ankle evaluation. history how did this injury occur? –mechanism of injury when? where does it...
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Ankle EvaluationAnkle EvaluationAnkle EvaluationAnkle Evaluation
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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?
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Observation• Obvious deformities• Discoloration/ecchymosis• Swelling• Muscle Atrophy / bilateral symmetry• Foot abnormalities
– Toes, arches, callous formation
• Gait / Shoe wear patterns
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Bony Palpation• Fibula• Tibia• Talus• Navicular• Phalanges• Cuboid
• Cuneiforms• Metatarsals• Base of the 5th
metatarsal• Lateral Malleolus• Medial Malleolus• Calcaneous
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Soft Tissue• Gastrocnemius• Soleus• Tibialis Anterior• Posterior Tibialis• Fibularis (formally known as the
Peroneals)– Longus– Brevis– Tertius
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Ligaments/Tendons• Anterior Talofibular• Calcaneofibular• Posterior Talofibular• Deltoid• Posterior Tibiofibular• Anterior Tibiofibular• Achilles Tendon
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Bursa• Retrocalcaneal bursa
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Range of Motion• Passive ROM• Active ROM• Resistive ROM
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Dermatomes
• L1 – S2
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Special Tests• Anterior Drawer• Talar Tilt• Side to Side Test• Thompson Test• Tap or Percussion Test• Compression Test• Equinas Deformity• Functional Testing
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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
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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
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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
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Tap or Percussion Test• Position
– Lying Supine– Foot off Table
• Action– Examiner puts ankle in max
Dorsiflexion– Apply firm tap to heel
• Positive Findings– Pain @ site of injury indicative of a fx– Vibration of tapping along the long
axis of the bones will exaggerate pain @ the fx site
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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
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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
– Pain @ site indicative of a Fx– Compressing two bones together may
exaggerate the pain @ Fx site• Special Considerations
– Avoid if obvious deformity is present– NOT EXCLUSIVE of a Fx
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Equinas Deformity• Causes:
– Congenital– Casting or
crutching– High Heeled shoes– Diabetes
• TX:– Heel lifts– Splints– Orthotics– Physical therapy– Surgery