Rubin A, Sallis R
Kaiser Permanente Medical Center, Fontana, California, USA.
Am Fam Physician. 1996 Oct;54(5):1609-18.
The evaluation of ankle injuries is a common challenge for family physicians. Diagnosis is made by using knowledge of the anatomy and function of the ankle joint to aid in taking an adequate history and performing an appropriate physical examination. The patient should be questioned about the mechanism of injury, previous injury, disability, treatment and pain. The ankle should be evaluated for ecchymosis, swelling, areas of tenderness and laxity. These measures help to determine what, if any, additional diagnostic procedures may be needed. Most ankle sprains are lateral, affecting the anterior talofibular, calcaneofibular and posterior talofibular ligaments. Other injuries include medial ankle sprains affecting the deltoid ligament, trauma to the Achilles and peroneal tendons, tarsal tunnel syndrome, fractures, syndesmotic sprains, synovial impingement and chronic instability. Criteria for radiographic evaluation include inability to bear weight initially or when examined, and tenderness over the medial or lateral malleolus. Accurate diagnosis is critical for appropriate treatment and minimizing functional disability.
对家庭医生来说，评估脚踝损伤是一项常见挑战。通过运用踝关节的解剖学和功能知识来辅助获取充分病史并进行适当体格检查，从而做出诊断。应询问患者有关损伤机制、既往损伤、残疾情况、治疗及疼痛方面的问题。应对脚踝进行瘀斑、肿胀、压痛部位及松弛度的评估。这些措施有助于确定是否需要进行其他诊断程序（若需要的话）。大多数脚踝扭伤发生在外侧，累及距腓前韧带、跟腓韧带和距腓后韧带。其他损伤包括累及三角韧带的内侧脚踝扭伤、跟腱和腓骨肌腱损伤、跗管综合征、骨折、下胫腓联合扭伤、滑膜撞击和慢性不稳定。影像学评估的标准包括最初或检查时无法负重，以及内踝或外踝压痛。准确诊断对于恰当治疗和将功能残疾降至最低至关重要。
