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Assessment of acute foot
and ankle sprains
EN623 Lynam L (2006) Assessment and management of acute foot and ankle sprains.
Emergency Nurse. 14, 4, 24-33. Date of acceptance: June 2006
Authors
Louise Lynam ANP(Emergency),
RGN, HDEN, MSc is an advanced
nurse practitioner in emergency
care at the Adelaide and Meath
Hospital, Dublin
Summary
Acute ankle and foot trauma is a
regular emergency presentation
and prompt strategic assessment
skills are required to enable nurses
to categorise and prioritise these
injuries appropriately. This article
provides background information
on the anatomy and physiology
of the lower limb to help nurses
to identify various grades of ankle
sprain as well as injuries that are
limb threatening
Key words
n Patient assessment
n Anatomy and physiology
n Foot care and disorders
These key words are based
on subject headings from
the British Nursing Index.
Online
For related articles visit our online
archive at:
www.emergencynursing.co.uk
and search using the key words
above.
This article has been subjected
to double blind peer review
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EN1404 24-34 CPDLnm623.indd 24
Aims and intended outcomes
This article aims to provide nurses, specific­
ally those who work in emergency and
minor injury units, with a logical approach
to assessing acute foot and ankle injuries.
It discusses the anatomy and physiology of
the foot and ankle, common mechanisms
of injury and relevant diagnostic techniques.
Initial emergency treatment is mentioned
but the article does not cover specific man­
agement of foot and ankle trauma.
On completing this article, the reader
should be able to:
n Illustrate the normal anatomy of the
foot and ankle
n Understand injury mechanisms and their
possible outcomes
n Discuss the assessment progression from
history taking and physical examination,
to diagnosing common foot and ankle
injuries
n Recognise the potential complications assoc­
iated with injuries to the foot and ankle.
Introduction
The ankle is the most common site of
acute musculoskeletal injuries (Barker et al
1997), and injuries to the foot and ankle
are the most common injuries seen in
emergency departments (EDs) (Stiell et al
1992), with acute ankle sprains accounting
for 10 per cent of all visits (Garrick 1997).
Sprains have been shown to be 2.4 times
more common in the dominant leg and
have a 73.5 per cent prevalence of recur­
rence (Yeung et al 1994). Their misman­
agement can lead to chronic and persist­
ent conditions (Kesson and Atkins 1998).
The vast majority of ankle injuries involve
one or more of the lateral support­
ing lig­aments and can usually be man­
aged success­fully in primary care settings
(Garrick and Schelkun 1997).
During sport, the ankle is subjected to
considerable compression forces. These
have been calculated as five times body
weight during walking and 13 times body
weight during running (Bennet 1994).
Moreover, because the foot is regularly
in contact with the ground, compression
forces may be repeated 5,000 times every
hour when running.
Common injuries seen in EDs range from
foot and ankle sprains to tendon ruptures,
foot and ankle fractures, and dislocations.
To reduce treatment costs and increase
patient recovery, nurses should use
research evidence when managing and
treating these injuries (Smith 2003).
Detailed history taking and examination,
with reference to underlying anatomic
structures, can help nurses recognise
potential limb threatening injuries.
TIME OUT 1
Reflecting on your own practice,
consider the number of patients
you have seen with acute ankle
or foot trauma. How did they
present? How did you decide on
an appropriate triage category
in each case? You might wish
to write down some of the
presentations and what led
you to your decisions.
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10/7/06 4:36:46 pm
TIME OUT 2
Fig. 1. Bones of the foot and ankle
Tibia
Fibula
Calcaneus
Navicular bone
Cuboid bone
Middle cuneiform
Lateral cuneiform
Refer to Fig. 1. Ask a colleague to
help you identify the bones of the
foot and ankle on the diagram
and then refer their position
to your own lower limb.
This is called identifying
surface anatomy.
The collateral ligaments on each side of
the ankle are roughly triangular in their
attachment, and they link with the talus
and calcaneus, or heel bone.
The medial collateral, or deltoid, lig­ament
actually consists of four ligaments, forming
a strong triangular band radiating from the
medial malleolus and talus to the navicular
bone on the foot (Fig. 2). Because this liga­
ment offers such strong support, traumatic
injuries cause ankle fractures more often
than ligament ruptures (Kannus and Ren­
strom 1991).
The lateral collateral ligament consists
of three separate ligaments, the names
of which suggest their bony attachment
(Fig. 3):
n The anterior talofibular ligament (ATFL)
is an integral part of the ankle capsule.
The weakest of all the lateral collateral lig­
aments, it arises from the tip of the lateral
malleolus and passes across the talus
n The calcaneofibular ligament (CFL) is a
narrow cord, separate from the capsule,
that arises from the lateral malleolus and
attaches to the calcaneus
n T he posterior talofibular ligament
(PTFL) is a strong band that arises from
the back of the lateral malleolus and
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Talus
Medial cuneiform
Metatarsal bones
Sesamoid bones
Proximal phalanges
Distal phalanges
Middle phalanges
Fig. 2. Medial collateral ligaments of the ankle
Four ligaments
comprsing the medial
collateral, or deltoid,
ligament
Peter Gardiner
The ankle
The ankle joint (Fig. 1) is uniaxial, in that
movement occurs in one plane. It is located
between the lower, or distal, ends of the
tibia and fibula, which form the mortise,
and the talus bone, which lies underneath
(Kesson and Atkins 1998).
The talus fits into the mortise to form
a hinge joint, with the tibia forming the
medial malleolus, which is nearest the
midline, and the fibula forming the lat­
eral malleolus, which is furthest away
from the midline.
The joint surfaces are covered with
hy­aline cartilage, surrounded by a fibrous
capsule lined with synovium and reinforced
by strong ligaments.
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continuing professional development
Fig. 3. Ligaments and tendons of the foot and ankle
Calcaneal
(Achilles)
tendon
Anterior tibiofibular ligament
Anterior talofibular ligament (ATFL)
Interosseous talcalcaneal ligament
Calcaneonavicular and calcaneocuboid
ligaments
Dorsal cuboideonavicular ligament
Dorsal cuneonavicular ligaments
Dorsal intercuneiform ligament
Dorsal tarsometatarsal ligaments
Superior peroneal
retinaculum
Calcaneofibular
ligament (CFL)
Inferior peroneal retinaculum
Dorsal cuneocuboid ligament
Dorsal calcaneocuboid ligament
Peroneus longus and brevis tendons
attaches to the back of the talus (Kes­
son and Atkins 1998).
The interosseous ligament, which connects
the tibia and fibula proximally and the
tibio­fibular syndesmosis distally is another
important ankle ligament.
TIME OUT 3
Understanding anatomy is
essential for accurate assessment
and diagnosis of ankle and foot
injuries. List the names of any of
the ligaments around the foot
and ankle you can recall.
Remember that their names
evolve from their bony
attachments.
The foot
The foot consists of 26 bones and 57 joints,
which together act as a rigid structure for
weightbearing. The foot helps to support
the body and control posture by maintain­
ing the centre of gravity (Miller 1996). It is
divided into the hindfoot, the midfoot and
the forefoot.
Fig. 4. Arterial supply to the foot and ankle
The hindfoot
The hindfoot, which is composed of three
joints, links the midfoot to the ankle.
The calcaneus, which joins the talus to
form the subtalar joint, is the largest bone
in the foot and enables the foot to rotate
at the ankle. The calcaneus is cushioned by
a layer of fat.
Anterior tibia
artery
The midfoot
Peroneal artery
Posterior tibia artery
Medial
maleolus
Dorsal pedis artery
Posterior
tibial pulse
The midfoot has five irregularly shaped
tars­al bones: the navicular bone, the
cuboid bone, and the lateral, middle and
medial cun­eiform bones. Connected to
the forefoot and hindfoot by muscles and
the plantar fascia, or arch ligament, these
form the foot’s arch and serve as a shock
absorber.
The forefoot
Lateral plantar
artery
Medial plantar artery
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EN1404 24-34 CPDLnm623.indd 26
The forefoot is composed of five toes,
or phalanges, and their connecting long
bones, or metatarsals. Each toe, or pha­
lanx, is made up of several small bones.
The big toe, or hallux, has two phalanges,
two interphalangeal joints and two tiny,
round sesamoid bones, which enable it to
move up and down. Each of the other four
toes has three bones and two joints.
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The phalanges are connected to the
metatarsals by five metatarsal phalangeal
joints at the ball of the foot, which bears
half the body’s weight.
The tendons of the peroneus muscle pass
distally to the lateral malleolus, with the
peroneus brevis inserting at the base of the
fifth metatarsal and the peroneus longus
inserting at the under, or plantar, surface
of the foot.
TIME OUT 4
What mechanisms of injury can you
name? Make a list of the possible
injuries, sprains, tendon ruptures,
fractures or dislocations
that can occur from the
mechanisms you have listed.
Arterial supply
Blood to the foot and ankle is supplied by
the femoral artery, which becomes the pop­
liteal artery on entering the popliteal fossa,
and divides into the anterior and post­erior
tibial arteries below the knee joint.
The anterior tibial artery enters and supp­
lies the anterior compartment of the leg by
passing between the tibia and fibula above
the interosseous membrane. It continues
to the dorsum of the foot as the dorsalis
pedis artery, and enters the sole of the foot
by passing between the first and second
metatarsals.
The posterior tibial artery continues
through the calf between the soleus and
deeper muscles, and enters the lateral
compartment as the peroneal artery. It then
enters the sole of the foot, and passes the
medial and lateral plantar arteries, which
anastomose with each other, as well as the
dorsalis pedis artery to supply the anterior
foot and toes (Fig. 4).
Nerve supply to foot and ankle
The tibial nerve passes through the pop­
liteal fossa, and branches off to form the
gastrocnemius, popliteus, soleus and sural
nerves. The sural nerve is joined by fibres
from the common peroneal nerve, which
runs down the calf and supplies the lateral
aspect of the foot.
Anteriorly, the common peroneal nerve
leaves the popliteal fossa, crosses behind
the head of the fibula and around the
neck, and divides into deep and superficial
branches (Fig. 5).
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The deep peroneal nerve supplies muscles
of the anterior chamber, as well as cutane­
ous branches to the cleft between the big
and second toe. The superficial peroneal
nerve supplies the muscles in the lateral
compartment, the skin over the anterior
lower leg and the dorsum of the foot.
History taking
Taking patient history is an extremely
important part of evaluating any lower
limb injury, and doing so accurately gives
vital clues to diagnosis. Questioning should
reveal the mechanism of injury and the
immediate signs and symptoms after an
incident (Bruker and Khan 1998).
Nurses should ask when, where, how,
why, and what happened next, and note
patients’ descriptions of the immediate
symptoms after injury (Guly 1996).
Fig. 5. Nerve supply to the foot and ankle
Common peroneal nerve
Superficial nerve, which supplies the
lateral compartment
Deep peroneal nerve, which supplies
the anterior compartment
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continuing professional development
Fig. 6. Plantar flexion: the movement of the foot downwards
questions include: was the injury on a sports
field? Or a result of a road accident? Could
a wound be contaminated with dirt or oil?
Was the patient trapped for a time? Could
they have hypothermia or be in shock?
How and why?
Tom Walsh
Fig. 7. Dorsiflexion: the movement of the foot upwards
When?
The time of incident can help identify
an injury’s level of severity. A patient
who seeks help immediately, and is nonweightbearing, is more likely to have a
severe injury than one who presents a few
days after an incident and is fully weight­
bearing, defined by the ability to take four
steps. A delay in seeking help can suggest
a chronic rather than an acute problem.
At the time of the injury, the patient may
have heard a snap or tear but, while these
may be diagnostically significant in an
acute knee injury, they are not in an acute
ankle injury (Bennet 1994).
Where?
Asking where an injury occurred helps to
ascertain issues relevant to the injury such
as whether it happened at work. If so, a
health and safety issue may arise there, pos­
sibly involving flooring or footwear. Other
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EN1404 24-34 CPDLnm623.indd 28
Why and how questions clarify circum­
stances before and during the incident
and provide a picture of the trauma event.
For example, did the patient slip on a wet
floor? Was there dizziness or pain before
falling? Can the patient give a clear pict­ure
of the event? Is the patient confused or
complaining of chest pain? Such questions
rule out any clinical cause for the injury.
How a patient’s lower leg became twisted,
or how a blunt trauma was received, as
well as the approximate position­ing of the
limb at the time of injury, are significant
points to note for an accurate diagnosis.
Knowing what the patient was doing at
the time of injury can help to estimate the
severity of the forces to the foot or ankle
(Garrick and Schelkun 1997).
The talus of the ankle is more susceptible
to inversion forces in plantar flexion (Fig. 6)
than dorsiflexion (Fig. 7), when there is
bony stabilisation in the mortise.
The most common mechanism of injury
in ankle sprains is a combination of plantar
flexion and inversion (Fig. 8). The lateral
ligaments, which are referred to earlier,
are often damaged, particularly the ATFL
(Attarian et al 1985, van Dijk 2002).
What happened next?
Ask the patient what happened after the
incident. Did they weightbear or have they
not walked since? Did they apply ice or take
any analgesia before coming to A&E?
TIME OUT 5
Have you ever injured your ankle
or foot? If not, find a colleague
who has and take a history using
the points discussed above. Start
with when, where, why, how
and what happened next.
What were their immediate
symptoms?
Relevant symptoms
Pain, bruising, or ecchymosis, swelling and
deformity can be present after injury to the
foot or ankle:
emergency nurse vol 14 no 4 july 2006
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n Pain is significant and its severity and locat­
ion are useful guides for diagnosis. Some
pain can be referred from other injuries
and careful physical examination helps to
be specific about whether it is the foot or
ankle that is actually injured. If the patient
cannot give a good history, pain indicators
can be useful (Guly 1996)
n Ecchymosis can take a while to develop
and, because of gravity, often pools
around the foot
n Swelling can develop up to 24 hours
after injury. If the limb is not elevated
and the patient presents after a few
days, gross swelling can make the site
of pain more difficult to locate. Swell­
ing that occurs immediately rather than
over a few days is often indicative of a
more severe injury (Nurse and Rimmer
2001). The site of swelling can suggest
the location of the pathology, and the
degree of swelling is usually, but not
always, a reliable indication of sever­
ity. The affected and unaffected limbs
should be compared because patients
with clinical disorders such as renal or
heart failure can have residual chronic
pitting oedema
n Gross deformity should not occur with
an ankle injury, although severe swell­
ing can give this impression (Wolfe et al
2001). An obvious deformity requires
immediate intervention because it can
indicate ankle dislocation and therefore
threaten limb function.
Relevant previous injury
A recurrent injury can indicate ligament
instability (Guly 1996). If there is a wound,
tetanus status is needed, although other
details, such as clinical history, regular and
recent medications, and history of aller­
gies, are also relevant to treatment.
Factors such as whether patients live
alone or have other disabilities and so
require early physio- or occupational
therapy need to be addressed at this early
history taking phase.
TIME OUT 6
How is pain assessed in emergency
departments? Do you use pain
indicators? What can be done
to alleviate pain before drug
intervention for a patient
with lower leg trauma?
Physicial Examination
Following history taking, a directed, system­
atic, physical examination is undertaken
to clarify diagnosis and management
options and to ensure that associated
injuries are not overlooked (Hockenbury
and Sammarco 2001). More experienced
nurses are familiar with history taking and
accurate physical examination. The ‘look,
feel and move’ guide is one commonly
used approach (Wardrope 1998).
Look
First assess the patient’s gait and whether
they are weightbearing; remember that
the ability to take four steps or two trans­
fers, is defined as fully weightbearing even
if the patient limps.
The examination should be carried out on
a bench or trolley with both limbs exposed
fully to above the knee so that any wounds,
haematomas, old scars, or obvious gross
deformities can be seen immediately.
Fig. 8. Ankle inversion and eversion sprains
Strained
medial
collateral
ligament
Inversion sprain
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Peter Gardiner
Strained
lateral
collateral
ligament
Eversion sprain
29
10/7/06 4:37:02 pm
continuing professional development
A deformity suggestive of dislocation
requires immediate treatment and exper­
ienced help. Lower limb discolouration,
reduced sensation or severe pain can
also indicate dislocation that is affecting
blood flow and nerve transmission (Karls­
son et al 2003).
Neurovascular injury is the principal con­
cern with any dislocation because vascular
compromise can cause avascular necrosis of
the talus if it is not quickly reduced. Tented,
white skin, which occurs when the disloc­
ated bone has moved, can be subject to
ischaemic necrosis (Mackway-Jones 1997).
In patients with obvious or complete
neurovascular compromise, reduction
and splinting are needed to avoid vascular
compromise. Limb position and possible
fractures can then be viewed using X‑rays
(Keaney 2005).
Wounds can be cleaned and covered with
a temporary povidone-iodine non-adhesive
dressing at this stage (Holt 2000).
Feel
A thorough physical examination can help
decrease the need for many X-rays, but the
obvious area of injury should be palpated
last to avoid causing pain immediately,
which can make patients anxious.
Fig. 9. Ligaments and tendons of the right lower leg
Peroneus longus
Peroneus brevis
Calcaneofibular ligament (CFL)
Peroneus brevis tendon
attached to the base
of the fifth metatarsal
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EN1404 24-34 CPDLnm623.indd 30
Start at the head of the fibula and palpate
to 6cm posterior to the lateral and medial
malleolar tips. Palpate the calcaneus and
ensure that the Achilles tendon is intact.
Compare its insertion with the unaffect­ed
limb and use the calf squeeze test, also
known as the Thompson test or Simmonds
test, to assess for rupture.
To do the test, ask the patient to lie front
down and squeeze both calf muscles. This
should result in normal plantar flexion; it is
considered positive if there is no response.
Palpate all the bones of the foot, includ­
ing the tarsals, metatarsals and phalanges.
The base of the fifth metatarsal, where
the peroneus brevis tendon is attached
(Fig. 9), is a common site of fracture when
the peroneus brevis tendon is pulled in an
invers­ion injury.
X-rays
The Ottawa Ankle Rules (Fig. 10) are a set
of criteria developed by Stiell et al (1992)
in Ottawa to help practitioners decide
whether patients with acute ankle injury
need X-ray.
In brief, an ankle radiographic series is
indicated only if the patient has pain near
a malleolus and:
n Is 55 years or older
n Cannot weightbear on the ankle after
injury
n Has bone tenderness at the posterior
edge or tip of either malleolus and can­
not walk four steps on it, or
n Has pain in the midfoot zone at the
navicular region or at the base of fifth
metatarsal (Stiell et al 1994).
When the rules were published, the authors
claimed that they had 100 per cent sensit­
ivity and 40 per cent specificity for detect­
ing malleolar fractures so that all patients
who truly had fractures would be X-rayed
(Stiell et al 1992).
Neurovascular status
The neurovascular status of the limb can be
checked by touch, first to determine temper­
ature; high temperature suggests infection
while low temperature suggests ischaemia.
Capillary refill can be tested by push­
ing on the tip of the big toe or the nail
bed until blanching occurs. When either
is released, the length of time it takes for
a red colour to return is noted. If this is
more than three seconds, an abnormality
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consistent with arterial insufficiency is
considered to be present.
Pedal pulses must also be checked.
The most dorsal prominence of the navicu­
lar bone provides a landmark by which to
locate the dorsalis pedis, while the groove
between the medial malleolus and the
Achilles tendon helps locate the posterior
tibial artery (Mowlavi et al 2002) (Fig. 4).
The common peroneal nerve, which
winds around the neck of fibula, can be
injured resulting in footdrop and loss of
sensation in the lower anterior leg and
dorsum of foot. This nerve is also at risk of
anterior compartment syndrome.
Compartment syndromes
Trauma can cause compartment syn­
dromes in the lower leg or foot as in other
parts of the body. The mechanism of injury
here is usually severe local trauma, though
associated skeletal injury may be minimal,
with the classic warning sign being intense
pain unrelievable by analgesia. Initial symp­
toms are progressive pain, numbness in
the toes and decreased motion, but the
most reliable sign is tense tissue bulging
(Fakhouri and Manoli 1992).
If compartment syndrome is suspected,
immediate attention is required to avoid loss
of limb. Treatment of acute compartment
syndrome usually involves a fasciotomy, in
which longitudinal incisions are made in
each of the affected compartments. These
incisions are left open to be sutured at a
later date (Swain and Ross 1999).
Assessing ligament damage
Palpate the collateral ligaments, namely
the deltoid ligament and the ATFL, CFL
and PTFL, to determine which structures
may have been injured.
TIME OUT 7
Check your own pedal pulses.
Work with a colleague,
referring to an anatomy
book on the arterial blood
flow to the lower limbs.
Fig. 10. The Ottawa Ankle Rules
Posterior edge or tip
of lateral malleolus
Posterior edge or tip
of medial malleolus
Malleolar zone
Midfoot zone
6cm
6cm
Lateral view
An ankle X‑ray series is required only if there is pain in the
malleolar zone and any of these findings:
n Bone tenderness at the posterior edge or tip of the lateral
malleolus
n Bone tenderness at the base of fifth metatarsal
n An inability to weightbear immediately or when in
emergency department
vol 14 no 4 july 2006 emergency nurse EN1404 24-34 CPDLnm623.indd 31
Navicular bone
Medial view
A foot X‑ray series is required only if there is pain in the
midfoot zone and any of these findings:
n Bone tenderness at the base of the fifth metatarsal
n Bone tenderness at the navicular bone
n An inability to weightbear immediately or when in
emergency department
Peter Gardiner
Base of fifth metatarsal
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continuing professional development
Initial emergency treatment
Once a clinical dislocation has been ruled out,
the patient’s pain must be addressed. Treat­
ment with Protection, Rest, Ice, Compression
and Elevation (PRICE) is recommended for
both initial management in an emergency
setting and discharge management.
The goal is to prevent swelling, bleeding
and oedema around the capsule of the
ankle, which can result in loss of motion
(Garrick and Schelkun 1997).
Activities should be reduced to allow
healing while resting, and cryothearpy
should be used immediately (Knight 1995).
This can be done with ice packs placed on
a thin layer of cloth on the foot or ankle;
ice applied directly to the skin can damage
it. Heat should not be applied in the acute
phase because it encourages swelling and
inflammation (Wolfe et al 2001).
Limb elevation by between 15 and 25cm
above the level of the hip encourages
venous and lymphatic drainage until the
swelling resolves. Immobilisation with splints
can be necessary for patients with possible
fractures, or who are non-weightbearing
and in pain. Temporary vacuum splints
are practical and help reduce pain by stab­
ilising any potential fracture (Holt 2000).
Analgesia should be given immediately
and before examination if required.
Fig. 11. The anterior drawer test
Fig. 12. The talar tilt test
Tom Walsh
Laxity tests
Eighty five per cent of ankle injuries are
sprains, and 85 per cent of lateral collateral
ligaments, namely ATFL, CFL and PTFL, are
injured through inversion sprains (Garrick
1997, Wolfe et al 2001).
Diagnosing ankle ligament rupture can
be supported by laxity tests after foot or
ankle fracture has been excluded.
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The anterior drawer test assesses the
stability of the ATFL and is undertaken by
cupping the heel in one hand and pulling
it forward while stabilising the tibia with
the other hand (Fig. 11). Movement, or
translation, of more than 10mm, or a 3mm
difference between sides, suggests ATFL
disruption (Kannus and Renstrom 1991).
Comparison of the affected and uninjured
sides is critical because the degree of laxity
varies greatly between patients.
The talar tilt tests both the ATFL and
CFL. The ankle is inverted and the laxity
compared to that of the uninjured side
(Fig. 12). A complete rupture is evidenced
by a talar tilt of at least 20° and one that
is at least 10 per cent greater than on the
uninjured side, and is considered a third
degree ankle sprain (Rubin 1997).
TIME OUT 8
Practice laxity tests with your
colleagues. Remember
which ligaments in the lateral
complex you are straining.
Ankle sprain classification
Ankle sprains range in severity from
Grade I to Grade III. A review of the literat­
ure shows that there are slight variations
in labelling:
n Grade I injuries involve a stretch of the
ligament with microscopic, but not
macro­scopic, tearing. Generally, little
swelling is present, with little or no
funct­ional loss and no joint instability.
Patients can weightbear fully with no
mechanic­al instability
n Grade II sprains involve a stretch of the
ligament with partial tearing, moderateto-severe swelling, ecchymosis,
mod­erate functional loss and mild-tomod­erate joint instability
n Grade III sprains involve ligament rupture
so that the patient cannot weightbear
(Renstrom and Konradson 1997).
Prevention
Nurses can advise patients that maintaining
good muscle strength, balance and flexibil­
ity can help prevent ankle sprains, as can
warming up and stretching the muscles
and tendons that anchor the ankle before
exercise or other vigorous activities.
Other advice includes:
n Paying attention to walking, running or
work surfaces
n Obtaining advice on appropriate footwear
for specific activities, making sure that
shoes fit properly and avoiding high heels
n Paying attention to physical warning
signs such as pain and fatigue that can
indicate a need to slow down
n Losing weight to reduce the strain on
the ankles, if appropriate
n Avoiding sports and activities for which
people are not conditioned
n Using ankle support braces if people are
prone to ankle pain or twisting during
certain activities.
Conclusion
A good knowledge and understanding of
the anatomy and physiology of the foot
and ankle enable nurses working in emerg­
ency settings to undertake thorough and
accurate physical examinations of sus­
pected ligament­ous injuries.
Combined with comprehensive patient
histories, these can help ensure accurate
diagnoses, and initiate treatment or refer­
ral to the relevant departments.
Knight KL (1995) Cryotherapy in Sport Injury
Management. Human Kinetics, Champaign IL.
Rubin A (1997) Ankle ligament sprains. In Sallis R,
Mackway-Jones K (1997) Emergency Triage.
BMJ Publishing, London.
Medicine. Mosby, Oxford.
Miller MD (1996) Review of Orthopaedics.
WB Saunders, Philadelphia PA.
Emergency Nurse. 11, 3, 12-16.
Mowlavi A, Whiteman, J, Wilhelmi, BJ,
Neumeister MW, McLafferty R (2002) Dorsalis
pedis arterial pulse: palpation using a bony landmark.
Postgraduate Medical Journal. 78, 926, 746-747.
A study to develop clinical decision rules for
Nurse N, Rimmer M (2001) Musculoskeletal disorders.
In Cross S, Rimmer M (eds) Nurse Practitioner: Manual
of Clinical Skills. Baillière Tindall/RCN, London.
Stiell IG, McKnight RD, Greenburg GH et al
Renstrom P, Konradson B (1997) Ankle ligament
injuries. British Journal of Sports. 31, 1, 11-20.
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Massamino F (eds) ACSM’s Essentials of Sports
Smith M (2003) Ankle Sprain: a literature search.
Stiell IG, Greenberg GH, McKnight RD,
Nair RC, McDowell I, Worthington JR (1992)
the use of radiography in acute ankle injuries.
Annals of Emergency Medicine. 21, 4, 384-390.
(1994) Implementation of the Ottowa ankle rules.
Journal of the American Medical Association.
271, 11, 827-832.
Swain R, Ross D (1999) Lower extremity compartment
syndrome: when to suspect acute or chronic pressure
build up. Postgraduate Medicine Online. 105, 3. www.
postgradmed.com/issues/1999/03_99/swain.htm
(Last accessed June 29 2006).
van Dijk CN (2002) Management of the sprained
ankle. British Journal of Sports Medicine. 36, 2, 83‑84.
Wardrope J, English B (1998) Musculoskeletal Problems
in Emergency Medicine. Oxford. Oxford University Press.
Wolfe MW, Uhl TL, McCluskey LC (2001)
Management of ankle sprains. American Family
Physician. 62, 1, 93-104.
Yeung MS, Chan KM, McPhil CHS, Yuan WY
(1994) An epidemiological survey on ankle sprain.
British Journal of Sports Medicine. 28, 2, 112-116.
33
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continuing professional development
Continuing professional
development
Practice profile
Complete this form using a ballpoint
pen and CAPITAL letters only
1. First name:
2. Surname:
3. Job title:
4. Place of work:
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What do I do now?
n Using the information in section 1 below to
guide you, write a practice profile of between
750 and 1,000 words – ensuring that you
have related it to the article you have studied.
See the examples given in section 2 below.
n Write ‘Practice Profile’ at the top of your
entry followed by your name, the title of the
article, which is Assessment of acute foot
and ankle sprains, and the article number,
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n Complete all the fields of the cut-out form
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A certificate is awarded for successful com­
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copies of practice profiles are not returned.
1. Framework for reflection
Consider these points before submitting your
practice profile.
n What have I learnt from this article and how
does it relate to my practice?
n To what extent were intended learning out­
comes met?
n What do I know, or can I do, now, that I did
not or could not before reading the article?
n What can I apply immediately to my practice
or patient care?
n Is there anything that I did not understand,
or that I need to explore or read about fur­
ther, to clarify my understanding?
n W hat else do I need to do or know to
extend my professional development in
this area?
n What other needs have I identified in relat­
ion to my professional development?
n How might I achieve the above?
2. Practice profile example
Example 1 After reading a CPD article on
‘Communication skills’, Jenny, a practice nurse,
reflects on her own communication skills and
re-arranges her clinic room so that she will sit
next to her patients when talking to them. She
makes a conscious decision to pay attention
to her own body language, posture and eye
contact, and notices that communication with
patients improves. This forms the basis of her
practice profile.
Example 2 After reading a CPD article on
‘Wound care’, Amajit, a senior staff nurse on a
surgical ward, approached the nurse manager
about his concerns about wound infections
on the ward. Following an audit that Amajit
undertook, a protocol for dressing wounds
was established, which led to a reduction in
wound infections in his ward and across the
directorate. Amajit used this experience for
his practice profile and is now taking part in a
region wide research project.
3. Portfolio submission
Checklist for submitting your practice profile
✔ Have you related your practice profile to
the article?
✔ Have you headed your entry with: the title
‘Practice Profile’; your name; the title of the
article; and the article number?
✔ Have you written between 750 and 1,000
words?
✔ Have you kept a copy of the practice profile
for your own portfolio?
✔ Have you completed the cut-out form and
attached it to your entry?
✔ Have you indicated whether you would like
your practice profile to be considered for
publication?
✁
34
EN1404 24-34 CPDLnm623.indd 34
emergency nurse vol 14 no 4 july 2006
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