top of page
Search

Ankle

The first question after an ankle or foot injury might be: 'is it broken?'. If you are able to take four steps, it is likely that you ankle/foot is not broken.

However, the ankle and the foot is complex: there are multiple joints, ligaments, vessels, nerves, muscles and cartilages. Only the foot contains already 26 bones. So a diagnose of broken or not broken is not specific enough for good treatment. We want to know: what bone is broken? are ligaments torn? what if there is no prior injury?


Red Flags

  • Pins or needles in feet

  • Numbness

  • Incontinence

  • Numbness in groin region

  • Different shape of one foot or ankle in comparison with the other foot

  • Babinsky reflex

Cause

  • Injury

  • Insidious onset


Risk Factors

  • Back or leg pain

  • Hip or knee pain

  • Type of footwear (flats, sandals)

  • Foot problems in the past

  • Heavy loading (work, sports or hobbies)


Tests

  • Inspection: ligaments, bunions, claw toes, swelling, tenderness, color and temperature

  • Ottawa Ankle Rules (only applicable if you are over 18 years old): 6 cm of tenderness behind one of the two ankle sides, tenderness on the outside soul of your foot or on the inside soul of your foot, unable to set four steps. If you do the Ottawa Ankle Rules within 48 hours after injury and you have 0 items positive, the chance that you have a fracture is less than 1%.

  • Neurological if indicated: patella and achilles reflex, less feeling on the skin (dermatomes L1-S4), slump (if you have back pain as well)

  • Vascular if indicated: pulse behind the ankle

  • Posture: joint lines, foot arch (high arch, neutral foot or flat foot), leg length difference.

  • Navicular Drop

  • Gait assessment (including ankle, hip and knee functioning)

  • Calf examination (strength and flexibility)

  • Activity assessment: heal raise, standing up, squat, pistol squat, jump, standing on one foot, hop, running, active and passive range of motion test and strength test



Tests specifically for Lateral Ankle Sprain

A lateral (outside) ankle sprain is the most common sprain. A proper recovery is essential to avoid future recurrent ankle sprains and could even lead to chronic ankle instability.

Risk factors

  • Previous sprain

  • Being tall

  • Overweight

  • Limb dominance

  • Footwear (high heels)

Indications

  • Barely able to bare weight on affected ankle

  • Tenderness, swelling, bruising, higher temperature of the affected ankle

  • No tenderness of the bones (otherwise it might be broken instead of sprain, see Ottawa Ankle Rules)

  • Cold and/or numb foot indicates that Peroneal nerve could be involved in injury

Tests

  • Inversion of the foot is painful

  • Anterior Drawer

  • Talar Tilt

  • Squeeze

  • Kleiger (syndesmotic sprain)


Treatment


Inflammatory phase (0-3 days)

POLICE

  • Protect

  • Optimal Load

  • Ice

  • Compression

  • Elevation

Beginning exercises could be moving your feet in bed.

Proliferative phase (4-10 days)

  • Stability: Increase weight baring

  • Range of motion

  • Bracing

Early remodeling phase (11-21 days)

  • Strength

  • Dynamic stability

  • Range of motion

  • Functions (walking, walking up and down stairs etc.)

  • Education: avoiding recurrent sprains (footwear) and encouraging to trust ankle again and bracing

  • Quality of movement (symmetric walking)

Late remodeling phase

  • Work

  • Sports

Chronic instability

  • Stability

  • Strength


POSTERIOR TIBIAL TENDON DYSFUNCTION


Cause

  • Slow onset

  • Flatfeet (pes planus)

  • Repetitive loading

  • Hypertension

  • Insufficient vascularization in ankle region

Risk factors

  • Obesity

  • Diabetes

  • Previous injury

  • Steroid use

  • Middle aged women

  • Young athletes

Indications

  • Limited range of motion in ankle

  • Pain and/or swelling on medial side of the foot/ankle

  • Following activities are painful: standing on toes, walking stairs up and down and walking over uneven surfaces

  • Instability

Tests

  • Too many toes sign

  • Double heel raise

  • Single heel raise

  • Lift up your big toe

  • Flexion and inversion resistance

Kinematic chain

  • Evaluation to which degree hip and other joints are involved.

Education

  • Gradual Loading

Balance

Range of motion

  • In case you have limited range of motion

Strength exercises

  • Especially if you developed hypermobility in the ankle after the injury.

Brace

Only if you have laxity problems in your ankle.


CHRONIC ANKLE INSTABILITY PHYSIOTHERAPY UTRECHT

Chronic Ankle Instability could be developed after a prior injury. Most often it affects the lateral side of the ankle.

Indications

  • Still having balance problems 6 months after injury

  • Swelling

  • Less strength

  • Problems with walking, jumping and sports

  • Giving way

  • Limited range of motion or extra laxity of the ankle joint

Risk factors

  • Older age

  • Little strength

Tests

  • Single Leg Standing

  • Star Excursion Balance (postmedial and postlateral are mostly affected)

  • Gait Evaluation

  • Single Hop

  • Tripple Hop


Treatment general ankle injuries

Chronic Ankle Instability could be developed after a prior injury. Most often it affects the lateral side of the ankle.

Indications

  • Still having balance problems 6 months after injury

  • Swelling

  • Less strength

  • Problems with walking, jumping and sports

  • Giving way

  • Limited range of motion or extra laxity of the ankle joint

Risk factors

  • Older age

  • Little strength

Tests

  • Single Leg Standing

  • Star Excursion Balance (postmedial and postlateral are mostly affected)

  • Gait Evaluation

  • Single Hop

  • Tripple Hop





15 views0 comments

Recent Posts

See All

コメント


bottom of page