Foot and Ankle Assessment-Investigations and Tests: Difference between revisions
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==== ''X-Rays'' ==== | ==== ''X-Rays'' ==== | ||
Since an x-ray can be used to look at the bone, air and soft tissue, there may be soft tissue chang- es visible that could be used to aid the diagnosis of an Achilles rupture and potentially decrease the incidence of missed ruptures. | |||
five radiological x-ray signs that have been described to diagnose an Achilles tendon rupture; these are described in | |||
It was found that a soft tissue feature of loss of parallelism between the tendon and skin on a lateral ankle x-ray is sufficiently reliable and accurate to be rec- ommended in clinical use to aid diagnosis<ref name=":0">Bowen L, Evans R, Bodger O, Howard J, Anne-Marie H. [https://pdfs.semanticscholar.org/ebf8/385215a158a6c5a2ea5b63554eba5dfa2d42.pdf Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department]. Int J Foot Ankle. 2019;3:033.</ref> | |||
Evaluation of malleolar fractures solely on X-ray may be insufficient to identify many pathologies that potentially contribute to ankle arthrosis, with a consequent poor prognosis. <ref name=":1">Szymański T, Zdanowicz U. [https://reader.elsevier.com/reader/sd/pii/S1268773121000783?token=20BAABA2656F575E4601ED8303F1B6E4B0582F1FC9F97CE00713DCEF03C1EECA7C36EA352B30679E107BB48D397AC0AB&originRegion=eu-west-1&originCreation=20220108195539 Comparison of routine computed tomography and plain X-ray imaging for malleolar fractures—How much do we miss]?. Foot and Ankle Surgery. 2021 Apr 1.</ref>X-ray evaluation, regardless of evaluator experience. The most frequently overlooked injuries were: Tillaux fracture, Pillon fracture, loose bodies and syndesmosis injury. All of that missed pathologies required dedicated treatment and could be easily missed with standard surgical approach.<ref name=":1" /> | |||
==== ''Diagnostic Ultrasound'' ==== | ==== ''Diagnostic Ultrasound'' ==== | ||
==== ''MRI'' ==== | ==== ''MRI'' ==== | ||
the gold standard for the diagnosis of Achilles tendon rupture<ref name=":0" /> | |||
value of MR in evaluation of patients with ankle pain caused by traumatic injury. He concluded MR gives additional insight into ligamentous, tendon and [[/www.sciencedirect.com/topics/medicine-and-dentistry/cartilage-injury|cartilage injuries]]. However MR is expensive and not easily accessible on many ERs around the world | |||
While applying their classification, Rosenberg et al found MRI for diagnosing ruptures of the tendons to be sensitive in (95%) of cases and specific in (100%). MRI has (96%) accuracy in detecting tendon rupture <ref name=":2">Elgohary MM, Abdul Rahim SA, Ibrahim TA. [https://journals.ekb.eg/article_11782_9027f455004fbdf2c244f7188ed35c66.pdf Role of MRI in Evaluation of Traumatic Ankle Injuries]. The Egyptian Journal of Hospital Medicine. 2017 Oct 1;69(3):2016-24.</ref> | |||
MRI is particularly advantageous for assessing soft tissue structures around the ankle such as tendons, ligaments, nerves, and fascia and for detecting occult bone injuries<ref name=":2" /> | |||
==== ''CT Scan'' ==== | ==== ''CT Scan'' ==== | ||
The use of [[/www.sciencedirect.com/topics/medicine-and-dentistry/computer-assisted-tomography|CT]] in cases of foot and ankle trauma has been proposed in several previous studies | |||
CT is a very useful tool for assessing fractures in the ankle joint area <ref name=":1" /> | |||
=== Special Tests === | === Special Tests === | ||
Revision as of 22:04, 8 January 2022
Original Editor - Rachael Lowe
Top Contributors - Ewa Jaraczewska, Admin, Kim Jackson, Lucinda hampton, Samuel Adedigba, Nikhil Benhur Abburi, Jess Bell, Shejza Mino, Rachael Lowe, Kai A. Sigel, Simisola Ajeyalemi, Khloud Shreif, Evan Thomas, Rucha Gadgil, Wanda van Niekerk and Pinar Kisacik
Introduction[edit | edit source]
Taking a patient's history and completing an objective assessment is a gold standard of the foot and ankle assessment. The purpose of using special investigations and tests is to confirm the clinical diagnosis.
"We can't treat the patient just on x-rays or just on MRI findings. These things have to come together (with the objective assessment)". Helene Simpson
Techniques[edit | edit source]
Investigations[edit | edit source]
X-Rays[edit | edit source]
Since an x-ray can be used to look at the bone, air and soft tissue, there may be soft tissue chang- es visible that could be used to aid the diagnosis of an Achilles rupture and potentially decrease the incidence of missed ruptures.
five radiological x-ray signs that have been described to diagnose an Achilles tendon rupture; these are described in
It was found that a soft tissue feature of loss of parallelism between the tendon and skin on a lateral ankle x-ray is sufficiently reliable and accurate to be rec- ommended in clinical use to aid diagnosis[1]
Evaluation of malleolar fractures solely on X-ray may be insufficient to identify many pathologies that potentially contribute to ankle arthrosis, with a consequent poor prognosis. [2]X-ray evaluation, regardless of evaluator experience. The most frequently overlooked injuries were: Tillaux fracture, Pillon fracture, loose bodies and syndesmosis injury. All of that missed pathologies required dedicated treatment and could be easily missed with standard surgical approach.[2]
Diagnostic Ultrasound[edit | edit source]
MRI[edit | edit source]
the gold standard for the diagnosis of Achilles tendon rupture[1]
value of MR in evaluation of patients with ankle pain caused by traumatic injury. He concluded MR gives additional insight into ligamentous, tendon and cartilage injuries. However MR is expensive and not easily accessible on many ERs around the world
While applying their classification, Rosenberg et al found MRI for diagnosing ruptures of the tendons to be sensitive in (95%) of cases and specific in (100%). MRI has (96%) accuracy in detecting tendon rupture [3]
MRI is particularly advantageous for assessing soft tissue structures around the ankle such as tendons, ligaments, nerves, and fascia and for detecting occult bone injuries[3]
CT Scan[edit | edit source]
The use of CT in cases of foot and ankle trauma has been proposed in several previous studies
CT is a very useful tool for assessing fractures in the ankle joint area [2]
Special Tests[edit | edit source]
Ottawa Foot and Ankle Rules[edit | edit source]
Knee To Wall Test[edit | edit source]
Anterior Drawer Test[edit | edit source]
Squeeze Test[edit | edit source]
External Rotation Test[edit | edit source]
Cotton Test[edit | edit source]
Coleman Block Test[edit | edit source]
Other special tests include:
- Ankle ligament stress tests
- Talar tilt test
- Eversion stress test
- Silfverskiöld test
- Windlass test
- Impingement sign ankle
- Navicular drop test
Questionnaires[edit | edit source]
FAAM
FADI
Visa-A
CRPS
Additional details can be found on the Foot and Ankle Assessment page.
The following video demonstrates the application and interpretation of special tests for foot and ankle assessment:
References[edit | edit source]
- ↑ 1.0 1.1 Bowen L, Evans R, Bodger O, Howard J, Anne-Marie H. Investigating the Validity of Soft Tissue Signs on Lateral Ankle X-Ray to Aid Diagnosis of Achilles Tendon Rupture in the Emergency Department. Int J Foot Ankle. 2019;3:033.
- ↑ 2.0 2.1 2.2 Szymański T, Zdanowicz U. Comparison of routine computed tomography and plain X-ray imaging for malleolar fractures—How much do we miss?. Foot and Ankle Surgery. 2021 Apr 1.
- ↑ 3.0 3.1 Elgohary MM, Abdul Rahim SA, Ibrahim TA. Role of MRI in Evaluation of Traumatic Ankle Injuries. The Egyptian Journal of Hospital Medicine. 2017 Oct 1;69(3):2016-24.
- ↑ Kris Porter DPT. Movement Screen of the Lower Quarter. Available from: https://www.youtube.com/watch?v=l6gkHR02rIM [last accessed 30/6/2021]
