Ankle Viva Questions Flashcards
- What are the potential hypothesis for this patient?
Elstein = 4/5 differential diagnosis’
Medial Ankle
Deltoid ligament injury
Tarsal tunnel syndrome
Tibialis posterior tendinopathy/dysfunction
Flexor hallucis longus tendinopathy/dysfunction
Flexor digitorum longus tendinopathy/dysfunction
Navicular stress fracture
Medial malleolus fracture
Plantarfascitis
Medial tibial stres syndrome
Lateral Ankle ATFL/CFL/PTFL strain Peroneal longus/brevis dislocation/strain/tendinopathy Base of 5th metatarsal fracture Lateral malleolus fracture Syndesmosis injury
Posterior Ankle
Achilles rupture/tendinopathy
Gastroc tear
Foot
Lisfranc fracture/dislocation
Mortons neuroma
- Specific questions to aid diagnosis?
Previous knee or hip injury?
More details regarding aggravating factors
More details regarding psychological factors
- What is the basic anatomy of the ankle?
Medial Ankle Tom - Tibialis posterior Dick - Flexor digitorum longus And - Posterior tibial artery Very - Posterior tibial vein Nervous - Tibial nerve Harry - Flexor hallucis longus Deltoid ligaments
Lateral Ankle
ATFL, CFL, PTFL
Peroneal brevis/longus
Ankle/Foot Bones
Joints - Talocrural, Subtalar, Midfoot, Distal Tib-Fib
Tibia, fibula, talus, calcaneus, navicular, cuboid, 3 cuneiforms, 5 metatarsals, phalanges (proximal, middle, distal)
Muscles
Gastroc, soleus, flexor digitorum longus/brevis, extensor digitorum longus/brevis, flexor hallucis longus/brevis,
extensor hallucis longus/brevis, tibialis anterior, tibialis posterior, peroneus longus/brevis, plantaris
Plantarfascia
- Red flags specific to the ankle?
Fracture
Cellulitis
Deep vein thrombosis (DVT)
Peripheral arterial occlusion disease (PAD)
Compartment syndrome
Septic arthritis
Swelling within the joint
Hx of trauma
Unable to weightbare
How would you rule in or out the following injuries? Tarsal tunnel syndrome Plantarfascitis Flexor & Extensor hallucis/digitorum longus Tendinopathy/dysfunction Tib post tendinopathy/dysfunction Fracture ATFL, PTFL, CFL strain Deltoid ligament strain Syndesmosis Navicular stress fracture Medial tibial stress syndrome Achilles rupture Gastroc tear Mortons neuroma Lisfranc fracture/dislocation
Order reflects patients severity and irritability
Tarsal tunnel syndrome = Tinnels sign
Plantarfascitis = Palpation of proximal insertion of plantarfascia on medial calcaneus
Flexor & Extensor hallucis/digitorum longus tendinopathy/dysfunction = muscle testing
Tib post tendinopathy/dysfunction = foot posture index, navicular drop test, resisted PF + inversion (start in eversion)
Fracture = Ottowa Rules
ATFL, PTFL, CFL strain = Talar tilt/palpation
Deltoid ligament strain = Eversion / palpation
Syndesmosis = Squeeze test / ER + DF test
Navicular stress fracture = Palpation of naviculaer tuberosity
Medial tibial stress syndrome = Palpation of distal 1/3 of medial tibia positive if pain
Achilles rupture = Observation, Thompson test, palpation
Gastroc tear = Muscle testing
Mortons neuroma = Squeeze test
Lisfranc fracture/dislocation = Forced DF + Abd
In young patients who is important to get involved to help resolve psychosocial issues?
Family & coaches
- Outcomes measures?
SF-36 = QOL measurement (anxiety)
Foot and Ankle disability measure = High sens, spec and reliability
- Advice for treatment?
Educate and reassure patient regarding condition
Offload
PRICE
Advice on load management
Increase strength
Manual therapy
Proprioception/balance
Knee and hip?
- Nociceptive pain, peripheral neuropathic pain or central sensitisation? Or a combination?
Nociceptive pain = Sensitisation of peripheral nerves
Somatic referred pain = Nociceptive pain referral
Peripheral neuropathic pain = Nerve root pain (+ve dermatomes, myotomes, reflexes) Nerve trunk pain (weakness and change in sensation that does not follow a myotomal or dermatomal pattern)
Central sensitisation = Sensitisation of the central nervous system due to continuous nociceptive firing
How would you structure your objective assessment and why?
Severity and irritability
General structure Observation Joints above and bellow Palpation AROM PROM MMT Special tests Neruodynamic testing Functional testing
- General red flags?
Hx of cancer
Constant progressive unremitting night pain
Unexplained weightloss
Radiotherapy / chemotherapy
Anticoagulants
IV drug abuse
Long-term steroid abuse
Alcohol and drug abuse
Osteoporosis
Rheumatoid arthritis
Diabetes
Epilepsy
Asthma
Cardiac and circulatory problems
Cauda equina symptoms
5Ds & 3Ns - Diplopia, dysarthria, dysphagia, nystagmus, numbness, nausea
Pregnancy
Hx of trauma
Poor general health
During the SLR neurodynamic test, how can you bias the nerves in the lower leg?
SID - Sural nerve, Inversion and DF
PIP - Peroneal nerve, Inversion and PF
TED - Tibial nerve, Eversion and DF
