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Peroneal Tendon Instability , A Rare But Important Ankle Injury

Peroneal Tendon Instability

Ankle sprain is a common injury in Singapore athletes as well as the active adult. Most of the time, the ankle heals with a little care (rest, taping, ice). But one rare complication of lateral ankle sprains is a condition called peroneal tendon instability. A lateral ankle sprain means the side of the ankle away from the other leg is sprained. The two peroneal tendons go down the leg and around the back of the ankle bone. The tendons set down inside a tunnel formed by bone and connective tissue called the retromalleolar groove. A fibrous band (the superior peroneal retinaculum) goes across the tendon to hold them in the groove. […]

Achilles Tendonitis, Achilles Tear and Achilles Rupture in Singapore

Achilles tendonitis is a condition of irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common injury that tends to occur in recreational athletes. Overuse of the Achilles tendon can cause inflammation that can lead to pain and swelling. Achilles tendonitis is differentiated from another common […]

Achilles tendon rupture

WHAT IS ACHILLES TENDON RUPTURE?

Achilles tendon rupture is where the large tendon in the back of the ankle ruptures.

HOW IS ACHILLES TENDON RUPTURE DIAGNOSED?

There is a sudden pain behind the ankle. Physical examination shows a gap in the tendon and squeezing the calf muscle does not result in movement of the foot.

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Running and Ankle injury

Running is one of the easiest and most popular ways to stay fit. It is also one of the easiest ways to develop an injury. Running injuries are common and often effect the hips, knees, ankles, and feet of runners. The impact and stress of running is sometimes hard on the muscles and joints; especially […]

Strong varus movement at the ankle

Significance.

This movement tests the integrity of the strong distal tibiofibular ligaments.

Positioning.

The ankle is in neutral position and the knee extended. The examiner is distal to the foot. The ipSilateral hand fixes the leg at the inner side, just above the ankle. The contralateral hand grasps the foot at the heel.

Procedure.

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Combined dorsiflexion-eversion

Significance.

This is a specific test to demonstrate anterior periostitis of the fibula.

Positioning.

The knee is slightly flexed and the ankle in neutral position. The examiner is distal to the foot. His ipsilateral hand supports the heel and the contralateral hand is placed against the plantar and lateral side of the foot. […]

SPECIFIC TESTS

Combined plantar flexion-inversion Significance.

This movement brings all the lateral structures of ankle and foot under stretch and is therefore an extremely important test in sprained ankles.

Positioning.

The heel rests on the couch, the knee is slightly flexed and the ankle is in neutral position. The examiner is distal to the foot. […]

Resisted inversion of the foot

Positioning.

The patient lies supine with the knee extended and the foot in neutral position. The examiner is distal to the foot. The contralateral hand is placed at the lateral and distal end of the leg just above the lateral malleolus. The ipsilateral hand is placed against the medial border of the foot.

Procedure. […]

MAXIMAL ISOMETRIC CONTRACTIONS OF THE FOOT

Resisted dorsiflexion of the foot

Positioning.

The subject lies supine with the knee extended and the foot in neutral position. The examiner is distal to the foot. Both hands are placed at the dorsum of the forefoot.

Procedure.

Ask the patient to extend the foot.

Common mistakes.

None. Anatomical structures tested:

Muscle function:

• […]

Passive supination

Procedure.

Perform an abduction movement in the shoulder: the thumb pulls the inner side of the foot upwards while the fingers push the outer side downwards.

Common mistakes.

The ankle and subtalar joints are not stabilized.

Normal functional anatomy:

• Rallge: 45-90° • End-feel: soft ligamentous • Limiting structures: medial and lateral midtarsal ligaments.