Lab-2: Ankle

ANATOMY
1. Bony landmarks
-

Bones of the leg (Tibia & Fibula)

Bones of the ankle/foot (Talus, Calcaneus, Navicular, Cuboid, Cunneiforms,
Metatarsals & Phalanges)
Base of 5th metatarsal

2. Location of ligaments
- Anterior and posterior talofibular ligaments (ATFL, PTFL)
- Calcaneofibular ligament (CF)
- Deltoid ligament (D)
- Anterior & Posterior (inferior) tibiofibular ligament (AITL, PITL)
3. Location of major muscles
- Tibialis Anterior (dorsiflexion)
- Tibialis Posterior (Inversion & plantar flexion)
- Fibularis (Peroneus) Longus/ Brevis (Eversion)
- Gastrocnemius & Soleus (Plantar flexion)
4. Location of arteries/nerves
- Anterior tibial artery
- Posterior tibial artery
- Dorsalis pedis artery
- Tibial Nerve
- Common Fibular (peroneal) nerve
- Deep Fibular (peroneal) nerve
- Superficial Fibular (peroneal) nerve
5. Location of joints
- Talocrural joint (Joint between tibia/fibula & talus) (Allows DF/PF)
- Subtalar joint (Joint between calcaneus/talus) (allows Inv/Ev & Pronation and
Supination)
- Intertarsal joints (Allows Pronation / Supination)

ANKLE EXAM
History:
What do you feel? (Type, quality, severity, and location of pain)
How did it happen? (What was the mechanism of injury i.e. direction ankle rolled, etc.)
Was there any sounds or feelings?
How long has this been a problem? (If longer is it improving or worsening)
Have you had this before? If so, what was the previous treatment? Was it effective?
Observation:
Can the person walk or move normally? (Is the person in obvious pain?)
Are there deformities, swelling or bruising?
o Swelling usually occurs anterior to the malleoli when the ankle is dorsiflexed
compare to the good side
Palpation:
First ask for permission to conduct an exam (to touch the patient)
Try to select the places that are the most painful last
Squeeze test:
o Compress the tibia and the fibula together proximally and work distally (this will
be painful during a fracture or if the anterior inferior tibio-fibular ligament is
damaged.)
Palpate the medial and lateral ligaments for tenderness (very important!)
Special Tests:
1. AROM (Use a goniometer)
0~20 0 In dorsiflexion
0 ~50 0 In plantar flexion
0~350 in inversion
0~250 in eversion
Determines possible damage to contractile tissue; measures muscle strength and
movement coordination
2. PROM
Distinguishes injury to non-contractile tissues
3. RROM - Can assess muscle strength and nervous system capability
A) Tibialis Anterior - Resisted dorsiflexion
B) Gastrocnemius and Soleus - Resisted plantarflexion
C) Tibialis Posterior (and Anterior) - Resisted inversion
D) Fibularis longus, brevis and tertius - Resisted eversion

4. Functional Tests:
Walk on toes (plantar flexion)
Walk on heels (dorsiflexion)
Walk on lateral borders of feet (inversion)
Walk on medial borders of feet (eversion)
Hop on injured ankle
5. Ligament Stress Tests:
A) Anterior drawer test
Used to determine damage to anterior talofibular ligament primarily and general
ligament stability.
Pull through heel while patient seated and knee flexed to 900 and ankle plantar flexed
200.
B) Posterior drawer Test:
Used to determine damage to posteior talofibular ligament primarily and general
ligament stability.
Push through heel while patient seated and knee flexed to 900 and ankle plantar
flexed 200. A positive test occurs when foot slides backward excessively and/or
makes a clunking sound as it reaches the end point
C) Talar Tilt Test:
Performed to determine extent of inversion or eversion injuries
With foot at 90 degrees calcaneus is inverted and excessive motion indicates
injury to calcaneofibular ligament and possibly the anterior and posterior
talofibular ligaments
If the calcaneus is everted, the deltoid ligament is tested
D) Kleigers test
Used primarily to determine extent of damage to the deltoid ligament
With lower leg stabilized, foot is everted and externally rotated to stress the
deltoid ligament.
E) Squeeze Test
Tests for a fracture or damage to the anterior inferior tibio-fibular ligament

ANKLE INJURIES
1) Ankle Inversion Sprain
History/mechanism:
- Roll over on lateral aspect of ankle (PF/INV) is the most common mechanism
- The most common ankle injury (~ 90%)
- Likely due to medial malleolus being shorter than lateral and therefore the talus can
be forced to invert farther than it can evert
- Also due to ligamentous thickenings on the lateral side of joint being separate and not
as strong as the big deltoid ligament on the medial side
Observation:
- Swelling and pain to the lateral aspect of the ankle
Palpation:
- Tenderness over the Anterior talofibular ligament (very important!!!!)
Special tests
a) ROM
All ROM`s may be limited or uncomfortable
b) Muscle tests
All muscle tests can be uncomfortable
c) Ligament stress tests
a. Anterior drawer test
Positive if over a grade 1 injury
b. Talar tilt test
Positive (in the direction of inversion) if over a grade 1 injury
2) Ankle Eversion sprain
History/ Mechanism
- not very common (5-10% incidence)
- The mechanism is usually PF/EV
- e.g. Landing on another players foot; catching foot in field depression
Observation
- Swelling and pain to the medial aspect of the ankle
Palpation:
- Tenderness over the deltoid ligament (very important!!!!)
- Do squeeze test to assess for fractures

Special tests
-

Ligament stress tests

o Talar tilt test
Positive (in the direction of enversion) if over a grade 1 injury
o Kleiger`s Test
Positive if over a grade 1 injury

Ankle Tape Job

For taping techniques of the ankle, please refer to page 25-29 in Perrin.
1. Ensure patients foot is in dorsiflexion throughout the tape job
2. Apply heel & lace pads where necessary (clean skin, shave if necessary, apply adherent
spray if needed)
3. Apply prowrap if indicated
4. Apply Anchors (at least 3 proximally, and 1-2 distally)
a. Remember to splay foot when the distal anchor is applied
5. Apply stirrups
a. Usually 3 stirrups, in a fan shaped pattern through base of calcaneus -apply to
restrict inversion (lateral to medial) or to restrict eversion (medial to lateral)
6. Close down
a. Proximal strips: Ensure these strips end anteriorly in a conical shape
b. As you move to distal regions, accommodate the tape according to the contour of
the ankle and other nearby structures
7. Heel Locks
a. Must have at least 1 full heel locks or 2 halves. (doubling this is helpful for
greater stability)
8. Re-anchor and clean-up
9. Check for any possible mistakes (Wrinkles, Shadows or windows)