Lower leg

Cotton Test (Lateral Talar Glide)

+ test: distal tib-fib syndesmosis sprain

Inversion talar tilt test

- assesses calcaneofibular ligament + anterio talofibular ligament - stabilize lower leg with one hand and grasp heel with other - calcaneus and talus grasped as a unit and tilted into inversion in neutral position, repeat with 10 degrees of plantar flexion - *greater than 10 degrees* of tilt generally considered positive

Eversion talar tilt test

- assesses deltoid ligament, tib-fib sprain - stabilize lower leg with one hand and grasp heel with other - calcaneus and talus grasped as a unit and tilted into eversion - *greater than 10 degrees* of tilt generally considered positive

Kleiger's Test (External Rotation Test)

-Patient sits with legs over edge of table -Stabilize lower leg -Don't compress syndemosis -Grasp medial aspect of foot -Externally rotate foot ->Syndesmosis: ankle in dorsiflexion ->Deltoid complex: ankle in neutral or slight plantarflexion -(+) pain in anterolateral ankle -Implication: Syndesmosis (high ankle) sprain -(+) Medial joint pain or displacement of talus away from medial malleolus: -Implication: Deltoid sprain

Manuel Muscle Testing (MMT)

0= No contraction 1= There is flickering contraction 2= Full ROM with gravity counter balanced 3= Full ROM against gravity 4= Full ROM against gravity with added resistance 5= Full ROM and full muscle strength

Fracture

Mechanism: Blunt trauma, inversion or eversion stress AROM: do not perform anything on suspected fracture MMT: do not perform anything on suspected fracture PROM: do not perform anything on suspected fracture JT stability tests: do not perform anything on suspected fracture Selective test: Squeeze test (do not perform if fracture is obvious)

Traumatic compartment syndrome

Mechanism: Direct trauma to anterolateral or lateral portion of the leg, inversion mechanism that avulses the peroneals AROM: Decreased or absent ability to dorsiflex the ankle or extend the toes(anterior), Diminished or painful eversion(lateral) MMT: not indicated PROM: Pn during passive motion secondary to stretching the muscles in the involved compartment, creating pressure within Jt stability test: No applicable Selective tests: none

Medial Ankle Sprain

Mechanism: Eversion and/or rotation AROM: pn on the medial side of the ankle during plantarflexion indicates stretching of the ATFL or Tibionavicular ligaments. Pn during dorsiflexion indicates PTFL. Lateral pn may indicate pinching or trauma to lateral side MMT: Posterior tibialis weakness and pn PROM: Motion produces pn along ligaments JT stability tests: -stress test: eversion stress test -Jt play: cotton test, Talonavicular jt play Selective tissue test: -External rotation test (Kliegers)

syndesmosis sprain (high ankle sprain)

Mechanism: External rotation of the talus within the ankle mortise and/or dorsiflexion, forced hyperdorsiflexion or hyperplantarflexion, internal rotation of talus AROM: Motion is restricted and pn elicited with dorsiflexion and eversion; but also present at the end ranges of plantarflexion and inversion. rotating the foot increases pn anteriorly MMT: Tibialis anterior and posterior may be weak and painful PROM: all motions limited by pain, with greatest decrease noted in dorsiflexion and eversion Selective tissue tests: -External rotation test (Kleigers) -Dorsiflexion-compression test -Squeeze test -cotton test

Subluxating Peroneal Tendons

Mechanism: Forceful dorsiflexion and eversion or forceful plantarflexion and inversion AROM: tendons may be seen, felt, or heard as it dislocates and reduces while the foot and ankle move from plantarflexion and inversion to dorsiflexion and eversion MMT: Peroneals PROM: No significant findings Jt stability test: No significant findings Selective tissue test: No significant findings

Achilles Rupture

Mechanism: Forceful dorsiflexion or plantarflexion, usually the result of eccentric loading or plyometric contraction of the calf musculature AROM: Plantar flexion may still be possible with secondary movers MMT: Weak or absent plantarflexion PROM: Pn during dorsiflexion, empy end feel Jt stability test: Not applicable Selective tissue test: Thompson test

Lateral Ankle Sprain

Mechanism: Supination (inversion), Plantarflexion, or talar rotation in any direction AROM: Pn on lateral side of ankle during plantar flexion and inversion indicates stretching of the lateral ligaments. Pn medial indicates pinching of medial structures MMT: Peroneal are weak and Painful PROM: Pn at end range of motion; -Inversion and plantarflexion: ATFL, CFL -Inversion neutral position: CFL -inversion and dorsiflexion: PTFL Tests: -Special tests: + inversion stress test and/or + anterior drawer test in either laxity or pn -jt play: Increased medial glide at the subtalar; increased dorsal glide

Chronic Exertional Compartment Syndrome

Mechanism: Symptoms during or after running or other prolonged activity AROM: Decreased function in muscles of the involved compartment, Anterior: inability to dorsiflex the ankle or extend the toes MMT: Weakness noted during testing muscles in the involved compartment Anterior: Dorsiflexion. supination/inversion Deep posterior: plantarflexion, toe flexion, supination/inversion Lateral: pronation/eversion PROM: Increased pn with stretch of muscles in the involved compartment Jt stability test: Not applicable Selective tests: none

Achilles Tendinopathy

Mechanism: Typically the acute onset relating to a sudden , large increase in load or a blow to the achilles tendon. Tendinosis results from repetitive stressors and subsequent local tissue degeneration AROM: Pn and crepitus during plantarflexion and dorsiflexion. Dorsiflexion ROM may be diminished due to Achilles tightness MMT: Plantarflexion is painful/weak PROM: Pn at end range of motion of dorsiflexion, resulting from stretching the tendon JT stability tests: -stress tests: non-applicable -Jt play: Hypomobile lateral glide of the talus Selective tissue test: none

Medial Tibial Stress Syndrome

Mechanism: overuse/repetitive stress AROM: Unremarkable MMT: Symptoms reproduced with multiple repetitions of testing involved muscles: posterior tibialis, soleus, flexor digitorum longus, flexor hallucis longus PROM: Increased pn with ankle dorsiflexion, pronation, or toe extension Jt stability test: not applicable Selective test: navicular drop test

Leg and Ankle Stress Fractures

Mechanism: sudden increase in duration, frequency, or intensity of exercise or a change in playing surface or footwear AROM: All results may be normal in the acute stages or stress fracture MMT: In maturing stress fracture or right after exercise weakness may be present due to inflammation of muscle near fracture site PROM: Unremarkable findings Jt stability test: No applicable Selective tissue test: Squeeze test, Navicular drop test

Dorsiflexion and supination

Primary Mover: Tibialis anterior Secondary movers: Extensor hallucis longus, extensor digitorum longus, Peroneus tertius

Plantar flexors

Primary movers: Gastrocnemius, Soleus, Plantaris Secondary movers: flexor digitorum longus, flexor hallucis longus, tibialis posterior

Eversion and pronation

Primary movers: Peroneus longus and brevis Secondary movers: Extensor Digitorum Longus

Rearfoot inversion

Primary movers: tibialis posterior Secondary movers: Flexor digitorum longus, flexor hallucis longus

Anterior drawer test ankle

application of anterior force to the heel to assess the stability of the ankle joint + test: Sprain of anterior talofibular ligament and capsule

Squeeze Test

syndesmosis ankle sprain fracture