Ankle Stability/ Lateral Ankle Sprains

Question 1

What considerations should you have during initial assessment in those with LAS?

Answer 1

Age 
BMI 
Report of instability 
Pain with WB 
Ankle DF ROM 
Medial Joint line tenderness 
Balance 
Ability to jump/ land

Question 2

What special tests should you do to determine LAS

Answer 2

Reverse anterolateral drawer test
Anterolateral talar palpation
Traditional Anterior drawer test

Question 3

Describe anterior drawer test

Answer 3

Support foot with forearm and grasp heel while pushing posterior on tibia
OR you can stabilize in DF with towel under foot and push tibia posterior
Positive- more laxity compared to non-affected side or dimple at ATFL area

Question 4

What outcome measures should you use for CAI?

Answer 4

Cumberland Ankle Instability Tool

Identification of Functional Instability

Question 5

What outcome measures for Acute LAS?

Answer 5

Foot and Ankle Ability Measure- FAAM
LEFS
PROMIS- Patient- reported Outcome measure information system
CAT- physical function Computer adaptive test

Question 6

What physical exam to complete for Acute LAS, post acute LAS, or CAI

Answer 6

Ankle swelling 
ROM 
Talar translation 
talar inversion 
dorsiflexion in WB lunge test 
SL balance- EC 
Dynamic balance- star excursion test (> 3 cm difference)

Question 7

What interventions/ exercises to do for First time LAS?

Answer 7

Bracing (or taping) and progressive weight bearing
Protected AROM, stretching
Proprioceptive and balance exercises

Question 8

In severe injuries, what intervention would you recommend? for how long?

Answer 8

Semi- rigid bracing to below- knee casting for grade 3- short periods of 10 days or less. 4 weeks or longer= poor outcomes

Question 9

What manual techniques for acute/ post acute LAS?

Answer 9

lymphatic drainage
Active and passive soft tissue and joint mobilization
anterior to posterior talar mobilization

Question 10

Should you use U/S for LAS?

Answer 10

NO

Question 11

What are the recommendations for physical agents for LAS?

Answer 11

level C for:
Low level laser therapy- acute
Shortwave diathermy- reducing edema and gait
Cryotherapy- intermittent

Question 12

What interventions are recommended for CAI?

Answer 12

Manual- graded joint mobilizations, NWB and WB joint mobilizations and MWM to increase ROM, proprioception and WB tolerance
Proprioception and NM exercises

Question 13

What about dry needling?

Answer 13

Grade C evidence for fibularis in combo with proprioceptive exercises

Question 14

what % of people seek medical attention

Answer 14

50% individuals

Question 15

what age range is most prevalent for LAS

Answer 15

12 years or younger

Question 16

Incidence of LAS male to female

Answer 16

Double in females

Question 17

What sports is LAS most common with?

Answer 17

Court sports- volleyball, basketball

Question 18

Name some coexisting pathology with LAS

Answer 18

Trigonum syndrome
Osteochondral injury
Syndesomotic, deltoid, or subtalar ligament injuries
Talonavicular, calcaneonavicular, and calcaneocuboid joint injuries
Fibularis muscle injuries
Nerve pathologies

Question 19

What sensorimotor findings would you expect with CAI

Answer 19

1. Abnormal timing of muscle at ankle, knee, hip
2. Decreased strength/ force output at ankle
3. Impaired force/ proprioception at ankle
4. Decreased ankle DF at ankle
5. Increased subtalar and midfoot motion
   Can be in both limbs*

Question 20

Describe the weight bearing lunge test

Answer 20

AKA knee to wall test 
Perform in kneeling and measure distance
10-15 cm is considered normal 
Anterior pain- joint restriction 
posterior pain- soft tissue tension 
> 2.5 cm difference indicated in LAS

Question 21

Regarding hip strength- what is incidence in correlation with LAS?

Answer 21

Decreased ABD and extensor strength increases risk

Question 22

When performing hop test, what would indicate increased risk for LAS?

Answer 22

more than 12 change in support errors (shuffling, jumping on support foot, removing hands from iliac crest, putting non-support foot down)

Question 23

What physical characteristics (body type) leads to recurrent LAS/ CAI?

Answer 23

height >191 cm (6 foot 2)

Mass > 100 kg (220 lbs)

Question 24

What recommendations should you make for athletes wanting to return to sport?

Answer 24

1st time sprain- ~2 weeks
Severe injuries- ~3 weeks
Full return to participation expected 1 day- 3 weeks but full recovery without limitations could take months/ years

Question 25

What if an osteochondral injury is noted on XR?

Answer 25

MRI or CT w/o contrast

Question 26

Is U/S a good diagnostic for LAS?

Answer 26

Not usually

Question 27

What about NSAIDS for LAS?

Answer 27

Less pain for the first 2 weeks- oral/ topical

Diclofenac- superior results compared to piroxicam and Ibuprofen