Week 8 Lecture 8A - Foot and Ankle

Question 1

In pronation in the CKC, what motion(s) does the talus and calcaneus do?

Answer 1

Talus - plantar flexes and adducts

Calcaneus - everts

Question 2

Tibial Torsion - Angle between femoral condyles and malleoli

- degrees lateral rotation = normal
Excessive lateral torsion - Effect on foot function?

Medial malleolus – more anterior compared to the lateral – causes mortus to be angled out

If it is 25 degrees, they’ll be turned out – longer (Supination/Pronation) / excessive (supination/pronation) if they are turned out. Compensation could be dropping into valgus.

Answer 2

13-18; pronation; pronation

Question 3

Ankle Pain

Do you need x-rays?
Ottawa Ankle Rules

Radiographic series is only required if
there is any pain in the (forefoot/malleolar) zone AND (TWO/ANY) of these findings:

Bone tenderness at posterior edge or tip of lateral malleolus or,
Bone tenderness at posterior edge or tip of medial malleolus or,
Inability to bear weight both immediately after injury and in emergency department or clinic

Answer 3

malleolar; ANY

Question 4

Foot Pain

Do you need x-rays?
Ottawa Foot Rules

Radiographic series is only required if there is ANY
 pain in (forefoot/midfoot) zone AND (TWO/ANY) of these findings:

Bone tenderness at base of 5th metatarsal, or
Bone tenderness at the navicular, or
Inability to bear weight both immediately after injury and in emergency department or clinic

Answer 4

midfoot; ANY

Question 5

Ankle Fractures

Maisonneuve
(IR/ER) of foot > force separates tib/fib : (syndesmosis sprain)
Fx proximal fibula
Fx distal tibia (medial malleolus)

MOI: (IR/ER) force through ankle

ER force opens up the syndesmosis

Answer 5

ER; ER;

Question 6

Anatomy

Lateral ligamentous complex

Anterior talofibular ligament
ATFL
Taut with foot in 10 deg (DF - EVERSION/PF - INV)

Calcaneofibular ligament
CFL
Taut with foot in 0 deg (DF - EVERSION / PF - INV)

Posterior talofibular ligament
PTFL
Provides (sagittal/transverse) plane rotary stability

CFL – taut in neutral

Really important to know this information

Answer 6

PF-INV; PF-INV; transverse

Question 7

Injury Pattern

Vast majority of ankle sprains occur in (PF/ADD/INVERSION / DF/ABD/EVERSION)
Ankle “roll over”

Isolated (CFL/ATFL): 73% lateral ankle sprains (Fong)
ATFL + CFL: 20% (Brostrom)
ATFL + CFL + PTFL – less common.
All 3 with more severe sprains / ankle dislocation

Maximum load to failure of the CFL is 2 – 3.5 times (lower/higher) than the ATFL

Most are inversion sprains

Answer 7

PF/ADD/INVERSION; ATFL; higher’

Question 8

Classification

Grade (I/II) - Mild
Ligament stretch without macroscopic tear
Little swelling, mild tenderness
No instability

Grade (I/II) - Moderate
Partial macroscopic tear
Moderate pain, swelling, tenderness
ROM, mild to moderate instability

Grade (II/III) – Severe
Complete ligament rupture
Marked swelling, tenderness
Abnormal ROM and instability

Grade each ligament individually

Answer 8

I; II; III

Question 9

Ankle Sprains

Medial:
Less common
Mechanism? (Inversion/Eversion)
Ligaments involved? (ATFL/Deltoid)
Same grading
Fibular fx?

Answer 9

Eversion; Deltoid

Question 10

Syndesmotic Ankle Sprains(High Ankle Sprain)

Mechanism of Injury
Excessive (PF/DF)
(IR/ER) moment with foot in (DF/PF), (supinated/pronated) position
Foot is fixed to ground, (ER/IR) of the leg and body in respect to the foot

Excessive df opens up the mortus

Answer 10

DF; ER; DF; pronated; IR

Question 11

Rehabilitation of Ankle Sprains

Acute phase

Caution with what motion?

(eversion/inversion) for lateral sprains
(eversion/inversion) for medial sprains
Rotation ((DF/PF)) for syndesmosis sprains

RICE

Answer 11

inversion; eversion; DF