Foot and Ankle Assessment-Investigations and Tests: Difference between revisions
No edit summary |
No edit summary |
||
| Line 5: | Line 5: | ||
</div><div class="noeditbox">This article is currently under review and may not be up to date. Please come back soon to see the finished work! ({{REVISIONDAY}}/{{REVISIONMONTH}}/{{REVISIONYEAR}})</div> | </div><div class="noeditbox">This article is currently under review and may not be up to date. Please come back soon to see the finished work! ({{REVISIONDAY}}/{{REVISIONMONTH}}/{{REVISIONYEAR}})</div> | ||
== Introduction == | == Introduction == | ||
Taking a patient's history and completing an objective assessment is a gold standard | Taking a patient's history and completing an objective assessment is a gold standard for the foot and ankle assessment. The purpose of using special investigations and tests is to confirm the clinical diagnosis. <blockquote>"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'' </blockquote> | ||
== Techniques == | == Techniques == | ||
| Line 12: | Line 12: | ||
==== ''X-Rays'' ==== | ==== ''X-Rays'' ==== | ||
X-ray can help to investigate bone, air and soft tissue injury: | |||
* | * Assists with the diagnosis of the '''Achilles tendon rupture''' based on the presence of five radiological X-ray signs<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>. Lateral ankle X-ray is reliable to support diagnosis of the Achilles tendon rupture<ref name=":0" /> | ||
* | * May not be sufficient to identify '''malleolar fractures'''<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> | ||
* '''Syndesmosis injury''' is often overlooked on X-ray<ref name=":1" /> | * '''Syndesmosis injury''' is often overlooked on X-ray<ref name=":1" /> | ||
* Assists with diagnosis of the '''ankle fracture'''. AP, lateral and mortise views are recommended. Mortise view refers to AP view with 15° internal rotation. If possible, the | * Assists with diagnosis of the '''ankle fracture'''. AP, lateral and mortise views are recommended. Mortise view refers to AP view with 15° internal rotation. If possible, the X-ray should be done with patient in standing position. When ankle fracture was ruled out, but there is no progress in patient's rehabilitation and patient continues to complaint of pain: X-ray should be repeated within 6 weeks to rule out osteochondrial lesion or hairline fracture | ||
* Malalignment of the second tarsometatarsal joint is a common feature in '''Lisfranc fracture-dislocations.''' The X-ray's AP view shows lateral displacement of the second metatarsal base and diastasis over 2 mm between the first and second metatarsal bases. It is recommended that the x-ray of both feet is taken in weight bearing position on one foot and compared with the contralateral side. <ref>Stavlas P, Roberts CS, Xypnitos FN, Giannoudis PV. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989076/pdf/264_2010_Article_1101.pdf The role of reduction and internal fixation of Lisfranc fracture-dislocations: a systematic review of the literature]. Int Orthop. 2010 Dec;34(8):1083-91. </ref> | * Malalignment of the second tarsometatarsal joint is a common feature in '''Lisfranc fracture-dislocations.''' The X-ray's AP view shows lateral displacement of the second metatarsal base and diastasis over 2 mm between the first and second metatarsal bases. It is recommended that the x-ray of both feet is taken in weight bearing position on one foot and compared with the contralateral side. <ref>Stavlas P, Roberts CS, Xypnitos FN, Giannoudis PV. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989076/pdf/264_2010_Article_1101.pdf The role of reduction and internal fixation of Lisfranc fracture-dislocations: a systematic review of the literature]. Int Orthop. 2010 Dec;34(8):1083-91. </ref> | ||
* Hindfoot malalignment | * '''Hindfoot malalignment''' causes foot and ankle disability and the assessment of X-ray results of hindfoot alignment is important. The recommendation for a clinical and research purpose is to use the long axial hindfoot view in bilateral stance. <ref>ML Reilingh, L Beimers, GJM Tuijthof, SAS Stufkens, M Maas, et al. [https://www.researchgate.net/publication/40900666_Measuring_hindfoot_alignment_radiographically_The_long_axial_view_is_more_reliable_than_the_hindfoot_alignment_view Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view.] Skeletal radiology 2010;39 (11): 1103-1108.</ref> | ||
* The X-ray image | * The '''fracture of the sesamoid bone''' is shown on the the X-ray image as a rough space between the bone pieces. A smooth separation of two bones visible on the X-ray is a normal sign in about 10 % of population. | ||
==== ''Diagnostic Ultrasound'' ==== | ==== ''Diagnostic Ultrasound'' ==== | ||
Revision as of 23:20, 10 January 2022
Original Editor - Rachael Lowe
Top Contributors - Ewa Jaraczewska, Admin, Kim Jackson, Lucinda hampton, Samuel Adedigba, Nikhil Benhur Abburi, Jess Bell, Shejza Mino, Khloud Shreif, Rachael Lowe, Kai A. Sigel, Simisola Ajeyalemi, Rucha Gadgil, Wanda van Niekerk, Pinar Kisacik and Evan Thomas
This article is currently under review and may not be up to date. Please come back soon to see the finished work! (10/01/2022)
Introduction[edit | edit source]
Taking a patient's history and completing an objective assessment is a gold standard for 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]
X-ray can help to investigate bone, air and soft tissue injury:
- Assists with the diagnosis of the Achilles tendon rupture based on the presence of five radiological X-ray signs[1]. Lateral ankle X-ray is reliable to support diagnosis of the Achilles tendon rupture[1]
- May not be sufficient to identify malleolar fractures[2]
- Syndesmosis injury is often overlooked on X-ray[2]
- Assists with diagnosis of the ankle fracture. AP, lateral and mortise views are recommended. Mortise view refers to AP view with 15° internal rotation. If possible, the X-ray should be done with patient in standing position. When ankle fracture was ruled out, but there is no progress in patient's rehabilitation and patient continues to complaint of pain: X-ray should be repeated within 6 weeks to rule out osteochondrial lesion or hairline fracture
- Malalignment of the second tarsometatarsal joint is a common feature in Lisfranc fracture-dislocations. The X-ray's AP view shows lateral displacement of the second metatarsal base and diastasis over 2 mm between the first and second metatarsal bases. It is recommended that the x-ray of both feet is taken in weight bearing position on one foot and compared with the contralateral side. [3]
- Hindfoot malalignment causes foot and ankle disability and the assessment of X-ray results of hindfoot alignment is important. The recommendation for a clinical and research purpose is to use the long axial hindfoot view in bilateral stance. [4]
- The fracture of the sesamoid bone is shown on the the X-ray image as a rough space between the bone pieces. A smooth separation of two bones visible on the X-ray is a normal sign in about 10 % of population.
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 [5]
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[5]
MRI adequately demonstrates the sesamoid anatomy, plantar glenosesamoid apparatus, and the adjoining flexor, abductor, and adductor tendons and is the investigation of choice for metatarsalgia[6]
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 1.2 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.
- ↑ Stavlas P, Roberts CS, Xypnitos FN, Giannoudis PV. The role of reduction and internal fixation of Lisfranc fracture-dislocations: a systematic review of the literature. Int Orthop. 2010 Dec;34(8):1083-91.
- ↑ ML Reilingh, L Beimers, GJM Tuijthof, SAS Stufkens, M Maas, et al. Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view. Skeletal radiology 2010;39 (11): 1103-1108.
- ↑ 5.0 5.1 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.
- ↑ Batta NS, Gupta A, Batra V. Imaging Findings of Bilateral Medial Hallucal Sesamoid Insufficiency in a Marathon Runner. Indian J Musculoskelet Radiol 2019;1(1):57-60.
- ↑ Kris Porter DPT. Movement Screen of the Lower Quarter. Available from: https://www.youtube.com/watch?v=l6gkHR02rIM [last accessed 30/6/2021]
