The Ankle

Question 1

what ligaments make up the lateral ankle ligaments/lateral collateral ligaments (3)

Answer 1

Posterior talofibular ligament (PTFL)
calcaneofibular ligament (CF)
anterior talofibular ligament (ATFL)

Question 2

what are the ligaments of the medial ankle

Answer 2

deltoid ligaments (4)

Question 3

what 2 places can you take a pulse on the ankle/foot?

Answer 3

1. dorsal pedis
2. posterior tibial

Question 4

what is the ‘true ankle joint’

Answer 4

talocrural joint

Question 5

what does the talocrural joint
1. allow movement for
2. limit movement for
3. which ligaments is it supported by (medial & lateral side)

Answer 5

1. dorsiflexion & plantar flexion
2. inversion & eversion
3. medial- deltoid, lateral- all 3 lateral collateral ligaments

Question 6

what 3 bones form the talocrural joint and what else is it called?

Answer 6

talus, fibula & tibia
also called the mortis

Question 7

what movement/displacement is prevented by the malleoli

Answer 7

medial & lateral displacement

Question 8

what movement(s) is the ankle most and least stable in?

Answer 8

most- dorsiflexion
least-plantar flexion (most suseptible position for ankle sprain)

Question 9

why are inversion ankle sprains more common than eversion?

Answer 9

because the lateral malleoli sits lower on the ankle than the medial malleoli. So this allows the foot to turn in easier than to turn out

Question 10

what are normal active ROM for ankles & what does normal gait require?

Answer 10

dorsiflexion 20 degrees
plantarflexion 30-50 degrees
normal gait- 10 degrees dorsiflexion & 20 degrees plantarflexion

Question 11

define stance phase

Answer 11

time spent in weight bearing or in contact with the ground

Question 12

define step

Answer 12

sequence of events from a specific point in the gait on one extremity to the same point in the opposite extremity

Question 13

define step length

Answer 13

distance traveled between the initial contacts of the right and left foot

Question 14

define stride

Answer 14

2 sequential steps

Question 15

define stride time

Answer 15

time required to complete a singlr stride

Question 16

causes of over use injuries to the lower limb (10)

Answer 16

-prolonged training season
-impact force of activity
-training or competing on hard surfaces
-change of training surfaces
-downhill running
-muscle weakness
-high milage or sudden change in milage
-overtraining
-wrong type of footwear
-uneven surfaces

Question 17

soft tissue function: anterior tibiofibular ligament

Answer 17

helps prevent splaying of the tibia and fibula

Question 18

soft tissue function: posterior tibiofibular ligament

Answer 18

helps prevent splaying of tibia & fibula

Question 19

soft tissue function: deltoid ligament

Answer 19

resits eversion

Question 20

soft tissue function:anterior talofibular ligament

Answer 20

resist inversion

Question 21

soft tissue function: calcaneofibular ligament

Answer 21

resist inversion

Question 22

soft tissue function: posterior talofibular ligament

Answer 22

resist inversion

Question 23

what are the 3 main functional demands of the ankle

Answer 23

-absorption
-propulsion
-stability

Question 24

functional tests of the ankle (6)

Answer 24

-walk on toes
-walk on heels
-walk on lateral boarder of feet
-walk on medial boarders of the feet
-hop on injured ankle
-passive, active & resistive movements manually applied to the ankle

Question 25

inversion ankle strain 1. caused by what type of ankle movement (etiology) 2. MOI

Answer 25

1. caused by excessive inversion & plantar flexion 2. MOI: from transfer of weight, running, jumping, landing

Question 26

what (and list) the ottawa ankle rules

Answer 26

-Used to determine need for radiograph (x-rays) 1. if there is pain in malleolar or midfoot area 2. inability to bear weight for 4 steps at the time of examination 3. tenderness over inferior or posterior pole of either malleoli 4. tenderness along base of 5th metatarsal or navicular

Question 27

what does the Buffalo modification focus on?

Answer 27

tenderness along fibula

Question 28

how can a fibula fracture happen in an inversion ankle sprain?

Answer 28

talus overcompensates and jams into the fibula and breaks the distal end of the fibula

Question 29

etiology & S/S of grade 1 inversion ligament sprain

Answer 29

etiology: occurs with mild inversion & plantar flexion -stretches the anterior talofibular ligament (ATFL) -minimal/slight tearing of the fibers S/S: pain/swelling on the anterolateral aspect of the malleolus -point tenderness over AFTL -no laxity with stress testing

Question 30

etiology & S/S of grade 2 inversion ligament sprain

Answer 30

etiology: moderate inversion force (with or without plantar flexion) -moderate tearing of fibers S/S: tearing or popping sensation felt on the lateral aspect -pain/swelling on anyterolateral and inferior aspect of lateral malleolus -Ecchymosis -painful palpation of ATFL + CFL - tender over deltoid and PTFL -positive anterior drawer test -antaglic (painful) gait -functional instability

Question 31

why is there tenderness in the deltiods on a grade 2 ligament inversion sprain

Answer 31

the deltoid ligaments get compressed and pinched by the medial malleolus

Question 32

etiology & S/S of grade 3 inversion ligament sprain

Answer 32

etiology: complete rupture of one or more lateral ligaments -caused by significant force of inversion + plantar felxion - can cause damage to the capsule S/S: -severe pain, swelling, hemarthrosis, discoloration -unable to bear weight -positive tatlar tilt and anterior drawer test -functional & clinical instability

Question 33

define hemarthrosis

Answer 33

bleeding into a joint

Question 34

eversion (medial) ankle sprain etiology

Answer 34

- injury to medial deltoid ligaments - resulting from forceful eversion movement - from excessive plantar flexion, sometime dorsiflexion -takes longer to heal and can involve fibular fracture

Question 35

S/S of eversion ligament sprain

Answer 35

-severe pain -unable to bear weight -point tenderness over deltiod ligament -tenderness over anterior tibiofibular ligament -pain to mortis if there is a fracture

Question 36

why is eversion ligament sprains less common than inversion ligament sprains?

Answer 36

fibula sits lower & makes it harder to evert your foot

Question 37

general rules for ankle sprain management

Answer 37

1. immediate treatment: - protection -modified loading -pain -edema control -restoration of ROM as soon as possible 2. when using ice: - ice packs should not be applied directly on the skin -ice can be applied directly on the skin. Secured with tensor bandage 3. apply horseshoe for additional compression 4. crutches if limping 5. incorporate rehab as soon as weight bearing is possible 6. rule out fractures (ottawa ankle rules)

Question 38

order of operations (NICE/RICE/PIER)

Answer 38

can do any just include: rest ice compress elevate pressure NSAIDS (if wanted)