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Feb 27 ch 15 ankle and lower leg.doc

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University of Alberta
Physical Education and Sport
Brad Kern

Feb 27 – Ch 15 Ankle and Lower Leg Assessing the Lower Leg and Ankle History • Past history • MOI • When does it hurt? • Type of, quality of, duration of pain? • Sounds or feeling? • How long were you disabled? • Swelling? Location of swelling can tell you a lot of things. If swelling is inferior and interior to the lateral malleolus, we can have a general idea of what is going on. • Previous treatments? If they have had this injury before, what has previously been used on the injury before and has it worked? Observations • Postural deviations? It takes a long training process to correct postural deviations • Genu valgum or varum? Genu valgum (knock knees) is when the knees touch but ankles don't touch. Varum is when the knees bow out together. Lateral ligaments will be more apt to injuries • Is there difficulty with walking? If someone has an injured ankle, they wont want to plantarflex or dorsiflex. • Deformities, asymmetries, or swelling? For asymmetries, we have to do bilateral comparison. • Colour and texture of skin, heat and redness? Look for signs of inflammation • Patient in obvious pain? • Is ROM normal? Palpation • Begin with bony landmarks and progress to soft tissue. If we find our lateral malleolus, we can find certain ligaments and muscles. • With palpation we need to remember TIC (tenderness, instability and crepitus) • Attempt to locate areas of deformity, swelling and localized tenderness Special Tests – Lower Leg Percussion/bump and Compression tests • This tests assess the talus and fibula • A shockwave is sent through calcaneus, tibia, fibula, talus • If you sprain your ankle, you wont feel any pain from a bump test. • Used when fracture is suspected • Percussion test is a blow to the tibia, fibula or heel to create vibratory force that resonates within fracture causing pain • Compression test involves compression of tibia and fibula either above or below site of concern • For compression test, we squeeze the tibia and fibula together. This will cause the bone to bend. If the bone is fractured, we will see sharp and point specific pain Ankle Stability Tests Anterior drawer test • Used to assess anterior talofibular ligament primarily and other lateral ligament secondarily • This test can be done with a patient lying down or sitting down. • A positive test occurs when foot slides forward and/or makes a clunking sound as it reaches the end point Talar Tilt Test • Performed to determine extent of inversion or eversion injuries • These talar tilts all isolate different ligaments • Calcaneus is inverted and excessive motion indicates injury to calcaneofibular ligament and possibly the anterior and posterior talofibular ligaments • If the calcaneus is everted, the deltoid ligament is tested • When
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