Ankle instability
Maneesh Bhatia in 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).
Prognosis: Studies of disease course and outcomes
Milos Jenicek in Foundations of Evidence-Based Medicine, 2019
Clinical prediction rules (syn. clinical decision rules) are tools that assist practitioners by estimating the probability either of a diagnostic outcome or of a prognostic outcome.78 A clinical prediction rule is defined as a ‘decision-making tool for clinicians that includes three or more variables obtained from the history, physical examination, or simple diagnostic tests and that either provided the probability of an outcome or suggested a diagnostic or therapeutic course of action’.79 Clinical prediction tools belong therefore to both diagnosis and prognosis.80 For example the Ottawa Ankle Rules81 is a prediction tool that should help clinicians decide if a patient with an ankle injury evaluated in an emergency department needs ankle x-ray series or not: ‘An ankle x-ray series is required only if there is any pain in the malleolar zone and any of these findings:Bone tenderness at the posterior edge or tip of the lateral malleolus,orBone tenderness at the posterior edge or tip of medial malleolus,orInability to bear weight both immediately and in emergency department’.80,81
Trauma
Timothy Williamson, Bilal Salman, Rachael Boddy, Matthew Cooke, Peter Cameron in Care Bundles in Emergency Medicine, 2014
The Ottawa ankle rules are for assessing whether an ankle X-ray series is indicated. X-rays are only required if there is any pain in the malleolar zone and any one of the following. Bone tenderness along the distal 6 cm of the posterior edge or tip of the medial malleolus, orBone tenderness along the distal 6 cm of the posterior edge or tip of the lateral malleolus, orAn inability to bear weight both immediately and in the emergency department
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).
Related Knowledge Centers
- Ankle
- Fibula
- Malleolus
- Navicular Bone
- Tibia
- Bone Fracture
- Pain
- X-Ray
- Metatarsal Bones
- Pregnancy