Ankle EvaluationAnkle EvaluationAnkle EvaluationAnkle 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 5th

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– Pain @ site of injury indicative of a fx– Vibration of tapping along the long

axis of the bones will exaggerate pain @ 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

– 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

Equinas Deformity• Causes:

– Congenital– Casting or

crutching– High Heeled shoes– Diabetes

• TX:– Heel lifts– Splints– Orthotics– Physical therapy– Surgery