ANKLE ASSESSMENT BOX 2: CLASSIFICATION FOR ANKLE LIGAMENT INJURIES OR SPRAINS Grade Severity

Grade 1 - mild Less than 5mm movement

Grade 2 - moderate 5 to 10mm movement

Cause

- Single ligament - Mild Stretch - Anterior talofibular ligament most often

- Mild to moderate instability - Complete tear - Anterior talofibular ligament - Or partial tear of anterior talofibular and calcaneo- fibular ligaments

Grade 3 - severe More than 10mm movement

- Complete tear anterior talofibular, calcaneo fibular and anterior capsule

Signs

- Minimal swelling - Tender point - No haemorrhage

- Localised swelling – may be very large - Some haemorrhage

Functional outcome

- Little/no limp - Hopping difficult - Anterior draw negative

- If able to weight bear will limp

- Unable to hop - Cannot toe raise - Unable to run - Anterior draw may be positive

- Diffuse swelling on both sides of tendoachilles

- Haemorrhage appears quickly

- Tenderness medial and lateral

- Anterior draw positive - Unable to weight bear - PAIN ++ - Initial almost complete loss of movement

BOX 3: ANKLE LIGAMENT TESTS

1. Ankle drawer test – with the patient prone and their knee bent to 90O i. Anterior drawer test Place one hand on anterior tibia, just above ankle joint, the other hand holds the calcaneum, ankle in neutral, pull the foot anteriorly. Repeat test with foot in plantar flexion. Positive shows anterior movement of foot indicating anterior talofibular ligament instability.

ii. Posterior drawer test Patient as above, place one hand on posterior tibia to stabilise, hold plan- tar surface of heel and push foot pos- teriorly. Positive when there is poste- rior movement of the foot, indicating posterior talofibular ligament instability.

2. Eversion test Patient position as for anterior draw- er test, one hand holds the tibia to stabilise, other hand holds the mid- foot and everts to end of range. Positive result when pain with end range and increased laxity . This indicates deltoid (medial) ankle ligament disruption/sprain.

3. External rotation test Position as before. The foot is exter- nally rotated with a stabilised lower leg, to get the talus to rotate at the same time as stressing the tibiofibu- lar joint. Positive is when there is pain elicited along the joint line or medial ankle, indicating injury to the deep fibres of the deltoid ligament.

4. Peroneal tendon stability test As above, examiner holds foot with one hand. The other hand palpates for the peroneal tendon, just poste- rior to the lateral malleolus. The foot is then passively moved into the end range of inversion and the patient instructed to evert against resistance. With the palpating hand monitor the movement of the peroneal tendon. Positive demonstrates a palpable sublaxing of the tendon over the malleolus with pain, clicking, excess move- ment and catching behind the malleolus.

5. Talar tilt test Patient prone with knees extended over the edge of the couch. Hold the calcaneum in each hand with a finger on the lateral talus to monitor any movement. Ankle is in 10O

to 20O of

plantar flexion, the tester then inverts the talus to its end point being careful not to invert the foot. Foot inversion will assess subtalar movement. Positive increased range or pain on inversion indicates anterior talofibu- lar and calcaneofibular ligament instability.

12 sportex dynamics 2007:13(Jul):11-13

40 days (range 30-80 days)

Average recovery time

8 days (range 2-10 days)

20+ days (range 10-30 days)