Ankle

Next inspect the ankle joint proper. The medial and lateral malleoli, anterior tibiotalar joint line, and the regions of the deltoid, anterior talofibular (ATFL), and calcaneofibular (CFL) ligaments are all readily available to direct palpation, thus facil-

Figure 65-4 Medial side of the foot/ankle. Areas of tenderness correspond to the following diagnoses: 1, Achilles tendonitis; 2, retrocalcaneal bursitis; 3, calcaneal apophysitis; 4, calcaneal stress fracture; 5, tibialis posterior tendonitis/symptomatic accessory Figure 65-2 Single heel rise with hindfoot inversion. navicular; 6, bunion.

Figure 65-4 Medial side of the foot/ankle. Areas of tenderness correspond to the following diagnoses: 1, Achilles tendonitis; 2, retrocalcaneal bursitis; 3, calcaneal apophysitis; 4, calcaneal stress fracture; 5, tibialis posterior tendonitis/symptomatic accessory Figure 65-2 Single heel rise with hindfoot inversion. navicular; 6, bunion.

Figure 65-5 Haglund's deformity (pump bump).

itating diagnosis. For instance, tenderness to touch over only the ATFL and not the lateral malleolus helps differentiate an ankle sprain from a fracture. Care must also be taken to distinguish tenderness over the ATFL from a painful sinus tarsi, as can occur with sinus tarsi syndrome. When an isolated syndesmotic injury (i.e., high ankle sprain) is suspected, perform the squeeze test by compressing the tibia and fibula at the junction of the middle and distal thirds to reproduce the pain, or, alternatively, dorsi-flex and externally rotate the foot while stabilizing the leg at the knee. The resulting torque on the lateral malleolus will cause pain if the syndesmosis is injured.

The tibiotalar joint itself should be examined along the anterior joint line where painful spurs can develop, by plantar flexing the ankle and directly palpating the talar dome (to evaluate for osteochondral injury), and by differentiating soft-tissue edema from effusion. Check for an ankle effusion by simultaneously compressing the anteromedial (medial to the tibialis anterior tendon) and anterolateral clear spaces (lateral to the extensor digitorum longus tendon). A distinct fluid wave will be felt when an effusion is present. In addition, the foot is generally held in a slightly plantar-flexed position to relieve intra-articular pressure. Last, painful plantarflexion-dorsiflexion or inversion-eversion of the hindfoot will help differentiate tibiotalar versus subtalar joint pathology, respectively.

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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