Ankle Evaluation

History How did this injury occur? –Mechanism of injury When? Where does it hurt? Did you hear any sounds or feel a pop? Any previous Hx? Pain Levels and types of pain Training Methods Did you continue activity? Shoe type/playing surface Brace/taped?

Observation Obvious deformities Discoloration/ecchymosis Swelling Muscle Atrophy / bilateral symmetry Foot abnormalities –Toes, arches, callous formation Gait / Shoe wear patterns

Bony Palpation Fibula Tibia Talus Navicular Phalanges Cuboid Cuneiforms Metatarsals Base of the 5 th metatarsal Lateral Malleolus Medial Malleolus Calcaneous

Soft Tissue Gastrocnemius Soleus Tibialis Anterior Posterior Tibialis Fibularis (formally known as the Peroneals) –Longus –Brevis –Tertius

Ligaments/Tendons Anterior Talofibular Calcaneofibular Posterior Talofibular Deltoid Posterior Tibiofibular Anterior Tibiofibular Achilles Tendon

Bursa Retrocalcaneal bursa

Range of Motion Passive ROM Active ROM Resistive ROM

Dermatomes L1 – S2

Special Tests Anterior Drawer Talar Tilt Side to Side Test Thompson Test Tap or Percussion Test Compression Test Equinas Deformity Functional Testing

Anterior Drawer Position –Seated with knee flexed to 90 –Involved foot is slightly plantar flexed Action –Stabilize the Tibia and Fibula –Apply an anterior force to the Calcaneus and Talus Positive Finding –Anterior translation of the talus –Opening up of the joint –Positive for Anterior Talofibular ligament sprain

Talar Tilt Position –Seated –Stabilize the distal Tibia –Grasping Talus Action –Start in Anatomical Position –Tilts Talus into Inversion Positive Findings –Increase Inversion on affected side –Positive for a tear of the Calcaneofibular Ligament

Thompson Test Position –Prone –Heels hanging off table Action –Gastrocnemius – Soleus complex relaxed –Squeeze the belly of the muscle Positive Findings –Normal: foot plantar flexion –Positive: absence of plantar flexion upon squeezing –Rupture of Achilles Tendon

Tap or Percussion Test Position –Lying Supine –Foot off Table Action –Examiner puts ankle in max Dorsiflexion –Apply firm tap to heel Positive Findings site of injury indicative of a fx –Vibration of tapping along the long axis of the bones will exaggerate the fx site

Side to Side Test Position –Supine –Foot in max Dorsiflexion –Stabilize Tibia and Fibula Action –Cupping the Calcaneous –Move side to side within the joint Positive Findings –Opening of the Tibiofibular joint or pain in the Anterior or Posterior Tibiofibular ligament –Positive for “high ankle sprain” or a sprain of the Anterior Tibiofibular Ligament

Compression Test Position –Lying Supine (may be seated) –Ankle/Foot off of the table –Examiner notes location of pain Action –Squeezes Tibia and Fibula away from painful area Positive Findings site indicative of a Fx –Compressing two bones together may exaggerate the Fx site Special Considerations –Avoid if obvious deformity is present –NOT EXCLUSIVE of a Fx

Equinas Deformity Causes: –Congenital –Casting or crutching –High Heeled shoes –Diabetes TX: –Heel lifts –Splints –Orthotics –Physical therapy –Surgery