Group 7.

Pronation issues

The following questions should be answered

1. What is a classic history or capsule summary for this presentation? Specifically a typical
mechanism of injury and the typical aggravating and relieving factors.

Excessive outward turning of the ankle involving eversion of the calcaneus

Much less common that an inversion sprain

More common in overpronators or with a hypermobile subtalar joint

Often quite severe and may include avulsion of the medial malleolus, malleolar fracture or fibular
fracture.

The deltoid ligament is the ligament involved

2. What red flags and other conditions you need to eliminate? (include systemic and peripheral
presentations.

Neuropathy, infection, malignancy, Fracture

3. What outcome assessments would you use?

VAS & FAOS

4. If there is a grading scale, can you briefly describe it?

Grade 1:

Grade 2:

Grade 3:

5. What imaging techniques would you use and why?

MRI so as that we could pick up any soft tissue plus bone pathology

6. On the provided Images, please indicate the pathology and describe it?

Image 1 has posterior and lateral translation of the tibiotalar joint.

Image 2 shows lateral translation of the tibiotalar joint

 7. What relevant orthopaedic, quantitative and qualitative tests would you use? Demonstrate
one of each on the patient to the class.
 Inversion and eversion stress tests.
 L-M, M-L shear test of the talotibial joint
 Pes Planus test looking for flat foot
 Muscle tests of Tibialis anterior and posterior
 Talus Neutral test
 Tuning fork on the fibular to help check for a fracture.

8. Outline your management strategy including chiropractic and other techniques, treatment
plan; including your visit schedule, home advice, exercises and progressions. Include
expectations of what they can achieve at relevant time frames and what exercises you would
use in the relevant time frames.

Mild sprain – back on the field in 2 -3 weeks

Moderate to severe sprain – often leads to instability, at least 4 – 6 weeks

Complete rupture – Surgical intervention, 6 – 12 months.

PRICE for the first 2 – 3 weeks

Tapping the ankle for increased stability would be advised.

Strengthening exercises for inverter and evertor muscles.

Use of a wobble & rocker board to restore proprioception and strength.

Adjust the Tibiotalar joint if required

Image 1 Image 2