Professional Documents
Culture Documents
Ortho Ankle
Ortho Ankle
DOB
MRN
Date of Visit
KEY: Y = Yes(positive)
N = No(negative)
PMH/PSH
Prior ankle/foot injury or surgery
Other orthopedic history (surgeries, arthritis, trauma, injuries etc)
--------------------------------------------------------------------------------------------------------------------------------------------------Physical exam
Inspection
Limping gait
Y
N
Weight bearing Y
N
Swelling
Y
N
Ecchymosis
Y
N
Atrophy
Y
N
ROM
Plantarflexion
Full
Dorsiflexion
Full
Strength
Dorsiflexion
Full
Plantarflexion
Full
Inversion
Full
Eversion
Full
Special Tests
Effusion
Y
Special testing
Thompsons squeeze
Y
Anterior Drawer
Y
Talar Tilt
Y
Proprioception
Y
Tinels test (medial ankle) Y
Squeeze test
Y
Passive external rotation test
Lunge test (anterior impingement)
Palpation
Achilles tendon
Y
Palpation, continued
NE
NE
NE
NE
NE
Limited
Limited
Weak
Weak
Weak
Weak
Painful
Painful
Painful
Painful
NE
N
N
N
N
N
N
NE
NE
NE
NE
NE
NE
Y
Y
N
N
N
NE
NE
NE
Medial Malleolus
Y
N
NE
Lateral Malleolus
Y
N
NE
Peroneal tendons
Y
N
NE
Base of the 5th metatarsal Y
N
NE
ATFL
Y
N
NE
PTFL
Y
N
NE
CFL
Y
N
NE
Deltoid ligament
Y
N
NE
Talus
Y
N
NE
Navicular
Y
N
NE
Cuboid
Y
N
NE
Tibiofibular syndesmosis Y
N
NE
Neurovasc Exam
Sensation
Y
N
NE
Pulses (DP & PT)
Y
N
NE
OTTOWA ANKLE RULES - Consider X RAY if any one ore more
of the following:
- Inability to weight bear 4 steps immediately
Y
N
- Inability to weight bear 4 steps at evaluation
Y
N
- Tender on posterior half of medial malleolus
Y
N
- Tender on posterior half of lateral malleolus
Y
N
- Tender on posterior half of distal tibia or fibula
Y
N
- Tender at the base of the 5th metatarsal
Y
N
- Tender on cuboid
Y
N
EXCLUDE CHILDREN, PREGNANT WOMEN, THOSE NOT
CAPABLE OF PERFORMING EXAM FOR 2o REASONS
Ankle fracture
Osteoarthritis
Medial malleolar fx
Lateral malleolar fx
Maisonneuve fracture
Ankle impingement syndrome
Peroneal tendinopathy
Tibialis posterior tendinopathy
Achilles tendinopathy
Retrocalcaneal bursitis
Haglunds deformity
Stress Fracture:
______________________
Other:
______________________
Plan:
1) Treatment (Circle all employed)
RICE (Rest, Ice, Compression, Elevation)
Ankle brace/Immobilizer
Exercises: (specify)_____________________________________
Aspiration/Injection
Crutches/reduced weight bearing
Casting
2) Medications
NSAIDs
Y
N
Specify:________________________
Other:______________________________
3) Imaging
X-rays
Y
N
MRI
Y
N
If yes, specify test ordered:_____________________
4) Referral
Sports Med
Y
N
Orthopedics
Y
N
Physical Therapy
Y
N
5) Follow up: ______ wks
Figure 3- Demonstration of the anterior drawer and talar tilt tests to assess for stablility of ankle
ligaments. The anterior drawer test (left), in which the ankle is grasped in the neutral position
and translocated forward, assesses for ATFL injury. The talar tilt test tests the Calcaneofibular
ligaments integrity. Both exams are assessed by comparing the injured and uninjured ankles.
Figures 5: Ottowa Ankle rules, demonstrating zones for palpating the foot and ankle to assess for
potential bony disturbance/fracture.
Abbreviation Key
Grade II sprain: Partial tear, some degree of laxity, however with a stable endpoint, when
compared to uninjured ankle
Grade III sprain: Complete tear, gross laxity, when compared to the uninjured ankle, with no
discernable endpoint
Images obtained via Google Images; Captions adapted from Brukner & Khan, Clinical Sports Medicine, revised ed. 2