!

Cln1S Anu 8CnLS Cl AnkLL

Tle anlle is made up of disiinci bones, ile iibia, fibula,
ialus and calcaneus. Tle inieiaciion beiween ilese bones
allows foi movemeni of ile ioini in ceiiain planes. In iuin,
ile anlle is made up of sepaiaie ioinis:
O Ta!ovuva! joint: Tlis is a linge ioini foimed by ile disial
ends of ile fibula and iibula ilai enclose ile uppei suiface
of ile ialus. Ii allows foi boil doisiflexion (decieasing ile
angle beiween ile fooi and ile slin) and planiaiflexion
(incieasing ile angle).
O nIviov tibioIibu!av joint: Tlis is siiong ioini beiween
ile lowei suifaces of ile iibia and fibula. Tlis is suppoiied
by ile infeiioi iibiofibulai ligameni.
O ubta!av joint: Tlis ioini compiises of ile aiiiculaiing
suifaces of ile ialus and ile calcaneus. Ii piovides slocl
absoipiion and ile movemenis of inveision and eveision
(inwaid and ouiwaid anlle movemenis iespeciively) occui
leie.
LlaamenLs around ankle
Ths av xtvm!v impovtant in th stabi!itv oI
th ank! its!I:
O Latva! Co!!atva! Ligamnt:
Th !atva! o!!atva! !igamnt pvvnts xssiv
invvsion t is onsidvab!v wakv than th
!avgv mdia! !igamnt and thus spvains to th
!atva! !igamnt av muh mov ommon t is
mad up oI individua! bands:
a) ntviov ta!oIibu!av !igamnt (TL): passs
Ivom th Iibu!a to th Ivont oI th ta!us bon
b) Ca!anoIibu!av !igamnt (CL)- onnts th
a!anus and th Iibu!a
) Postviov ta!oIibu!av Ligamnt (PTL)- passs
Ivom th bak oI th Iibu!a to th vav suvIa
oI th a!anus
O B Mdia! Co!!atva! Ligamnt:
Th mdia! !igamnt a!so known as th d!toid
!igamnt is onsidvab!v thikv than th
!atva! !igamnt and spvads out in a Ian shap
to ovv th dista! (bottom) nd oI th tibia and
th innv suvIas oI th ta!us, naviu!av, and
a!anus
kL MU5CLL CI ANkLL
O Th pvona!s (\W^[ZWa_
[ZYa_ and \W^[ZWa_ T^Wb_)
on th outsid dg oI th
ank! and Ioot bnd th
ank! down and out
O Th a!I mus!s
(YS_`^[UZWa_ and _[Wa_)
onnt to th a!anus bv
th hi!!s tndon Whn
th a!I mus!s tightn,
thv bnd th ank! down
O Th postviov tibia!is
mus! suppovts th avh
and h!ps tuvn th Ioot
inwavd
O Th antviov tibia!is pu!!s
th ank! upwavd
AnkLL !Cln1 SPCWlnC LlCAMLn1S
nL8vL Anu 8LCCu SuL? Cl AnkLL
TIBIAL NERVE
POSTERIOR TIBIAL ARTERY
AlM Cl AnkLL ASSLSMLn1
O Assessmeni of any iniuiy slould include quesiions
conceining ile paiienis geneial lealil, pievious
iniuiies and cuiieni iniuiy. Tle aim of ilese quesiions
is io deieimine wlicl siiuciuie may be causing ile
pain and wlai iieaimeni is appiopiiaie
O Tle aim of assessing ile anlle aie io deieimine ile
degiee of insiabiliiy and and giade of ligameni
damage and as well as io clecl foi any oilei associaied
iniuiies sucl as fiaciuies, avulsion fiaciuies and
iendon oi neive damage
uLMCC8APlC uA1A Cl A1lLn1
O NAME
O AGE
O SEX
O OCCUPATION
O ADDRESS
nk! pain ssssmnt Qustionnaiv
O ow !ong hav vou had th ank! pain?
Whv: to stab!ish iI aut ov hvoni
O Point with on Iingv whv it huvts
Whv: a spvaind ank! auss mov gnva!izd pain, Ivatuv auss mov !oa!izd pain
O id th ank! pain stavt aItv an injuvv?
Whv: mav indiat ank! spvain ov Ivatuv
O o vou hav anv pain in anv oI th othv joints?
Whv: I sing! joint mav indiat that ank! pain is Ivom a !oa! ondition: iI manv joints invo!vd
manv indiat pavt oI a gnva!izd disas g Rhumatoid avthvitis
O s th pain wovs at anv pavtiu!av tim oI th dav?
Whv: Pain is wovs Iivst thing in movning with Rhumatoid avthvitis, pain is wovs aItv ativitv with
Ostoavthvitis
MECL TORY
O Past mdia! histovv?
Whv: OI psoviasis, hvoni diavvha, o!itis, uvthvitis ov ivitis mav indiat aus oI ank! pain
O Rnt mdia! histovv?
Whv: OI hpatitis, stvptooa! phavvngitis, vub!!a, dvsntvv, gonovvha, tubvu!osis ov tik
bit
O Past histovv oI ank! Ivatuv?
Whv: Ostoavthvitis mav ouv vavs aItv a bad!v damagd ov inauvat!v vstovd ank! Ivatuv
O ami!v histovv?
Whv: som disass with hvoni avthvitis vun in Iami!is in!uding Rhumatoid avthvitis , th
svongativ spondv!oavthvopathis and inI!ammatovv bow! disas
O Mdiations?
Whv: diuvtis an aggvavat gout
O ow did vouv ank! pain stavt?
Whv: Youv ank! pain mav b th vsu!t oI a spiIi injuvv ov inidnt and it is
impovtant Iov vouv ha!th pvoIssiona! to know what that inidnt was t
mav h!p iI vou dsvib in as muh dtai! as possib! th pvis vnts
!ading up to and in!uding th bginning oI vouv ank! pain I vou an
vmmbv a "popping" sound ov snsation at th tim th pain stavtd thn
it mav b du to an hi!!s Tndon Ruptuv
O Can vou dsvib th pain?
Whv: Thv av manv diIIvnt kinds oI pain, and bv simp!v xp!aining xat!v
what vou av I!ing is oI gvat impovtan
O Whv xat!v do vou I! th pain?
Whv: n auvat dsviption oI th !oation]s oI vou ank! pain an b vita!
in assisting vouv ha!th pvoIssiona! to Iovmu!at a ovvt diagnosis
O ow !ong hav vou xpvind th pain?
Whv: This an giv an indiation oI th stag oI th pavtiu!av undv!ving
ondition ausing vouv ank! pain dditiona!!v, som auss oI ank! pain
an !ast Iov a !ong pviod oI tim whvas othvs an b v!ativ!v shovt-
!ivd
O os anvthing mak th pain bttv ov wovs?
Whv: This an giv an indiation oI th aus oI vouv ank! pain,
p!us it is a good wav Iov vou to t!! vouv ha!th pvoIssiona!
xat!v what things vou do not want thm to do to vouv ank! I
wa!king ov app!id hat maks th pain I! bttv, thn this an
indiat an inI!ammatovv ondition oI som oI th tndons
invo!vd with th ank! joint Pain whih is wovs at night mav b
as a vsu!t oI an Ostoid Ostoma ov Rgiona! Pain vndvom
Notuvna! ank! pain whih is v!ivd with aspivin]ibupvoIn
mav b an Ostoid Ostoma
O Can vou wa!k on vouv ank!, ov has it bn !imiting vou?
Whv: Th Iuntiona!itv oI vouv ank! is an impovtant Iatov in both
diagnosing th aus oI vouv ank! pain, as w!! as Iovmu!ating a
managmnt p!an to assist in vtuvning vou to Iu!! mobi!itv I
vou hav som tvps oI ank! disovdv, ov vouv ativitv is vvv
!imitd bv vouv ank! pain thn vou mav nd to b vIvvd to
anothv ha!th pvoIssiona! Iov som dgv oI vhabi!itation
and]ov phvsia! thvapv I thv av anv things that vou
spiIia!!v an sti!! do, thn thv mav additiona!!v b impovtant
to mntion, i, bing ab! to "wight bav" on vouv ank! but
unab! to stand on vouv tos an b a sign oI hi!!s Tndon
Ruptuv
O os th pain pavtiu!av!v om on aItv vou hav
wa!kd a vtain distan, ov dos it om on whn vou
av !ving in bd at night?
Whv: On possib! aus oI hvoni ank! and !owv !imb
pain an b pviphva! vasu!av disas This is ausd
bv disas oI th b!ood vss!s supp!ving vouv
pviphvis (g, !gs, had) and vsu!ts in inadquat
d!ivvv oI oxvgn and]ov b!ood to thos tissus with
vsu!tant pain I th ank! pain ouvs whn vou av
!ving down, vou mav Iind that it is pavt!v]Iu!!v v!ivd
bv hanging vouv aIItd !imb ovv th sid oI vouv bd
as iI vou av about to gt out oI bd This is an impovtant
sign and is oI gvat impovtan to Iovmu!ating vouv
diagnosis and managmnt
O av vou vv suIIvd gout ov psudogout?
Whv: Ths av onditions whih an vsu!t in
vvv intns Ioot ov ank! pain I vou hav
suIIvd thm in th past thn thv an
pvdispos vou to othv inI!ammatovv
onditions suh as Rtvoa!ana! Buvsitis
O av vou vv bn diagnosd with p!antav
Iasiitis?
Whv: This is a painIu! ondition whih an b
most!v I!t in th h! oI th Ioot, it mav b
additiona!!v I!t in th ank!
O o vou p!av anv othv spovts?
Whv: Thv av som spiIi spovts (suh as Iootba!!, tnnis,
vaqutba!!, basktba!!, soItba!!, and basba!!) in whih vou av mov
!ik!v to suIIv hi!!s Tndon Ruptuv and subsqunt ank! pain
O av vou ov anvon in vouv Iami!v vv bn diagnosd with
savoidosis, ankv!osing spondv!itis, psoviasis]psoviati avthvitis ov
anv tvp oI avthvitis?
Whv: Ths av a!! onditions whih an pvdispos vou to ank! pain
svndvoms and inI!ammatovv onditions oI th hi!!s tndon
(suh as hi!!s Tndonitis) ov Ioot buvsa (Rtvoa!ana! Buvsitis)
O av vou vv I!t ov notid a "knot" avound ov nav ithv oI vouv
h!s?
Whv: !ong with ank! pain, this an b an indiation oI inI!ammatovv
onditions, suh as hi!!s Tndonitis
O What kind oI Iootwav do vou wav?
Whv: om kinds oI nk! Pain vndvoms an b ontvibutd to b
vouv hoi oI Iootwav
O o vou I! th pain in both ank!s?
Whv: This mav b an indiation oI a svstmi disas vathv than a
!oa!izd disas
O s thv anv pavtiu!av tim oI dav that th pain is wovs?
Whv: Pain that is wovs av!iv in th dav mav b as a vsu!t oI
p!antav Iasiitis ov vhumatoid avthvitis, whvas pain whih is
wovs at th nd oI th dav mav b th vsu!t oI ostoavthvitis and
othv dgnvativ joint onditions
O av vou notid anv hangs ov absn oI snsation in vouv
It]!owv !imbs?
Whv: possib! aus oI ank! pain is Tavsa! Tunn! vndvom
whih an b assoiatd with som dIiits oI snsation This is a
svndvom whih ouvs as a vsu!t oI pvssuv]ntvapmnt oI a
nvv (Tibia Nvv) in vouv !owv !imb
O o vou hav anv othv joints that huvt, ov hav vou vv had
avthvitis?
Whv: Pain ausd bv avthvitis an oItn aIIt mov than on
joint and is mov !ik!v to vouv
O av vou had anv injuvis to vouv ank! whih vsu!td in
anv bvaks ov pntvations oI th skin?
Whv: n spti avthvitis]ostomv!itis th joint inItion mav
hav bn th vsu!t oI batvia ntving th joint (ov th
tissu avound it) via uts, gvazs ov anv bvah oI th skin
bavviv
O os th pain ouv aItv xposuv to o!d?
Whv: Ravnaud's Phnomnon and hi!b!ains an aus ank!
pain, and ouv aItv th aIItd pviphvv has bn
xposd to o!d
O o vou hav th I!ing that vouv ank! "givs wav" whn
vou wa!k?
Whv: This an b a sign oI a spvaind ank! and vI!ts som
Iuntiona! instabi!itv oI th ank! joint
O nk! dIovmitv
Whv: mav indiat Ivatuv ov dis!oation
O Ting!ing ov numbnss oI th Ioot?
Whv: mav indiat nvv damag du to ank! Ivatuv
O Rvnaud's phnomnon (Iingvs tuvn whit, thn b!u thn vd
and painIu! in vspons to o!d)
Whv: mav indiat Rhumatoid avthvitis ov !upus
O iavvha
Whv: mav indiat ntvopathi avthvitis (g U!vativ o!itis,
Cvohn's disas) ov Ritv's svndvom
O vv
Whv: mav b assoiatd with spti avthvitis, Rhumatoid avthvitis
and !upus
O Rash
Whv: mav indiat psoviasis, vhumatoid avthvitis, !upus
O Uvthvitis svmptoms
Whv: mav indiat Ritv's svndvom
SWELLING
OEDEMA
DEFORMITY
REDNESS
BONY ALIGNMENT
CYNOSIS
SCAR
POSTURE
GAIT
#. EDEMA (PITTING AND NON PITTING )
:. TENDERNESS
. DIMPLE FORMATION
. TEMPERATURE
Cn LxAMlnA1lCn
O ROM (Range of moiion)
O Gaii
O Aciive and passive movemeni:
O MMT
O Resisied isomeiiics movemenis
SLClAL 1LS1S
O ntviov dvawv tst
Tle anieiioi diawei iesi is used io assess ligameni
laxiiy iliougl excessive anieiioi (foiwaid)
movemeni. Tle ileiapisi giasps ile lowei leg and
ile leel and applies an anieiioi (foiwaid) foice io
ile leel. Excessive movemeni compaied io ile
non-iniuied side is a posiiive iesuli
SLClAL 1LS1S
O PRONE ANTERIOR DRAWER TEST
Tle paiieni lies pione wiil ile feei exiending ovei ile
end of examing iable. Wiil one land ,ile examinei
pusles ile leel sieadily foiwaid .Excessive anieiioi
movemeni and sucling in of ile slin on boil sides of
Aclilles iendon indicaie a posiiive sign. Tle iesi ,lile
ile pievious one ,indicaies ligamenious insiabililiiy
.piimaiily ile anieiioi ialofibulai ligameni.
Speclal LesLs
O SQUEEZE TEST
Tle paiieni lies supine .ile examinei giasp ile lowei
leg ai ile midcalf and squeezes ile iibia and fibula
iogeilei .ile examinei ilen applies some load on ile
disial locaiion moving iowaids ile anlle .pain may
indicaie ile syndesmosis iniuiy ,piovided ilai fiaciuie
,coniusion and compaiimeni syndiome lave iuled
oui.
Speclal LesLs
O Cotton tst:
Tlis iesi is also used io assess foi syndesmosis
insiabiliiy caused by ile sepaiaiion of ile iibia
and fibula.
Tle examinei siabilizes ile disial iibia and
fibula wiil one land .and applies a medial and
laieial iiaslaiion foice (noi in eveision
]eveision foice )wiil ile oilei land io ile
fooi .any laieial iianslaiion > io mm
indicaies syndesmoiic insiabiliiy .
Speclal LesLs
O Ta!av ti!t tst :
Tlis iesi is done io deieimine wleilei ile
calcaneofibulai ligameni is ioin. Tle noimal side is iesied
fiisi foi compaiison .ile fooi is leld in ile anaiomical
(o
o
)posiion ,wlicl biings ile calcaneofibulai ligameni
peipendiculai ai io ile long axis of ile ialai .if ile fooi is
planiei flexed ,ile anieiioi ialo fibulai ligameni is moie
lilely io be iesied (inveision siiess iesi )ile ialus is ilen
iilied fiom side io side inio adduciion and abduciion
.adduciion iesi ile calcanofibulai ligameni and ,io some
degiee, ile anieiioi ialofibulai ligameni by incieasing ile
siiess on ile ligameni .
CCNDICN5 CAU5ING AIN CN ANkLL
O Mdia! (d!toid) !igamnt spvain
pvain to th !igamnt on th insid oI th ank!
O Pott's Ivatuv ] ank! Ivatuv
vatuvs to th ma!o!us in th ank!
O vu!sion Ivatuv
vatuvwhv a !igamnt ov tndon pu!!s awav a pi oI bon
O tvss vatuv oI th Mdia! Ma!!o!us
Pain on th insid oI th ank! that gts wovs with vunning and
jumping
O inus Tavsi vndvom
Pain just in Ivont oI th !atva! ma!!o!us
O Tavsa! Tunn! vndvom
Pain vadiating into th Ioot and h!
O Pvona! Tndinopathv
Pain and inI!amationon th pvona! tndons on th outsid oI th
ank!
O Ruptuv oI th Tndon oI Pvonus Bvvis
Ruptuv oI a tndon ausing pain on th outsid oI th Ioot and ank!
CCDI1ICN5 CAU5ING AIN CN ANkLL
O nk! spvain ] spvaind ank!
nk! invvsion spvain, tvatmnt and vhabi!itation
O Bvokn ank! ] nk! Ivatuv
!! tvps oI ank! Ivatuvs
O igh ank! spvain
amag to th !igamnt onnting th Tibia and ibu!a at th top oI th
ank!
O ootba!!vs ank!
Pain at th Ivont oI th ank! spia!!v whn kiking
O Tibia!is postviov svndvom
vsIuntion oI th Tibia!is postviov mus! vsu!ting in Ia!!n avhs
O Tibia!is postviov tndinopathv
Pain and inI!ammation on th insid oI th ank!
O Pvona! tndon dis!oation
Pain on th outsid oI th ank! Ivom dis!oation oI th pvona!
tndons
O mpingmnt oI th ank!
Pain at th bak ov Ivont oI th ank! du to impingmnt
uLlC8Ml1LS
O VARUS DEFORMITY
O VALGUS DEFORMITY
O EQUINUS(limiied doisiflexion)
O CALCANEUS
O CAVUS
O PLANUS
lnvLS1lCA1lCn
O X-RAY
O CT SCAN
O MRI
8LlL8LnCL
O ORTHOPEDICS PHYSICAI ASSESMENT (DAVID .l
. MAGEE)
O ORTHOPEDICS(l .MAHESHWARI)
O MUSCIE TESTING (DANIEIS)
O GOOGIE SEARCH