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Cook Children’s 1

Ankle Examination

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Lower Extremity Injuries The History

• How, When and Where ?

• Swelling?

• Ability to Ambulate?

• Did you hear or feel a Pop?

• Did you Relocate an Injured part?

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Lower Extremity Injuries The History

• How, When and Where ?

• Swelling?

• Ability to Ambulate?

• Did you hear or feel a Pop?

• Did you Relocate an Injured part?

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Lower Extremity InjuriesThe Physical Examination

• Have the patient demonstrate the

area of maximal tenderness

• Use one finger to localize

tenderness

• Is the tenderness located over the

bone or the soft tissues?

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Injury Terms:

Sprain vs Strain

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Sprains

Severity:

• Grade I - min. structural disruption

• Grade II - partial disruption

• Grade III - complete disruption

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Physeal Fracture Patterns

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Salter IV Distal Tibia

Fracture

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Physeal Fracture of the Fibula

• Sprain vs. Fracture

• Weak link in the chain

• Clinical diagnosis !

• Radiographic

“confirmation”

Ankle Ligament Anatomy

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Ankle Anatomy

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Ankle Examination

• Palpate for tenderness

• Look for swelling

• Range of Motion

• Test muscle groups

• Stability

• Hindfoot and Midfoot Motion

• have the patient stand if possible and also

toe or calf raises to assess foot motion

and position 12

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Ankle Examination

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Ankle Examination -

Calf Raise

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Notice the recreation of the arch and

tilt of the heel inward demonstrating

normal mobility of the hindfoot and

midfoot with the rise of the heel off the

floor

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Ankle Examination for

Stability

• Anterior/Poste

rior Drawer

• Medial and

Lateral

Stability

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Inversion and

Eversion Testing

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Os Trigonum

• Posterior talus

• Usually an incidental

finding

– Pain

– Snapping/popping

• Occasionally

symptomatic after

trauma or repetitive use

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Os Trigonum

• DDx: Plica, OCD

• Treatment– Usual conservative

measures

– Inject

– Cast

– Excise (rare)

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Sever’s Disease

• This condition occurs secondary to stress at the calcaneal physis.

• MOI is same as Osgood Schlatter’s of knee, overuse.

• Cessation of activity and referral.

• Minimum 6 weeks of immobilization.

Ankle Sprains

• Most Involve the Lateral

Side

• 1/3 lead to more than 2

weeks

of disability

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Ankle Sprains

• Extremely Common

• Frequency in Basketball: 70%

• Severe Grade: 32%

• Recurrence: 80%

• Rehab / Prevention

Ankle Bracing

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Lisfranc Injury

Lisfranc Injury• Mechanisms:

– longitudinal

– twist

– bend

• Treatment:– Identify or suspect !

– Splint, Ice, Elevate,

– Early referral to

– Ortho for ORIF

Forefoot InjuriesForefoot Injuries

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Metatarsal Stress Fracture