Chapter 5. Objectives. Normal Ankle Range of Motion. Lateral Ankle Sprains. Lateral Ankle Sprains. Assessment of Lateral Ankle Sprains

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1 Objectives Chapter 5 Assessment of Ankle & Lower Leg Injuries Review the following components of injury assessment related to the ankle and lower leg Stress tests Special tests Normal Ankle Range of Motion Lateral Ankle Sprains Dorsiflexion Plantarflexion Inversion Eversion plantarflexion inversion discoloration (subacute) pain along lateral ankle Lateral Ankle Sprains Assessment of Lateral Ankle Sprains Palpation of key landmarks ATF CF PTF Lateral malleolus Cuboid Sinus tarsi Base of 5 th Metatarsal Peroneal Tendons Anterior Drawer assesses integrity of ATF ligament 1

2 Assessment of Lateral Ankle Sprains Assessment of Lateral Ankle Sprains Anterior Drawer assesses integrity of ATF ligament Inversion Talar Tilt assesses integrity of calcaneofibular ligament Assessment of Lateral Ankle Sprains Medial Sprains Stress x-ray dorsiflexion eversion external rotation discoloration (subacute) pain along medial ankle Lateral Medial Sprains Assessment of Medial Ankle Sprains Palpation of key landmarks Deltoid Ligament anterior tibiotalar tibionavicular tibiocalcaneal posterior tibiotalar medial malleolus lateral malleolus sustentaculum tali navicular talocrural joint Eversion Talar Tilt assesses integrity of deltoid ligament vary amount of DF/PF to stress different parts of ligament 2

3 Assessment of Syndesmotic (High) Ankle Sprains forced dorsiflexion external rotation pain along anterolateral aspect of ankle superior to ATF may also report pain along anterior deltoid pain with forced dorsiflexion Syndesmotic (High) Ankle Sprains Palpation of key landmarks AITF PITF Interosseous Membrane Lateral Malleolus Proximal Tibiofibular Joint Length of Fibula Assessment of Syndesmotic (High) Ankle Sprains Kleiger Test (External Rotation Test) primarily assesses integrity of anterior tibiofibular ligament also stresses the deltoid ligament Ankle & Lower Leg Fractures compression torsion shear tensile deformity pain Assessment of Ankle & Lower Leg Fractures Heel Tap Test/Bump Test Assessment of Ankle & Lower Leg Fractures Pott s Compression (Squeeze Test) 3

4 Assessment of Ankle & Lower Leg Fractures On-the-field concerns check distal pulses control bleeding immobilize fx site prior to removing from field monitor & treat for shock Stress Fractures May involve tibia, fibula, or talus Pre-disposing factors Narrow tibial shaft Excessive ER of hip Pes cavus Testing X-ray Bone scan /Symptoms Gradual onset along shaft of bone Activity = worse; rest = better Weakness Cramping Point tenderness at a single spot Ankle Dislocation Os Trigonum Injury Excessive rotation with INV or EV Loss of function Snap or crack Malalignment Anterior displacement of talus Separation of Steida s Process from talus Forced DF or PF Impinges surrounding structures causing symptoms Swelling TTP btw Achilles and talus in PF Tx Boot/cast until painfree Possible orthotic or surgery Achilles Tendinitis Achilles Tendinitis Anatomic factors Direct blow TTP Crepitus Tight triceps surae group Thickening of tendon Burning Pre-disposing factors Tibial varum Calcaneovalgus Hyperpronation Foot rigidity Tightness of triceps surae and hamstrings Running mechanics Duration and intensity of running Type of shoes Running surface Biomechanics of foot and ankle Age Gender 4

5 Achilles Tendinitis Achilles Tendon Rupture Peritendinitis Inflammation of tissues surrounding the tendon Tendinosis Degeneration of tendon Tendon Rupture Complete tear of tendon Forceful, sudden contraction Weakness in PF, inability to push off Visible defect C/o being kicked in leg Achilles Tendon Rupture Achilles Tendon Rupture CONSERVATIVE Advantages No wound problems Decreased medical costs Disadvantages Increased rate of rerupture Decreased function Patient dissatisfaction compared to sx repair SURGICAL Advantages >5% rate or re-rupture Greater return to preinjury activity Return of PF strength, power, endurance Disadvantages Surgical complications Wound healing Thompson s Test Assesses for function of Achilles tendon Tarsal Tunnel Syndrome Anterior Compartment Syndrome Tinel s Sign gently tap over posterior tibial nerve assesses for injury/ inflammation of posterior tibial nerve Traumatic direct blow Acute Exertional symptoms occurring during activity due to pressure increase Chronic Exertional occurs secondary to anatomic abnormalities obstructing blood flow /Symptoms Pallor (redness) Pulselessness Paresthesia Paralysis 5

6 Anterior Compartment Syndrome On-Field Assessment Acute injury medial emergency REFER Chronic with activity, with rest Tested Measure compartment pressure MRI After fasciotomy Wound healing Restore ROM and strength Goals: Rule out fracture and dislocation Determine weight-bearing status Identify best method for removing athlete from field On-Field Assessment Remove shoe AFTER r/o fx & dislocation Then remove tape or brace History Determine MOI Sound/Sensations Inspection Palpation Bony, then soft tissue ROM Willingness to move limb and bear weight Questions??? 6

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