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Ankle instability
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Clinical examination of an acute ankle injury should initially follow the Ottawa ankle rules to rule out a fracture. There is often tenderness over the lateral ligaments. The optimal time to assess a LAS is on day 5 after the injury when the pain has diminished, with 96% sensitivity and 85% specificity to detect ligament rupture (11). An anterior drawer test is performed with the ankle in slight plantarflexion (Figure 12.8) and considered positive when there is laxity, a soft end point and a dimple is seen just anterior to the tip of the fibula (when compared to the un-injured side) (11). The absence of visible discolouration and a negative anterior drawer sign at this stage reliably indicates that the ATFL is intact (11). To assess CFL, a talar tilt test is performed with the ankle in neutral (Figure 12.9).
Diagnostic research
Published in Nicholas Summerton, Primary Care Diagnostics, 2018
These indicants were subsequently prospectively evaluated and refined in a second study amongst a new set of patients.24 A final study sought to use a controlled trial in order to assess the feasibility and impact of introducing the indicants (combined together as a clinical decision rule - the ‘Ottawa ankle rules’) to a large number of physicians in the emergency departments of eight teaching and community hospitals in Canada.25 This work demonstrated that the use of the ‘Ottawa ankle rules’ led to reductions in the use of ankle radiography, waiting times and costs without an increased number of missed malleolar fractures.
Injuries of the ankle and foot
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
About 15% of ankle sprains reaching the Emergency Department are associated with an ankle fracture. This complication can be excluded by obtaining an X-ray, but there are doubts as to whether all patients with ankle injuries should be subjected to X-ray examination. More than 20 years ago The Ottawa Ankle Rules were developed to assist in making this decision. X-ray examination is called for if there is: (1) pain around the malleolus; (2) inability to take weight on the ankle immediately after the injury; (3) inability to take four steps in the Emergency Department; (4) bone tenderness at the posterior edge or tip of the medial or lateral malleolus or the base of the fifth metatarsal bone.
Evaluation of anterotalofibular and calcaneofibular ligament stress tests utilizing musculoskeletal ultrasound imaging
Published in Physiotherapy Theory and Practice, 2022
Rob Sillevis, Eric Shamus, Arie van Duijn
The International Ankle Consortium developed the International Ankle Consortium Rehabilitation-Oriented AssessmenT (ROAST) tool based on a Delphi study (Delahunt et al., 2018). The ROAST recommends that clinicians go through a systematic approach evaluating patients with ankle sprains. This should include an assessment of the osseous and ligamentous structures (Delahunt et al., 2018). To assess the osseous structures, the ROAST recommends using the Ottawa Ankle Rules. These have a high sensitivity, and if they are used following an ankle inversion trauma and none of the rules are positive, the posttest probability of ankle joint fracture is less than 1% (Delahunt et al., 2018). To assess ligament integrity, the anterior drawer test is recommended over the talar tilt test (Delahunt et al., 2018). The ROAST identifies the anterior drawer test as the most sensitive clinical stability test to assess for the complete rupture of the anterior talofibular ligament (Delahunt et al., 2018). Docherty and Rybak-Webb (2009) reported minimal differences between the reliability of both tests with the talar tilt test having an intra-rater reliability of 0.74 and an inter-rater reliability of 0.76. The anterior drawer test has an intra-rater reliability of 0.65 and an inter-rater reliability of 0.81 (Docherty and Rybak-Webb, 2009). Based on the current literature there is no clear diagnostic utility or clear preference of either the anterior drawer or the talar tilt test when evaluating the integrity of the ATFL (Cleland, Koppenhaver, Su, and Netter, 2016).