Foot and Ankle Injuries Today’s lecture can be viewed at in … · 2019-02-04 · Eversion/Medial...

1

Foot and Ankle Injuries

in Athletics

Thomas W Kaminski PhD ATC

FNATA FACSM RFSA

Professor

Director of Athletic Training Education

University of Delaware

Todayrsquos lecture can be viewed at

the following URL address

httpsitesudeleduchs-ateplectures

We most likely will not get

through all these slides today

however the presentation is

thorough and complete and will

make for an excellent study

guide for the BOC

examination

Good Luck

Learning

ldquoAll of life should be a

learning experience not

just for the trivial

reasons but because by

continuing the learning

process we are

challenging our brain

and therefore building

brain circuitryrdquo

Arnold Scheibel

A First State

Fact

Delaware is 96 miles

long and varies from

9 to 35 miles in

width

UD is located here

2

Athletic Training amp Sports

Health Care The Journal for the

Practicing Clinician

httpwwwhealioco

mjournalsatshc

Laboratory Manualto accompany

Rehabilitation Techniques in Sports Medicine

and Athletic Training

6th Edition

httpswwwhealiocombooksathletic-

training7b927168ac-1da2-422c-b98e-ae9013d4e15b7drehabilitation-techniques-for-

sports-medicine-and-athletic-training-sixth-edition

Perhaps ATCrsquos Need to Incorporate

this Into Their Assessment SchemeAnatomical Review

Cyriax- ldquoDiagnosis

is only a matter of

applying onersquos

anatomyrdquo

3

Lower Extremity ~ Foot


Clinical PEARL

Navicular Palpation

bull Palpated 2-3 cm

anteroinferior to

the medial

malleolus

bull More prominent

with foot adducted


4

Radiographically Viewed

Ankle Joint (Medial View)

1 Fibula

2 Tibia

3 Ankle joint

4 Promontory of tibia

5 Trochlear surface of talus6 Talus

7 Posterior tubercle of talus

8 Calcaneus

9 Sustentaculum tali10 Tarsal tunnel

11 Navicular

12 Cuneiforms

13 Cuboid

Challenge

yourself to

identify the

anatomical

structures

Articulations

The Ankle Mortise Major Lateral Ligaments

5

The Medial ldquoDeltoidrdquo Complex Ankle Syndesmosis

IOM = Interosseous

membrane

IOL = Interosseous

ligament

AITFL = Anterior

inferior Tibiofibular

Ligament

PITFL = Posterior


Ligament

The Subtalar Joint The Ligaments of the Subtalar Joint

6

WOW

Muscular Anatomy

Compartments of the Leg

bull Anterior

Medial (Tibial Bone)

Lateral (PeronealFibularis

Region)

Posterior

Superficial

Deep

Anterior

7

Lower-Leg Compartment

ContentsLower Leg Musculature

Anterior Posterior

Tibialis Anterior Extensor Digitorum Longus

8

PeronealsCan you tell

which one

At what bony

landmark do they

bifurcate

Posterior Compartment (S)

Plantaris


Soleus

Posterior Compartment (D)

TOM

DICK

9


HARRY

Note we

have

excised

the TampD

Talocrural and

Subtalar Joint Motion

Talocrural Joint Subtalar Joint

HAS ANYONE

SEEN FERRIS

Circa 1986

Can

anyone

name this

voice

Ben

Stein

Selected Injuries Involving the

Ankle Region

10

InversionLateral Sprains

bull 85-95 of all ankle sprainsndash lateral malleolus extends

further

bull medial acts as a fulcrum

ndash weaker lateral ligs

bull MOI

ndash inversion (CF lig)

ndash inv + pf (ATFCFTibFib ligs)

bull most common mechanism

bull ROndash ldquopush-offrdquo fxrsquos of medial

malleolus

ndash other associated fxrsquos amp nerve injury

Ankle Sprain - Risk Factors

Consequences of an Acute Ankle Sprain

bull Most commonly injured structures in 547 patients with soft tissue injuries due to an acutely twisted ankle

ndash Presented to emergency room or occupational medicine clinic

bull ldquoInjuryrdquo based on pain at site of structure

ndash Anterior Talofibular Lig (83)ndash Calcaneofibular Lig (67)

ndash Posterior Talofibular Lig (34)

ndash Deltoid Lig (32)

ndash Ankle joint capsule (32)

ndash Dorsum of foot (20)

ndash Sinus tarsi (16)

ndash Peroneals (15

ndash Bifurcate Lig (8)

ndash Syndesmosis (6)

bull Most common clinical presentations

ndash ATFL + CFL = 34ndash ATFL + CFL + PTFL = 31ndash ATFL only = 16ndash Other = 14ndash PTFL only = 2ndash CFL only = 1

bull Most common primary diagnosesndash Grade 1 sprain = 71ndash Other = 15ndash Grade 2 sprain = 10ndash Grade 3 sprain = 3ndash Syndesmotic sprain = 1

Fallet et al J Foot Ankle

Surg 1998

11

RecommendationsThe purpose of this position statement is to present recommendations for certified athletic trainers and other allied health professionals in the conservative management and prevention of ankle sprains in athletes Our recommendations will be reinforced by relevant scholarly evidence currently available in peer-reviewed publications and graded according to the Evidence Category Taxonomy (SORT) Evidence Based Scale

Recommendations from Five (5) Different Categories

bull Diagnosis

bull Treatment and Rehabilitation

bull Return-to-Play Considerations

bull Prevention

bull Special Considerations

What is Evidence-Based PracticeCurrent State of AT Practice

Clinical Experience

Patient Values

Best Research

12

Evidence CategoriesSORT Taxonomy

Evidence Categories Made Simple

Level of Evidence

SORT Grade Clinical PracticeRecommendation

A Based on consistent and

good evidence

No brainer You should be doing this

in clinical practice

B Based on inconsistent or

limited-quality

evidence

Should probably include in our

clinical practice

C Based on consensus or

usual practice

Flip a coin --- it is up to you to decide

Clinical assessment of acute lateral ankle sprain injuries consensus

statement and recommendations of the International Ankle Consortium

AuthorsDelahunt E 12 Bleakley CM 3 Bossard

DS 12 Caulfield BM 14 Docherty CL 5

Doherty C 4 Fourchet F 6 Fong DT 7

Hertel J 8 Hiller CE 9 Kaminski TW 10

McKeon PO 11 Refshauge KM 9 Remus A 4 Verhagen EA 12 Vicenzino BT13 Wikstrom EA 14 Gribble PA 15

Clinical Diagnostic Assessment

Eamonn Delahunt et al Br J Sports Med

doi101136bjsports-2017-098885

13

Implementing the Position Statement Recommendations

httpswwwnataorgnews-

publicationspressroomstatementsposition

bull Section I Risk and Risk Reduction of

Ankle Sprains

bull Section II Diagnosis

bull Section III Treatment and Rehabilitation

bull Section IV Surgical

Considerations

Helpful Resource

httpswwwhealiocombooksathletic-training7b43034553-4c8b-

472d-98d2-aca4eefd4c487dquick-questions-in-ankle-sprains-expert-advice-in-sports-medicine

Did This 2012 JAT Article Make You Stop and Think About Current Ankle Sprain

Management

14

An Interesting Take on an

Old Practice

POLICE = Protection Optimal Loading Ice Compression and Elevation

BJSM 2016

15

The Future of Acute Ankle Sprain Treatment Intervention

Footbeat in Action

International Ankle Consortium Rehabilitation-Oriented ASsessmenT

(ROAST)

bull The International Ankle Consortium ROAST will help clinicians identify mechanical andor sensorimotor impairments that are associated with

chronic ankle instability (CAI)

bull This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle

sprain injuries

ROAST

16

OTTAWA ANKLE RULES

bull Developed to reduce the use of unnecessary radiographs in the diagnosis of acute foot and ankle injuries in emergency departments

bull Estimated only 15 of footankle injuries presenting to emergency departments are fractures

bull Use of these diagnostic rules have significantly reduced unnecessary x-rays

OTTAWA ANKLE RULES

Clinical PEARL

Ottawa Ankle Rules Palpation Points

bull Medial bull Lateral

Ankle Instability

17

Overview ndash Ankle Instability

bull Inversion ankle sprains are a frequent orthopedic injury

bull The majority of appropriately rehabilitated ankle sprains will do well but saying ldquothey all do wellrdquo is a misnomer

bull Symptoms

ndash pain

ndash feeling of giving way

ndash swelling

ndash recurrent injury

Chronic

Ankle Instability

Mechanical

InsufficienciesFunctional

Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired

Proprioception Impaired

Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002

Now This Takes Some Coordination Ankle Instability (Mechanical)

bull Definition

ndash lateral ligament laxity (Freeman et al - 1965)

ndash joint motion that exceeds physiologic motion (Tropp - 1985)

bull Assessment Tools

ndash anterior drawer test

ndash talar tilt

ndash roentgenographic studies (Telos Stress)

A fancy name for x-ray

18

Telos Stress X-RayLigMaster Stress with Musculoskeletal

Ultrasound Imaging

TALUS

FIBULA

AB

A represents Talofibular

Interval from MSUS

image

Instrumented Ankle ArthrometryAnkle Instability (Functional)

bull Definition

ndash disability to which patients refer when they say

the foot tends to ldquogive wayrdquo (Freeman et al -

1965)

ndash joint motion beyond voluntary control but not

necessarily exceeding physiologic ROM (Tropp

- 1985)

19

Ankle Instability (Functional)

bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle

Instability Tool (CAIT)

bull Designed to measure functional ankle instability

bull 9 questions related to subjectsrsquo perception of ankle stability during various activities

bull Shown to be valid and reliable

bull How do you score

ndash Maximum score = 30

ndash Scores lt 25 = ankle instability

The Cumberland Ankle Instability Tool A Report of Validity and Reliability Testing

Claire E Hiller MAppSc Kathryn M Refshauge PhD Anita C Bundy ScD Rob D Herbert PhDSharon L Kilbreath PhD Arch Phys Med Rehabil Vol 87 September 2006

20

EversionMedial Ankle Sprains

bull less common (5 - 15

prevalence)

ndash strong deltoid complex

ndash bony structure of ankle

mortise

bull MOI

ndash eversion + df (ruptures

deltoid + tibfib ligs)

bull RO associated fxrsquos

ndash rotation + eversion (fx

fibular shaft + sprain of

deltoid complex)

Syndesmotic Ankle Sprains

bull uncommon injury the ldquohigh ankle sprainrdquo

bull more disabling with prolonged recovery time

bull MOIndash forced df

bull talus located between malleoli forces bones apart

ndash damage to syndesmosis (fibrous sheath)

ndash forced rotation with a fixed foot

bull shape of the talus acts as a fulcrum forcing the tibia and fibula apart

17 - 74 of ankle injuries

among young athletes


bull Sx

ndash point tenderness and swelling localized over the anterior + posterior tibiofibular ligaments

ndash bilateral compression increases pain

ndash walk on toes

ndash inability to push off

bull Tx

ndash ICERS2

bull immobilization usually for a period of 2-3 weeks

ndash depends on the severity of mortise separation

ndash NSAIDrsquos

Clinical PEARL

Syndesmosis Palpation

bull Anterior Inferior

Tibiofibular

Ligament

bull Interosseous

Membrane

bull Posterior Inferior

Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space

(arrows) as a result

of disruption of the

syndesmosis The

clear space is

normally less than 5

mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014

Did this really happen Ankle Fractures

bull Ankle fractures are usually

defined as single malleolar

bimalleolar or trimalleolar

bull Isolated fibular fractures are

the most common type of

fracture and without

displacement usually requires

4-6 weeks to heal

Trimalleolar involves medlat

and posterior tibial malleolus

Tibial Plafond - the

articular surface of the

distal end of the tibia

22

Posterior Malleolar Fracture

Ankle Dislocation

bull Ankle dislocation

results from complete

disruption of articular

elements in the ankle

bull An isolated ankle

dislocation without

associated fracture is

quite rare

Acute Ankle Dislocation

23

Englandrsquos Physiotherapist (Gary

Lewin) Dislocates Ankle during

2014 World Cup --- Ughhhh

(Landed on a water bottle celebrating a goal)

Achilles Tendon Injuriesbull common tendon of the triceps surae (2 heads of

gastrocnemius amp soleus) inserting into the calcaneus

bull receives its greatest stress during knee extensionankle dorsiflexion

bull Tendinitis (aka tendonitis)

ndash most common form of tendinitis seen in athletics

ndash Et

bull overuse

ndash Sx

bull crepitus

bull inflammatory rxn

Can you think of a MOI

Triceps Surae Achilles Tendon Injuries

bull Tendinitis (conrsquot)

ndash Txbull cryotherapy

bull NSAIDrsquos

bull heel lifts

bull decreasemodify activity

bull stretchingstrengthening of gastrocsoleus

bull orthotics

bull gradual return to activity

bull Ruptures

ndash 75 seen in males 30 - 40 yr old who participate in intermittent activities

Chauncey Billups NBA ----

httpswwwyoutubecomwatchv=qGwnFAbDOZ8

24

Clinical PEARL

GastrocnemiusSoleus Stretch

Gastrocnemius Stretch

(Straight Knee)

Soleus Stretch

(Bent Knee)

Achilles Tendon Injuriesbull Ruptures (conrsquot)

ndash Sites

bull calcaneal insertion

bull 2-6 cm above insertion pt (poor vascularity)

ndash most common site of injury

bull M-T junction

ndash MOI

bull forced pf during knee extension

ndash common move during propulsion activities

bull sudden forced df of an already pf foot

ndash return from a jumping movement

ndash most common mechanism

Side View of Ruptured Achilles Tendon Notice

depression at site of rupture (red circle)

httpswwwinstagramc

ompBJqyDOphcnT

Achilles Tendon Injuries

bull Ruptures (conrsquot)

ndash Factors Contributing to Ruptures

bull microtraumainflammation

bull dominant extremity

bull age

bull steroid usage

ndash SignsSx

bull painful swollen calf

bull ecchymosis

bull palpable deformity

bull pf MMT = weakness

ndash Tx

bull pf splint 10deg-15deg NWB transport surgery

Achilles Tendon Rupture (Repaired)

25

Os Trigonum Syndrome (Posterior

Ankle Impingement)

bull Os Trigonum - D bone posterior stylus of the talus

ndash 7 of population has a free os trigonum (non-union)

bull Path

ndash traction apophysitis during early childhood caused the separation

bull FHL irritates the bone as it passes by

bull PF motions impinge the posterior process

Os Trigonum Syndrome

bull Sx

ndash painful amp limited pf

ndash pain on great toe flexion

bull Dx Tests

ndash bilateral x-rays (feet pf)

ndash bone scans or MRI

bull Tx

ndash symptomatic therapy

(conservative)

ndash surgical intervention in

some cases

Differential Diagnosis

A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum

Distal Fibular Fracture

26

Proximal Tibia FractureFoot Injuries

Every Athletic Trainerrsquos

Worst NightmareArch Injuries

bull Longitudinal Arch

ndash know anatomy

ndash sprain - intertarsal ligaments

ndash pes planus - flat foot

ndash pes cavus ndash high arch

bull Transverse Arch

ndash know anatomy


bull look for callosities under 2nd

metatarsal headhttpteachmeanatomyinfol

ower-limbmiscfoot-arches

27

Mortonrsquos Neuromabull Definition - a type of

metatarsalgia (pain in the metatarsals) associated with a localized thickening (neuroma) at the point where the medial amp lateral branches of the plantar nerve join between the 3rd amp 4th metatarsal heads

ndash Sx

bull pinpoint tenderness between 3rd amp 4th metatarsal heads

bull decreased sensation in 3rd and 4th toes

Mortonrsquos Neuroma

bull Hx

ndash complain of sprained

transverse arch sharp-

shocklike pain during

activity that is relieved

when the shoe is removed

numbness in the 3rd amp 4th

toes

bull Tx

ndash transverse arch pad

ndash proper shoes

ndash NSAIDrsquos

ndash RICE

Plantar Fascitisbull Definition -

inflammation of the

fascia covering the

plantar aspect of the

foot most common

site is from the

attachment off the

medial tubercle of the

calcaneusNote ndash the long plantar ligament

is found laterally and connects to

the cuboid is part of the plantar

fascia

Clinical PEARL

Plantar Fascia Palpation

bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -

ndash sprain of plantar capsuloligamentous complex of the great toe

bull MOI

ndash hyperextension

ndash hyperflexion + valgus stress (uncommon)

bull Predisposing Factors

ndash artificial turf

ndash flexible footwear

ndash pes planus

ndash decreased ankle or MP joint motion

Turf Toe

bull graded according to sxrsquos (I II III)

bull Sx

ndash inflammatory signs

ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2

bull rigid foot insole

bull taping

bull restricted activity

bull crutches NWB in severe cases

Lisfranc Injury

bull The injury is named after Jacques Lisfranc de St Martin a French surgeon and gynecologist who described the injury in 1815

bull Lisfranc Ligament

ndash ligament between the 2nd metatarsal and the medial cuneiform (oblique fashion)

bull MOI

ndash axial load of pf footbull usually traumatic

bull Sx

ndash swelling amp tenderness midfoot

ndash ecchymosis late

ndash pain on stress of 1st2nd metatarsal bases

Lisfranc Fracture

AP radiograph of the

forefoot There is

homolateral Lisfranc

fracture-dislocation

29

Lisfranc Injury

bull Tx

ndash no flattening of long arch

bull NWB cast 6 wks

bull walking cast 2 wks

ndash flattening of long arch

bull ORIF

bull poor prognosis

bull 145 wks return to sports on average

Open Reduction

and Internal

Fixation

Foot Fractures

bull neck of talus (forced DF)

bull calcaneus (crush injurycompression)

bull avulsion of base of 5th metatarsal (strong

contraction of peroneus brevis)

bull metatarsal fractures (direct trauma)

bull Jones fracture (just distal to the base of the

5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal

Tuberosity Fracturebull most common

bull ldquotennis fracturerdquo

bull MOI

ndash inversion force with pull by lateral plantar fascia

bull Tx

ndash undisplacedbull wooden sole shoe

bull symptomatic care

bull union in 8 wks

ndash gt 2 mm displacement = ORIF

30

5th Metacarpal FractureJones Fractures

bull 1902 Sir Robert Jones described 4 cases

bull Definition -ndash transverse fx the junction of the

diaphysis and metaphysis

bull intraarticular fx (between 4th amp 5th)

bull distal to base of 5th

ndash a pt between insertions of peroneus brevis amp tertius

bull MOIndash pf ankle with a large adduction

force to forefoot

bull Txndash SLC for 6-8 wks

ndash ORIF in competitive athletes

Classification SchemeJones Fracture

Lateral radiograph of the foot A patient

stepped off a curb and sustained a fracture of

the proximal aspect of the fifth metatarsal

31

Jones Fracture ndash UD Soccer

Player Fall 2017Ouch ndash Sports Related Concusion

Neuropathies and

Compartment Syndromes Definitions

bull Neuropathy - any disorder affecting the nervous

system

bull Radiculopathy - disorder of the spinal nerve roots

bull Compartment Syndrome - condition in which

increased intramuscular pressure in a confined

anatomical space brought on by overactivity or

trauma impedes blood flow and function of tissues

within that space

32

LE Neuropathies ndash Foot

bull Tarsal Tunnel Syndrome

ndash Tunnel formed by the flexor retinaculum (lacinate ligament) medial wall of the calcaneus posterior talus distal tibia and medial malleolus

ndash Structures include

bull Posterior tibial nerve

bull PT tendon

bull FDL tendon

bull FH tendon

bull Posterior tibial artery amp vein

Lacinate

mean

rough

edges



ndash Uncommon in athletes

ndash Etiology

bull Vascular compromise of

the nerve (sensory)

bull Direct compression

neuropathy (sensory +

motor)

ndash Abnormalities of the

tunnel

ndash Extrinsic factors that

compress

Clinical PEARL

Tarsal Tunnel Palpation

bull Passively dorsiflex the ankle and extend the toes

bull Palpate between the medial malleolus and Achilles tendon

bull Tinelrsquos Sign ndash tapping over the tarsal tunnel

LE Neuropathies ndash Lower Leg

bull Entrapment of the

SPN

ndash Etiology

bull Facial impingement as

it exits the deep fascia

approx 6 cm above the

lateral malleolus

bull Chronic ankle sprains

subject the nerve to

recurrent stretching

33


bull Sural Nerve Entrapment

ndash Secondary to 5th met fxrsquos

ndash Recurrent sprains (PFinv)

ndash Ganglions

ndash Extrinsic compression (tight ski boot)

Thank You

Joe Flacco ndash QB Baltimore RavensFormer VP Joe

Biden

Our Famous

DelawareansFormer NJ Governor ndash Chris

Christie

Bill Prentice ndash Principles

of Athletic Training

Wake UpReview of the

Clinical Foot and Ankle

Assessment

34

Anterior Talofibular Ligament (ATF) Anterior Talofibular Ligament (ATF)

Anterior Talofibular Ligament (ATF) Calcaneofibular Ligament (CF)

35

Range of Motion Testing

bull AROM

bull PROM

bull RROM

ndash MMT

ndash ldquoBreak Testrdquo

AROM

bull Plantar Flexion

Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion

Weight Bearing AROMPlantar and Dorsiflexion

Weight Bearing AROM

Inversion and Eversion

RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion

Show Me the Evidence

bull Sensitivity ndash those people correctly identified by the test as having the condition of interest (Positive (+) Predictive Value)

bull Specificity ndash those people correctly identified as NOT having the condition of interest (Negative (-) Predictive Value)

BOC

38

Special Tests for Ligamentous

and Capsular Laxity

Anterior Drawer Test

Sensitivity 32 - 80

Anterior Drawer SchematicAnterior Drawer Schematic

Anterior translation is gt

when the ankle is in 15deg

of plantar flexion

39


(variation)Talar Tilt

(Inversion Stress)

Sensitivity 52

Talar Tilt SchematicI

n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40

Medial Subtalar-Glide Test

Used to assess laxity of the

subtalar joint resulting from

lateral ligament injury

Test is performed by

translating the calcaneus

medially on the talus in the

transverse plane ---

excessive laxity is a (+) test

Ankle Syndesmosis

Ankle SyndesmosisRisk Factors for Syndesmotic

Ankle Sprainsbull Prospective cohort (USMA) study

examining the causes of SAS and medial ankle sprains (118 of all ankle sprains) over a 4 yr period

bull Gender

ndash more medial sprains vs

ndash longer recovery time vs

bull Sport

ndash FB soccer team handball basketball

bull Level of Competition

ndash Intercollegiate gt intramural

bull Body Mass Index (BMI)

ndash gt BMI is associated with more SAS and medial sprains

Athletic Training Research Laboratory

41

Mechanism of Injury ndash Ice Hockey Video bull Evaluation usually

involves

ndash Location and extent of pain

ndash Anatomic palpation

ndash Various stress tests

ndash Differential diagnosis

bull Medial (Deltoid) ligament involvement

bull Associated fractures of either the tibia or fibula

bull Lateral ankle sprain

Assessment Considerations


Assessment of Pain

bull Patient complaints of pain include

ndash Anteriorly between distal fibula and tibia (AITFL)

ndash Posteromedially at level of the ankle

ndash Pain with WB and ldquopushing-offrdquo

ndash Some may complain of pain extending proximally (interosseous membrane)

bull The ldquohigh ankle sprainrdquo


Palpationbull Evidence of swelling

ndash Severe swelling usually not present if it is may take on a ldquorectangularrdquo appearance

bull Tenderness between fibula and tibia (AITFL and PITFL)

bull Tenderness over the medial malleolusndash Isolated syndesmotic

ligamentous injury is rare may have lesions of deltoid ligament too

bull Depends on evaluators ability to find ligamentIM

bull Pain on palpation is the most frequent positive testndash Alonso- JOSPT1998

ndash Nussbaum AJSM 2001


42

Palpation ndash ldquoTenderness Lengthrdquo

bull Term coined by Nussbaum et al Am J Sports Med 2001

ndash Measure length of tenderness from distal tip of fibula to the most proximal portion of tenderness

ndash Made along anterior portion of interosseous membrane (space between lateral palpable border of tibia and the medial palpable border of fibula

ndash ldquoTenderness Lengthrdquo can be used to predict time lost from competition (gt the distance = more time lost)

Days Lost = 5 + (093) x tenderness length in cm plusmn 372 days


Gait Assessment

bull Normal heel-toe walking gait may be replaced by a heel-raise gait

ndash Used to avoid excessive ankle DF and pain during ldquopush-offrdquo

bull Antalgic gait with short duration of ldquostancerdquo phase

on the injured foot may also be present


Hopping Assessment

bull Perform a single-leg hop pushing off from the toes

ndash Performed only after RO evidence of fracture

ndash 10 reps

bull Inability to perform the hop or hopping with extreme pain

is indicative of SAS

ndash Rising on the toes produces hindfoot inversion which stresses the syndesmosis


Special Tests Kleiger Test (aka External Rotation Test)

bull Described by Hopkinson et al Foot Ankle 1990 amp Boytim et al Am J Sports Med 1991

bull Externally rotate the foot while holding the ankle in a neutral position (can be performed either seated or supine)

ndash Doesnrsquot measure instability

ndash If (+) in the early stages (first few weeks) indicative of damage to

syndesmotic ligaments

ndash Best interrater reliability (075)

bull Alonso JOSPT 1998

ndash 5560 patients in Nussbaum et al

(2001) study had (+) tests


43

Kleiger Test(External Rotation Test)


Special Tests Squeeze Testbull Described by Hopkinson et al

Foot Ankle 1990bull Compress rdquocuprdquo tibiafibula

together at mid calf moving upward proximallyndash Can also be performed seated

bull Causes separation of distal tibiofibular syndesmosis ndash Teitz amp Harrington Foot Ankle Int1998

bull Not sensitive to minor or partial injuries of the syndesmotic ligs ndash 2060 - Nussbaum et al AJSM

2001ndash Interrater reliability is low (050)

bull (+) Test correlates w longer return

bull Hopkinson 1990 Taylor 1992 Nussbaum 2001


Special Tests Cotton Test (aka Lateral Talar Glide)

bull Described by Cotton Dislocations and Joint-Fractures 1910

bull Used to evaluate lateral translation of the talus in the ankle mortise

bull Performed with the patient supine

bull Stabilize the distal leg but do notcompress syndesmosis while opposite hand cups the calcaneus and talus

bull (+) Test is uarr lateral translation of the talus relative to the opposite uninjured limb and uarr PAIN


Special Tests Fibular-Translation Test

bull Described by Ogilvie-Harris et al Arthroscopy1994

bull Performed by translating the distal fibula anteriorly and

posteriorly on the tibia

bull (+) test results when

pain is produced at the syndesmosis or when fibular displacement is gt the uninvolved limb


44

Special Tests Point Test (aka Palpation Test)

bull Described by Boytim et al Am J Sports Med 1991

bull Supine or sitting

bull Pressure with finger directly over the anterior aspect of the distal tibiofibular syndesmosis

bull uarr pressure gradually

bull (+) test involves a report

of pain by the patient


Special Tests Dorsiflexion Maneuver

bull First described by Ward J Manip Phyiol Ther 1994

bull Performed to force the wider anterior portion of the talar dome into the ankle mortise thus inducing separation of the distal tibia and fibula

bull Patient is seated passive movement into DF

bull (+) test is pain experienced in the distal tibiofibular syndesmosis

bull Interrater reliability is low (036)


Special Tests Crossed-leg Test

bull Kiter E Foot Ankle Int 2005

bull Mimics the squeeze test and attempts to induce separation of the distal syndesmosis

bull Resting point should be mid-calf

bull Pt applies a gentle force on medial knee

bull (+) test is pain in distal syndesmosis


Special Tests Heel Thump Test

bull Described by Lindenfeld amp Parikh Foot Ankle Int 2005

bull Performed to force the talus into the ankle mortise

bull Patient is seated

bull Examiner applies a gentle but firm thump on the heel with their fist

bull Force applied at center of heel and in line with long axis of tibia



45

Special Tests Stabilization Test

bull Williams et al Am J Sports Med 2007

bull Apply several layers of tape (tightly) above the ankle joint to ldquostabilizerdquo the distal syndesmosis

bull Patient is then asked to stand walk perform a toe raise and jump

bull (+) test if these maneuvers are less painful with the tape in place


Special Tests Malleolar CompressionRebound Test

ndash Compress malleoli and look for pain with

rebound

ndash Hard frequently very sore

ndash Not well publicized or

investigated yet


What Does the Evidence Suggest

bull None of the syndesmotic stress tests could distinguish which ligaments were sectioned Furthermore the small displacements measured during the stress tests (with the exception of the external rotation test) suggest it is unlikely that the displacement induced in injured syndesmoses can be clinically differentiated from normal syndesmoses Therefore pain rather than increased displacement should be considered the outcome measure of these tests ndash Beumer A van Hemert WL Swierstra BA Jasper

LE Belkoff SM A biomechanical evaluation of clinical stress tests for syndesmotic ankle instability Foot Ankle Int 2003 Apr24(4)358-63


46

Ankle Joint Swelling Weight-Bearing Lunge Test

Ankle Joint Strength Testing Ankle Joint Strength Testing

47

Ankle Joint Strength Testing Assessing Dynamic Ankle

Stability Isotonic Strength

Isotonic activities re

dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups

however rarely used in

the ankle

Some examples of

isotonic exercises are

shown here

PrimUs System

Assessing Dynamic Ankle Stability

Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP

Isokinetic DynamometerConcept introduced in 1967 by Hislop amp Perrine (Hislop HJ Perrine JJ (1967) Phys Ther 47 114-117)

Contemporary dynamometers enable the researcher to gather both CON and ECC data

Allows for the examination of reciprocal muscle group ratios (knee shoulder ankle)

48

BESS Testing One Leg Stance Testing

Y-Balance Testing

Developed amp described by ndash Functional Movement Systems ndash Plisky et al

Reliable dynamic balance assessment tool Cut-off = 896 for the composite score relative to limb length ndash Sensitivity of 100 and specificity

of 717 ndash Males lt 896 are 35X more likely

to obtain a noncontact lower extremity injury

ndash Female lt 94 are 65 times as likely to sustain a musculoskeletal injury

In the ANT reach a difference gt 4 cm between the limbs is associated with an elevated risk of injury

Assessing Activity Levels

49

Assessing FootAnkle Function (FAAM) Special Tests -

Fracture Identification

Squeeze Test

(Potts Compression Test)

Pottrsquos Fx = fx distal fibula and medial malleolus Sir

Percival Potts identified this compound fx in 1756

Bump Test

(Heel Tap or Percussion Test)

50

Special Tests -

Thompson Test

(Achilles Tendon Rupture)

(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign

Dr Homan (of Homans sign fame) discredited his own test as being useless in the

evaluation of DVT and admitted he was sorry he ever published its description

On-Field Assessment Review

bull History

ndash MOI location pain

ndash Unusual soundssensations

ndash Information from others

bull ObservationInspection

ndash Deformity swelling ecchymosis

ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness

crepitation deformity

bull distal tibia

bull distal fibula

bull ligamentous structures

bull syndesmosis

bull Achilles tendon

bull foot region

On-Field Assessment Reviewbull Neurovascular

ndash Dorsalis pedis pulse

ndash Sensation over foot (dorsum and lateral border) calcaneus

bull Special Tests

ndash Pottrsquos Compression Test

ndash Anterior Drawer Test

bull AROM Tests

A Cool Web Site

httpahnmnsueduathletictrainingspata




THANK

2

Athletic Training amp Sports

Health Care The Journal for the

Practicing Clinician

httpwwwhealioco

mjournalsatshc

Laboratory Manualto accompany

Rehabilitation Techniques in Sports Medicine

and Athletic Training

6th Edition

httpswwwhealiocombooksathletic-

training7b927168ac-1da2-422c-b98e-ae9013d4e15b7drehabilitation-techniques-for-

sports-medicine-and-athletic-training-sixth-edition

Perhaps ATCrsquos Need to Incorporate

this Into Their Assessment SchemeAnatomical Review

Cyriax- ldquoDiagnosis

is only a matter of

applying onersquos

anatomyrdquo

3



Clinical PEARL

Navicular Palpation


anteroinferior to

the medial

malleolus

bull More prominent

with foot adducted


4



1 Fibula

2 Tibia

3 Ankle joint




8 Calcaneus


11 Navicular

12 Cuneiforms

13 Cuboid

Challenge

yourself to

identify the

anatomical

structures

Articulations


5


IOM = Interosseous

membrane

IOL = Interosseous

ligament

AITFL = Anterior


Ligament

PITFL = Posterior


Ligament


6

WOW

Muscular Anatomy


bull Anterior



Region)

Posterior

Superficial

Deep

Anterior

7



Anterior Posterior


8


which one

At what bony

landmark do they

bifurcate


Plantaris


Soleus


TOM

DICK

9


HARRY

Note we

have

excised

the TampD

Talocrural and



HAS ANYONE

SEEN FERRIS

Circa 1986

Can

anyone

name this

voice

Ben

Stein


Ankle Region

10



further



bull MOI





malleolus













ndash Peroneals (15







Surg 1998

11



bull Diagnosis



bull Prevention



Clinical Experience

Patient Values

Best Research

12



Level of Evidence



good evidence




limited-quality

evidence


clinical practice


usual practice











doi101136bjsports-2017-098885

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

3



Clinical PEARL

Navicular Palpation


anteroinferior to

the medial

malleolus

bull More prominent

with foot adducted


4



1 Fibula

2 Tibia

3 Ankle joint




8 Calcaneus


11 Navicular

12 Cuneiforms

13 Cuboid

Challenge

yourself to

identify the

anatomical

structures

Articulations


5


IOM = Interosseous

membrane

IOL = Interosseous

ligament

AITFL = Anterior


Ligament

PITFL = Posterior


Ligament


6

WOW

Muscular Anatomy


bull Anterior



Region)

Posterior

Superficial

Deep

Anterior

7



Anterior Posterior


8


which one

At what bony

landmark do they

bifurcate


Plantaris


Soleus


TOM

DICK

9


HARRY

Note we

have

excised

the TampD

Talocrural and



HAS ANYONE

SEEN FERRIS

Circa 1986

Can

anyone

name this

voice

Ben

Stein


Ankle Region

10



further



bull MOI





malleolus













ndash Peroneals (15







Surg 1998

11



bull Diagnosis



bull Prevention



Clinical Experience

Patient Values

Best Research

12



Level of Evidence



good evidence




limited-quality

evidence


clinical practice


usual practice











doi101136bjsports-2017-098885

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

4



1 Fibula

2 Tibia

3 Ankle joint




8 Calcaneus


11 Navicular

12 Cuneiforms

13 Cuboid

Challenge

yourself to

identify the

anatomical

structures

Articulations


5


IOM = Interosseous

membrane

IOL = Interosseous

ligament

AITFL = Anterior


Ligament

PITFL = Posterior


Ligament


6

WOW

Muscular Anatomy


bull Anterior



Region)

Posterior

Superficial

Deep

Anterior

7



Anterior Posterior


8


which one

At what bony

landmark do they

bifurcate


Plantaris


Soleus


TOM

DICK

9


HARRY

Note we

have

excised

the TampD

Talocrural and



HAS ANYONE

SEEN FERRIS

Circa 1986

Can

anyone

name this

voice

Ben

Stein


Ankle Region

10



further



bull MOI





malleolus













ndash Peroneals (15







Surg 1998

11



bull Diagnosis



bull Prevention



Clinical Experience

Patient Values

Best Research

12



Level of Evidence



good evidence




limited-quality

evidence


clinical practice


usual practice











doi101136bjsports-2017-098885

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

5


IOM = Interosseous

membrane

IOL = Interosseous

ligament

AITFL = Anterior


Ligament

PITFL = Posterior


Ligament


6

WOW

Muscular Anatomy


bull Anterior



Region)

Posterior

Superficial

Deep

Anterior

7



Anterior Posterior


8


which one

At what bony

landmark do they

bifurcate


Plantaris


Soleus


TOM

DICK

9


HARRY

Note we

have

excised

the TampD

Talocrural and



HAS ANYONE

SEEN FERRIS

Circa 1986

Can

anyone

name this

voice

Ben

Stein


Ankle Region

10



further



bull MOI





malleolus













ndash Peroneals (15







Surg 1998

11



bull Diagnosis



bull Prevention



Clinical Experience

Patient Values

Best Research

12



Level of Evidence



good evidence




limited-quality

evidence


clinical practice


usual practice











doi101136bjsports-2017-098885

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

6

WOW

Muscular Anatomy


bull Anterior



Region)

Posterior

Superficial

Deep

Anterior

7



Anterior Posterior


8


which one

At what bony

landmark do they

bifurcate


Plantaris


Soleus


TOM

DICK

9


HARRY

Note we

have

excised

the TampD

Talocrural and



HAS ANYONE

SEEN FERRIS

Circa 1986

Can

anyone

name this

voice

Ben

Stein


Ankle Region

10



further



bull MOI





malleolus













ndash Peroneals (15







Surg 1998

11



bull Diagnosis



bull Prevention



Clinical Experience

Patient Values

Best Research

12



Level of Evidence



good evidence




limited-quality

evidence


clinical practice


usual practice











doi101136bjsports-2017-098885

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

7



Anterior Posterior


8


which one

At what bony

landmark do they

bifurcate


Plantaris


Soleus


TOM

DICK

9


HARRY

Note we

have

excised

the TampD

Talocrural and



HAS ANYONE

SEEN FERRIS

Circa 1986

Can

anyone

name this

voice

Ben

Stein


Ankle Region

10



further



bull MOI





malleolus













ndash Peroneals (15







Surg 1998

11



bull Diagnosis



bull Prevention



Clinical Experience

Patient Values

Best Research

12



Level of Evidence



good evidence




limited-quality

evidence


clinical practice


usual practice











doi101136bjsports-2017-098885

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

8


which one

At what bony

landmark do they

bifurcate


Plantaris


Soleus


TOM

DICK

9


HARRY

Note we

have

excised

the TampD

Talocrural and



HAS ANYONE

SEEN FERRIS

Circa 1986

Can

anyone

name this

voice

Ben

Stein


Ankle Region

10



further



bull MOI





malleolus













ndash Peroneals (15







Surg 1998

11



bull Diagnosis



bull Prevention



Clinical Experience

Patient Values

Best Research

12



Level of Evidence



good evidence




limited-quality

evidence


clinical practice


usual practice











doi101136bjsports-2017-098885

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

9


HARRY

Note we

have

excised

the TampD

Talocrural and



HAS ANYONE

SEEN FERRIS

Circa 1986

Can

anyone

name this

voice

Ben

Stein


Ankle Region

10



further



bull MOI





malleolus













ndash Peroneals (15







Surg 1998

11



bull Diagnosis



bull Prevention



Clinical Experience

Patient Values

Best Research

12



Level of Evidence



good evidence




limited-quality

evidence


clinical practice


usual practice











doi101136bjsports-2017-098885

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

10



further



bull MOI





malleolus













ndash Peroneals (15







Surg 1998

11



bull Diagnosis



bull Prevention



Clinical Experience

Patient Values

Best Research

12



Level of Evidence



good evidence




limited-quality

evidence


clinical practice


usual practice











doi101136bjsports-2017-098885

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

11



bull Diagnosis



bull Prevention



Clinical Experience

Patient Values

Best Research

12



Level of Evidence



good evidence




limited-quality

evidence


clinical practice


usual practice











doi101136bjsports-2017-098885

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

12



Level of Evidence



good evidence




limited-quality

evidence


clinical practice


usual practice











doi101136bjsports-2017-098885

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

13





Ankle Sprains




Considerations

Helpful Resource




Management

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

14


Old Practice


BJSM 2016

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

15


Footbeat in Action


(ROAST)




sprain injuries

ROAST

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

16

OTTAWA ANKLE RULES




OTTAWA ANKLE RULES

Clinical PEARL



Ankle Instability

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

17




bull Symptoms

ndash pain


ndash swelling


Chronic

Ankle Instability

Mechanical


Insufficiencies

Pathological

LaxityArthro-

kinematic

Restrictions

Synovial

Changes

Degenerative

Changes

Impaired


Neuromuscular

Control

Strength

DeficitsImpaired

Postural

Control

Recurrent

Ankle

Sprain

Hertel J Athletic

Training 2002


bull Definition





ndash talar tilt



18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

18


Ultrasound Imaging

TALUS

FIBULA

AB


Interval from MSUS

image


bull Definition



1965)



- 1985)

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

19


bull Assessment

Tools

ndash muscular

strength

bull isometric

bull isokinetic

ndash stabilometry

ndash peroneal

reaction times

Cumberland Ankle










20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

20



prevalence)



mortise

bull MOI






deltoid complex)












bull Sx



ndash walk on toes


bull Tx

ndash ICERS2



ndash NSAIDrsquos

Clinical PEARL



Tibiofibular

Ligament

bull Interosseous

Membrane


Tibiofibular

Ligament

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

21

Radiological View

Radiograph

showing widening

of the tibiofibular

clear space



syndesmosis The

clear space is


mm wide

Ankle Fractures

Alecia Bell UD

WBB Player 11-

2014









4-6 weeks to heal






22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

22


Ankle Dislocation






dislocation without


quite rare


23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

23










ndash Et

bull overuse

ndash Sx

bull crepitus






bull NSAIDrsquos

bull heel lifts



bull orthotics


bull Ruptures




24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

24

Clinical PEARL



(Straight Knee)

Soleus Stretch

(Bent Knee)


ndash Sites




bull M-T junction

ndash MOI








httpswwwinstagramc

ompBJqyDOphcnT






bull age

bull steroid usage

ndash SignsSx


bull ecchymosis



ndash Tx



25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

25


Ankle Impingement)



bull Path





bull Sx



bull Dx Tests



bull Tx


(conservative)


some cases


A Shepherds

fracture

(avulsion

fracture of the

posterolateral

process of

talus) which is

often difficult to

differentiate

radiographically

from an os

trigonum


26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

26





ndash know anatomy





ndash know anatomy





27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

27



ndash Sx




bull Hx







toes

bull Tx


ndash proper shoes

ndash NSAIDrsquos

ndash RICE


inflammation of the

fascia covering the


foot most common

site is from the

attachment off the





fascia

Clinical PEARL


bull Passively

extend hallux

bull Palpate

starting at the

medial

tubercle of

calcaneus

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

28

Turf Toe

bull Definition -


bull MOI






ndash pes planus


Turf Toe


bull Sx


ndash ecchymosis

ndash tenderness

bull Tx

ndash ICERS2


bull taping



Lisfranc Injury




bull MOI


bull Sx




Lisfranc Fracture


forefoot There is



29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

29

Lisfranc Injury

bull Tx


bull NWB cast 6 wks



bull ORIF

bull poor prognosis


Open Reduction

and Internal

Fixation

Foot Fractures







5th metatarsal)

Calcaneal Fracture

Lateral

radiograph of

the ankle

There is a

hatchet injury

to the

calcaneus

5th Metatarsal



bull MOI


bull Tx



bull union in 8 wks


30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

30









force to forefoot







31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

31



Neuropathies and



system






within that space

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

32






bull PT tendon

bull FDL tendon

bull FH tendon


Lacinate

mean

rough

edges




ndash Etiology


the nerve (sensory)



motor)


tunnel


compress

Clinical PEARL







SPN

ndash Etiology




lateral malleolus




33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

33





ndash Ganglions


Thank You


Biden

Our Famous


Christie





Assessment

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

34



35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

35


bull AROM

bull PROM

bull RROM

ndash MMT


AROM


Note that PF is

two words

AROM

bull Dorsiflexion

AROM

bull Inversion

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

36

AROM

bull Eversion


Weight Bearing AROM


RROM


Any UNF

students in

the audience

Who is this

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

37

RROM

bull Dorsiflexion

RROM

bull Inversion

RROM

bull Eversion




BOC

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

38


and Capsular Laxity


Sensitivity 32 - 80




of plantar flexion

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

39



(Inversion Stress)

Sensitivity 52


n

v

e

r

s

i

o

n

E

v

e

r

s

i

o

n

Talar Tilt

(Eversion Stress)

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

40










Ankle Syndesmosis




bull Gender



bull Sport







41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

41


involves










Assessment of Pain

















42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

42








Gait Assessment






Hopping Assessment



ndash 10 reps
















43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

43


























44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

44































45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

45









rebound



investigated yet






46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

46



47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

47




dynamic and involve

both ECC and CON

muscle actions

1 RM is commonly

used a measure of

strength in larger

muscle groups


the ankle

Some examples of


shown here

PrimUs System


Isokinetic Strength

Isokinetic

Dynamometry

ndash objective

ndash quantifiable

ndash quasi-CKC

assessment

ndash reliable

Capable of

measuring both

ECC and CON

muscle actions

Kin Com 125 AP




48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

48


Y-Balance Testing








49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

49



Squeeze Test




Bump Test


50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

50

Special Tests -

Thompson Test


(-) (+)

Special Tests -

Thompson Test


Special Tests -

Homanrsquos Sign




bull History






ndash Positioning

ndash Skin color

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

51


bull Palpation

ndash Tenderness


bull distal tibia

bull distal fibula


bull syndesmosis


bull foot region




bull Special Tests



bull AROM Tests

A Cool Web Site





THANK

Foot and Ankle Injuries Today’s lecture can be viewed at in … · 2019-02-04 · Eversion/Medial...

Documents

Transcript of Foot and Ankle Injuries Today’s lecture can be viewed at in … · 2019-02-04 · Eversion/Medial...