Your patient presents to your clinic with lateral ankle pain. Ask your patient 4 subjective questions.
- Any gait aids?- Specific mechanism?- Current or past orthotics experience?- Footwear? Recent change in footwear?- Pain patterns?- Really important: have you sprained your ankle before?- Ottawa ankle rules: ask about location of pain- Pain at night?
You perform an objective postural assessment on your patient. Name 4 things you are looking for.
pronation/supination, ER or IR of the foot, valgus or varus, deformities,
Palpate the following structures on your patient.Talus, styloid process of 5th MT, talocrural joint line, subtalar joint, tibio-fibular ligament (ant & post component).
Perform AROM of the ankle in both OKC and CKC positions.
OKC: AROM in supine in all motions CKC: DF - knee-to-wall PF - calf raise Pron/sup/inv/ev - standing torso twist
Your patient comes into the clinic with pain and feeling of "giving way" over the L lateral ankle. Perform 2 special tests to assess the anterior stability of the ankle.
Anterior drawer, Talar tilt (CFL).
Your patient comes into the clinic with pain and feeling of "giving way" over the L postero-lateral ankle. Perform 2 special tests to assess the postero-lateral stability of the ankle.
Posterior drawer, talar tilt (PTFL)
Your patient was playing basketball when they landed on their R leg with their foot in excessive dorsiflexion and eversion resulting in significant pain in the ankle region. What is your hypothesis for their injury? Perform a test to rule in your hypothesis.
External rotation test (TFL)
Your patient has been experiencing numbness and tingling in their foot. Perform a test to rule in/out tarsal tunnel syndrome.
Your patient was a playing in a soccer game when they feel a snap and heard a pop in the back of their ankle. Perform a test to rule out an achillies tendon rupture.
Perform a test to rule out a syndesmosis injury
hop test (do max 10x) pos if pain
Perform 2 functional tests to assess the biomechanics of the soleus muscle.
deep squat and lunge
Perform 2 tests to assess balance and neuromuscular control of the ankles
star-excursion balance test, Romberg test, single leg balance,
Your patient experienced a grade 2 lateral ankle sprain 3 months ago and continues to experience decreased dorsiflexion. Perform a treatment technique to increase DF range and prescribe one exercise to improve DF ROM.
Mulligan glides, distraction, tib ant contract-relax with DF mobExercise: knee to wall, self mob with band, soleus stretching