligament pathology or anterior portions of the deltoid ligament (anterior tibiotalur and tibionavicular)

(+) sign: pain, provocation of symptoms, or excessive anterior translation of the talus =

straight anterior movement/translation = medial and lateral ligament insufficiencies – indicating deep and superfical deltoid ligaments (ATL & anterolateral capsule)

anterior translation on lateral side = ATFL and anterolateral capsule

anterior translation on medial side = deltoid ligament

Question 6

Talar tilt test

Answer 6

tests calcaneofibular ligament or deltoid ligament tears
(+) sign: pain occurs/provocation of symptoms or excessive gapping
Inversion stress: tests calcaneofibular ligament & anterior tibfib
Eversion stress: tests deltoid ligament (tibiocalcaneo ligameent)

Question 7

External rotation stress test

Answer 7

-syndesmotic instability (ankle sprain)
(+) sign: pain over anterior/posterior tibiofibular ligaments and interosseus membrane

-if pain medially & talus displaces from medial malleolus it could be a tear in the deltoid ligament

Question 8

Thompson’s test

Answer 8

(+) test: absence of expected plantar flexion when the calf muscle is squeezed which may indicate a rupture or 3rd degree strain of Achilles

Question 9

Syndesmotic instability tests

Answer 9

External rotation stress test

Medial subtalar glide test

Question 10

Neurological dysfunction tests

Answer 10

Tinel’s sign

Question 11

Ankle DVT risk assessment

Answer 11

Wells scale