Ankle

Question 1

What are 5 complications of ankle sprains?

Answer 1

1. Anterior Tibiofibular ligament sprain (Malingerer’s Ankle AKA “High Ankle Sprain”)
2. Talar Dome Fracture/ Osteochondral Fracture
3. Avulsion fracture of the base of 5th metatarsal (“Jones Fracture”)
4. Sinus Tarsi Syndrome
5. Posterior Talar Process Fracture

Question 2

Name 4 differentials of ankle sprains.

Answer 2

1. Bifurcate Ligament Sprain
2. Peroneal Tendon Dislocation
3. Footballer’s Ankle (Soccer Ankle)
4. Ski boot Neuropathy

Question 3

Malingerer’s Ankle AKA “High Ankle Injury”

Answer 3

• Is an Anterior Tibiofibular Ligament Sprain.
• It has a longer healing time, due to the sprain not being recognized early enough.
• Excessive force can twist Talus in the Mortise Joint, causing a sprain

Question 4

How does a patient with a High Ankle Sprain present?

Answer 4

• Pain on walking
• Pain on palpation
• Tib-Fib Squeeze Ortho may or may not be positive (Usually only complete tears are positive)

Question 5

What is a Talar Dome Fracture (Osteochondral Fracture)?

Answer 5

• Secondary to ankle sprains
• Is often not recognized
• X-RAY: Medial Oblique (25* inversion from A-P)

Question 6

Name the 4 Stages/ Types of (Talar Dome) Fracture and appropriate Tx plan.

Answer 6

1. Compression only = Conservative care
2. An edge of the fracture is lifted = Conservative care
3. The fracture fragment is free, but approximated = Conservative care or surgery
4. The fracture is fragment free and not approximated = surgery

Question 7

What is Sinus Tarsi Syndrome?

Answer 7

• Late sequel of an ankle sprain
• Becomes evident weeks or months after injury
• Poor or no rehab indicating factor
• Pronation must be present
• Scar tissue formation can cause compression of the Talocalcaneal ligaments leading to pain and proprioceptive problems

Question 8

How does a patient with Sinus Tarsi Syndrome present?

Answer 8

• Localized pain anterior to the lateral malleolus
• Patient has difficulty walking on uneven surfaces
• Ankle may have a feeling of giving way (semi-pathognomonic)
• Ortho Test: Talar Rock Test (Interosseous Talocalcaneal ligament; Sheer Talus & Calcaneus)

Question 9

What is a “Jones Fracture,” the best X-Ray to take and Treatment?

Answer 9

• A “Jones Fracture” is an avulsion fracture of the 5th MT base.
• (MOI: In an ankle sprain, the peroneal tendon may pull significantly on the Peroneus Brevis insertion on the tuberosity of the 5th MT)
• Included in the Ottawa Rule
• X-ray: A-P
• Tx: Immobilzation w/ a cast or brace, 6-12 weeks; if fragment is displaced, surgery is indicated

Question 10

How does a Posterior Talar Process Fracture occur and present?

Answer 10

• Excessive plantar flexion can fracture the Posterior Talar Process
• Posterior ankle pain
• Pain with forced plantarflexion of the foot or forced dorsiflexion of the great toe
• X-Ray/ CT: R/O Fx or accessory ossicle

Question 11

What is a “Snowboarder’s Ankle Fracture” and how does it present?

Answer 11

• Fracture of lateral process of the Talus (a portion of the Posterior Talar Facet)
• MOI: Dorsiflexion and Inversion
• Current study +/- w/ External Rotation
• X-Ray not as sensitive, CT scan if highly suspected

Question 12

How does a Peroneal Tendon Dislocation occur and how does it present?

Answer 12

• MOI: Forceful contraction of peroneals during dorsiflexion
• Common in young skier falling forward or following an ankle sprain
• Patient Presents: hears clicking when walking or running
• Tests: Resisted dorsiflexion and eversion; able to palpate/ inspect tendon anterior to lateral malleolus? Able to reproduce clicking?

Question 13

What are the degrees in the Talar Tilt Test and their corresponding ligaments?

Answer 13

1. 0* Plantar Flexion + Inversion = Calcaneofibular ligament
2. 20* Plantar Flexion + Inversion = Talofibular ligament
3. 0* Plantar Flexion + Eversion = Deltoid ligament (Posterior Tibiotalar & Tibiocalcaneal ligaments)
4. 20* Plantar Flexion + Eversion = Deltoid ligament (Tibionavicular & Anterior Tibiotalar ligaments)