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- Ankle instability can be diagnosed easily with simply a history of instability
- Assessing
instability clinically is a little more challenging
- Instabilty needs to be quantified via stress radiography
- Stress
radiography involves anterior drawer - tests Anterior talofibular ligament
- Stress radiography involves talar tilt
- tests Calcaneofibular ligament
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Clinical anterior drawer
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Positive "pucker sign"
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Stress radiography can be performed either manually
or with a Telos device
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Manual stress - anterior drawer
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Telos device - anterior drawer
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Talar tilt
- ankle is inverted to stretch the
calcaneofibular ligament
- tilt is measured in degrees
- 0 - 15 is normal
- > 15 abnormal
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Talar tilt of the talus
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Technique for measuring talar tilt
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Anterior Drawer Measuring Techniques
- Concentric
Circles
- Parallel Lines
- Posterior displacement
New Method
- Anatomic
Normal Measurements on
non-stressed lateral
- Men - 10mm
- Women - 8mm
Stress Measurements
S - N = degree of instability
0 - 5 normal
5 - 10 mild instability
10 - 15 unstable
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Measure from the edge of the fibula to the vertical
ridge of the lateral talar process
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Anterior drawer measurement on lateral radiograph
19mm
- 10mm = 9mm
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