Lecture 6 - Ankle and Foot Ax

Question 1

on the court/field peripheral joint assessment

Answer 1

• history of symptoms (what, where, how)
• active (ROM and pain levels) / passive (non-contractile) / resisted
• activate EAP?
• ask athlete if they can get up (protect, support, control)
• help athlete off the field
• reassess off field

Question 2

sideline peripheral joint assessment

Answer 2

1. History
   - LODRFICARA
2. Observation
   - skin colour/temp/bruising
   - deformities, swellings, atrophy, hypertrophy
3. ROM
   - Active (ROM)
   * athlete does movement without therapist
   * assesses ROM and pain verses uninjured side
   - Passive (non contractile)
   - therapist moves athletes joints through ROM
   - stabilize above and below joint in question
   * assess ROM, quality of movement, apprehension to movement and pain
   - Resisted (contractile tissue)
   * isometric contractions (hold 5s)
   * test muscle strength and contractile tissues
4. Special Tests
   - ROM testing helps narrow down what structures are injured
   - isolate the structure that is suspected of being injured
   - palpations
   *perform last, previous tests will narrow the sear

Question 3

epidemiology of ankle sprains

Answer 3

• ankle injuries occur more in females then males
• account for 10-12% of injuries across all age groups
• lateral or inversion sprains are the most common
• high ankle sprains account for 1-11% of ankle sprains in gen pop, but 40-75% in athletes

Question 4

how to test for inversion ankle sprain

Answer 4

MOI: plantar flexion and inversion; most commonly sprained ligament is the ATFL, followed by CFL
- observations
- special tests
* inversion talar tilt
* anterior drawer

Question 5

how to test for eversion ankle sprain

Answer 5

MOI: eversion and external rotation (abduction of the foot coupled with internal rotation of the lower limb)
- observation
- special test
* eversion talar test

Question 6

ankle sprain management

Answer 6

• RICE
• taping and bracing
• helpful in reducing reoccurrence of ankle sprain
• literature is mixed on which is better
• ROM
• strengthening
• balance
• functional/sport specific exercises
• RTP

Question 7

how to test for a high ankle sprain

Answer 7

MOI: hyperpronation (external rotation, eversion, abduction), hyperdorsiflexion/hyperplantar flexion, axial loading or another athlete falling onto the fixed athlete
- observations
- special tests
*forced dorsiflexion

Question 8

management of high ankle sprains

Answer 8

more conservative approach
- PRICE principles
supportive tabing and bracing limit hyperdorsiflexion, external rotation, and hyperpronation

Question 9

muscular conditions of the ankle/foot

Answer 9

shin splints and compartment syndrome

Question 10

turf toe

Answer 10

MOI: hyperextension of the MTP joint
- observations
* swelling
* ecchymosis
* misalignment
- Palpation
* collateral ligament and joint capsule
- ROM
- special tests
* varus and valgus

Question 11

turf toe management

Answer 11

• RICE
• taping or bracing
• further management depends on severity

Question 12

when do we X-ray the ankle and/or foot (ottawa)

Answer 12

X-ray ankle if…
- bone tenderness with palpation of the distal 6cm of the medial or lateral malleolus
- inability to weight bear for 4 steps immediately and in ED
X-ray foot if…
- bone tenderness with palpation of the navicular or the base of the fifth metatarsal
- inability to weight bear for 4 steps immediately and in ED

Question 13

stress fracture of the foot

Answer 13

also know as a march fracture
- common in soldiers
consider REDs or female athlete triad