8977 Lecture Notes - Lecture 10: Arthropathy, Greenstick Fracture, Avulsion Fracture
3 Jul 2018
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Department
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Professor
ANKLE INJURIES
Common/ Less Likely/ NTBM?
Objective Examination
Expose ankle (deformities, postural defects, scars, swelling, bruising, and wounds)
Use *for issues. Don’t need to do every test. Explain if you don’t.
Always test unaffected side first.
Articular/Muscular tests
Ottawa rules if pt cannot weight bear (any pain straight to xray)
Observe (standing, walking, supine. Consider hips, knees, ankles, foot position)
Functional tests (SLS, knee to wall, heel raise, hop, jump, squat, lung)
AROM (DF, PF, INV, EV)
PROM (all ROM at joint; overpressure if restricted – measure with goni. Look for end feel)
Resisted (both sides simultaneously, all ROM at joint)
Palpation
Neurological tests – pins and needles/tingling. Reflexes, UMN, neural mobility (SLR, clonus, tapping)
Vascular tests - Peripheral pulses (make sure both sides are even) and capillary return (squeeze toes)
Special tests
Anterior drawer (ATFL) – draw heel up and away
Talar tilt Inversion (CFL) – plantar grade, INV
Talar tilt Eversion (middle deltoid band) – plantar grade, EV
Whitmore lower quadrant (Ant deltoid band) – PF, ER, EV
Squeeze test (sydesmosis, ATiFL) – 10cm above ankle
Lisfranc valgus –EV, IR
Piano key (Lisfranc) – PF, move 2nd phalange
Bifurcate – INV, varus force
Prone:
Whitmore lower quadrant (PTFL) –DF, ER, INV
Whitmore lower quadrant (Post deltoid band) –DF, IR, EV
Syndesmosis –DF, ER
Thompson test (achillies tear) – squeeze calf, foot should move
Diagnosis
Rule out less likely and NTBM. Rationalise why you have come to your conclusions.
Intervention (treatment for today and in future)
Acute phase
Support/ Protect/ Maintain:
Bandage ankle if swollen
Braces (air cast – syndesmosis, lateral ankle sprain. Moon boot – heeling fractures. Fracture – non-weight bearing with
crutches and get MRI)
Taping for stability and support (ankle, mid foot, plantar fascia, Lo-Di, orthotics)
Peroneals – isometrics then resisted movement with theraband as tolerated
Manage pain and inflammation: RICER and Electrophysial agents (EPAs). No HARM
Subacute phase
Regain ROM:
PPM – DF, PF, INV, EV movements as tolerated.
PAM – posterior talar glide.
Stretches as feels comfortable 2x30secs is optimal.
Soft tissue therapy
Regain control: DLS even weight, tandem stance (stride), SLBEO, SLBEC, wobbles, tramp weight shift, catch and throw.
Make sports specific.
Regain strength: Gastrocs and soleus – theraband, CKC (towel, floor) then OKC (PF, DF). Peroneals – isometric
resistance, shuttle runs.
Regain function/ proprioception: ADLs, steps and stairs, lateral shuffle, figure 8s, shuttle run, hop step, Newman
hop+hold, hexagon hop. Then back to sport/ activity after trial.
find more resources at oneclass.com
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Document Summary
Expose ankle (deformities, postural defects, scars, swelling, bruising, and wounds) Ottawa rules if pt cannot weight bear (any pain straight to xray) Functional tests (sls, knee to wall, heel raise, hop, jump, squat, lung) Prom (all rom at joint; overpressure if restricted measure with goni. Resisted (both sides simultaneously, all rom at joint) Vascular tests - peripheral pulses (make sure both sides are even) and capillary return (squeeze toes) Anterior drawer (atfl) draw heel up and away. Talar tilt inversion (cfl) plantar grade, inv. Talar tilt eversion (middle deltoid band) plantar grade, ev. Whitmore lower quadrant (ant deltoid band) pf, er, ev. Squeeze test (sydesmosis, atifl) 10cm above ankle. Piano key (lisfranc) pf, move 2nd phalange. Whitmore lower quadrant (post deltoid band) df, ir, ev. Thompson test (achillies tear) squeeze calf, foot should move. Rationalise why you have come to your conclusions. Braces (air cast syndesmosis, lateral ankle sprain. Fracture non-weight bearing with crutches and get mri)
