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A physical therapist evaluates a patient who sustained an ankle injury during a recreational soccer game. To determine whether imaging is necessary, the therapist applies the Ottawa Foot and Ankle Rules. According to this screening tool, which of the following factors would meet the criteria to refer the patient for an x-ray?

1. Pain near the medial malleolus and an inability to bear weight
2. Pain near the lateral malleolus and passive dorsiflexion limited to five degrees
3. Pain near the posterior calcaneus and a positive talar tilt test
4. Pain near the cuboid and swelling of the ankle joint

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A physical therapist evaluates a patient who sustained an ankle injury during a recreational soccer game. To determine whether imaging is necessary, the therapist applies the Ottawa Foot and Ankle Rules. According to this screening tool, which of the following factors would meet the criteria to refer the patient for an x-ray?

1. Pain near the medial malleolus and an inability to bear weight
2. Pain near the lateral malleolus and passive dorsiflexion limited to five degrees
3. Pain near the posterior calcaneus and a positive talar tilt test
4. Pain near the cuboid and swelling of the ankle joint

Ottawa Foot and Ankle Rules
The Ottawa Foot and Ankle Rules is an instrument used for patients with an acute traumatic injury to the foot or ankle (e.g., twisting injury, direct blow) in which a fracture may be suspected. If the patient meets the criteria within the instrument, then they should be referred for radiographs to rule out a fracture.

Let’s explore each of the options:
Option 1 - Pain near the medial malleolus and an inability to bear weight
To determine if the patient should be referred for radiographs, the patient must have pain near the malleolus (i.e., either medial or lateral) and meet one of the following two criteria: an inability to bear weight for four steps or tenderness at the tip or posterior edge of the distal six centimeters of the malleolus.

Option 2 - Pain near the lateral malleolus and passive dorsiflexion limited to five degrees
Pain near the lateral malleolus is one of the criteria that must be met to refer a patient for radiographs.

While a limitation in ankle range of motion may be associated with an ankle injury, it is not a factor that is considered as part of the Ottawa Foot and Ankle Rules.

Option 3 - Pain near the posterior calcaneus and a positive talar tilt test
Pain near the posterior calcaneus is not a factor that is considered with the Ottawa Foot and Ankle Rules. Rather, the patient would need to report pain near either malleolus or in the midfoot. Additionally, a positive talar tilt test would be associated with a ligament injury, not a fracture.

Option 4 - Pain near the cuboid and swelling of the ankle joint
Pain near the cuboid (i.e., midfoot) is one of the criteria that must be met to refer a patient for radiographs. However, swelling of the ankle joint, while possibly associated with an ankle injury, is not a factor that is considered as part of the Ottawa Foot and Ankle Rules.

The correct answer is Option 1

Let’s explore the all student data:
70% of students selected Option 1, Pain near the medial malleolus and an inability to bear weight, the correct response
15% of students selected Option 2, Pain near the lateral malleolus and passive dorsiflexion limited to five degrees
5% of students selected Option 3, Pain near the posterior calcaneus and a positive talar tilt test
10% of students selected Option 4, Pain near the cuboid and swelling of the ankle joint

System Classification
This question is a Musculoskeletal Systems question which represents approximately 27% of all exam items.

Content Outline Classification
This question is a Physical Therapy Examination question which represents approximately 24% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Check out page 114 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!