KNPE 324 - Ankle

You are assessing a cross-country athlete's complaint of activity related shin pain. Just based upon this information, what are two possible diagnoses that come to mind?

1. MTSS 2. Tibilais Anterior Strain

You take a history from an athlete who complains of insidious posterior foot pain (talus region), which is exacerbated by activity, located "in front of" the Achilles, and increases with plantarflexion (active and resisted). You perform the Thompson test, which is negative and all pain with palpation is located on the posterior talus, but no crepitus is felt. What might this athlete be suffering from?

1. os trigonum 2. retrocalcaneal bursitis

Identify 3 key clinical findings that may be associated with an Exertional compartment syndrome of the anterior compartment.

1. waxy skin appearance 2. severe swelling 3. extreme point tenderness

A "high ankle" sprain refers to an injury to what structure? a. Distal tibiofibular syndesmosis b. Anterior talofibular ligament c. Deltoid ligament d. Spring ligament

A

Joint stability tests (stress testing and special tests) are most accurate when they are performed how many days following injury? A. 4 to 7 days B. 7 to 10 days C. 2 to 4 days D. 1 to 2 days

A

Pronation is a combination of which of the following movements of the foot? A. Dorsiflexion, abduction, and eversion B. Dorsiflexion, abduction, and inversion C. Plantar flexion, adduction, and eversion D. Plantar flexion, abduction, and inversion

A

What position is the closed-packed position of the ankle? a. Maximal dorsiflexion b. Anatomical joint neutral c. Slight plantar flexion d. Plantar flexion

A

What type of gait deviation might the athletic trainer see with a patient who has sustained an ankle injury and has decreased range of motion in dorsiflexion? A. Hip hiking B. Wide walking base C. Extension lag D. Lateral trunk bending E. Trendelenburg gait

A

Which of the following disappears with an ankle sprain? a. Sinus tarsi b. Lateral malleolus c. Base of the 5th metatarsal d. Dorsalis pedis pulse

A

Which of the following is the most common MOI for the distal tibiofibular syndesmosis? a. Dorsiflexion and or external rotation of the talus b. Dorsiflexion and or internal rotation of the talus c. Plantar flexion and or external rotation of the talus d. Plantar flexion and or internal rotation of the talus

A

Dorsiflexion/plantar-flexion motion occurs at the A. all of these B. talocrural joint C. subtalar joint D. midtarsal joint

B

Following multiple ankle sprains over the course of the year, the athletic trainer detects some weakness of the inverters and everters of a patient's ankle. Which of the following muscles does not invert the ankle? A. Tibialis posterior B. Extensor digitorum longus C. Flexor digitorum longus D. Flexor hallucis longus E. C and D

B

The BEST clinical diagnostic tool to detect an Achilles Tendon rupture is: A. Gap test B. Thompson test C. Copeland test D. Thomas test

B

The most common MOI for a lateral ankle sprain involves what foot motion? a. Eversion b. Inversion c. Plantar flexion d. Dorsiflexion

B

Using the Ottawa Ankle Rules, which of the following athletes needs to be referred for X-Ray? A. Bone tenderness along the 1st metatarsal B. Bone tenderness along the distal 6cm of the posterior/medial edge of the tibia C. Bone tenderness located at the proximal tibia 6 cm from the tibial tuberosity D. Bone tenderness located at the cuneiforms

B

Which of the following structures is not located in the deep posterior compartment? A. Flexor hallucis longus B. Peroneus longus C. Flexor digitorum longus D. Tibialis posterior

B

Clinically a deltoid ligament sprain will present with: A. A positive squeeze test B. Pain with Kleiger's test only with forced dorsiflexion C. Pain with Kleiger's test with the foot in external rotation and dorsiflexion D. Pain located over the anterior aspect of the talocrual joint

C

The ATFL limits anterior translation of the talus on the tibia and tightens to provide support during what motion? a. Eversion b. Inversion c. Plantar Flexion d. Dorsiflexion

C

Which of the following is not a function of the fibula? a. it serves as a site of muscular origin and attachment b. it serves as a site of ligamentous attachment c. it provides medial stability to the ankle mortise d. it serves as a fully to increase the efficiency of the muscles that run posteriorly to it

C

Which of the following ligaments is assessed using the anterior drawer test of the ankle? A. Deltoid B. Calcaneofibular C. Anterior talofibular D. Anterior tibiofibular

C

Which of the following structures can be palpated just posterior to the fibular head? A. Peroneus longus B. Lateral meniscus C. Common peroneal nerve D. Peroneal artery

C

You suspect a patient is suffering from anterior compartment syndrome. Which nerve is involved in the pathology? a. sural nerve b. superficial peroneal/fibular nerve c. deep perineal/fibular nerve d. saphenous nerve

C

Briefly describe a patient profile for a patient suffering from Sever's Disease

Child between the ages of 5-15 suffering from heel pain as a result of repetitive plantarflexion and dorsiflexion. common in young cross country runners, causing a jagged line in the growth plate of the calcaneus illiciting point tenderness at the Achilles tendon insertion.

An athlete presents in the ATR with pain in the shin area. Which of the following would give you an impression that the injury may be a stress fracture? a. Diffuse pain in the area of the shin b. Night pain c. Pain at rest d. Point tenderness in the area of the shin

D

Bringing the foot into plantar flexion will stretch the A. Soleus B. Tibialis posterior C. Platntaris D. Tibialis anterior

D

The forceful or repetitive plantar flexion performed by a young active individual who is presenting with pain in the posterolateral aspect of the ankle could indicate: A. Sever's disease B. Achilles tendinitis C. Plantar fascitis D. Os trigonum

D

Which of the following is not an anatomical and physiological factor predisposing individuals to lateral ankle sprains? a. Decreased proprioceptive ability b. Tightness of the triceps surge muscle group c. Lack of muscular coordination d. Increased muscular strength

D

Which of the following is the difference between traumatic compartment syndrome and chronic exertional compartment syndrome? A. Signs of the injury B. Treatment of the injury C. Symptoms of the injury D. Onset of the injury

D

Dorsiflexion and external rotation of the talus is a common mechanism of injury for what ankle structure?

Distal tibiofibular syndesmosis Deltoid ligament

A grade I ankle inversion sprain involves which structure? A. Tibiofibular ligament B. Calcaneofibular ligament C. Posterior talofibular ligament D. Spring ligament E. Anterior talofibular ligament

E

A positive Thompson's sign is indicative of what problem? A. Tight hip flexor B. Tight iliotibial band C. Ruptured anterior tibialis tendon D. Ruptured posterior tibialis tendon E. Ruptured Achilles tendon

E

If the calcaneofibular ligament of the ankle is torn, which of the following would be positive? A. Anterior drawer B. Cotton test C. Klieger's test D. Clunk test E. Talat tilt test

E

Sign's and symptoms of Sever's disease include which of the following? A. Point tenderness with palpation of the hamate bone B. Point tenderness and swelling at the base of the fifth metatarsal C. Pain with active ankle inversion D. Pain between the first and second metatarsal shafts with toe flexion E. Point tenderness at or just anterior to the insertion of the Achilles tendon along the posterior border of the calcaneous

E

The deltoid ligament is the main structure injured in a lateral ankle sprain True or False

False

Identify two potential risk factors that predispose a patient to Achilles tendinopathy.

Family hx of Achilles tendon rupture Achilles tendinopathy Hx of corticosteroid injection Age Male

A complaint of a snapping tendon along the lateral ankle during walking is common in patients with peroneal tendon dislocations. True or False

True

Provide a potential mechanism of injury for a traction injury to a nerve in the lower leg.

Varus stress to the knee, hyperextension of the knee, plantarflexion and inversion of the ankle