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THE ;)OURNAL OF ORTHOPAED~C AND SPORTS PHYSICAL THERAPY Copyright O The Orthopaedic and Sports Medicine Sections of the American Physical Therapy Association

Measurement of Ankle Joint Swelling Using a Figure of 8*

PERRY S. ESTERSON,? MS, PT, ATC
The method of measuring joint swelling in a figure of 8 has the following advantages: 1 ) being readily reproducible, 2) measuring swelling at the various sites of ankle sprains, and 3) requires only a tape measure and marking pen.

Ankle sprains are injuries commonly seen in sports medicine. Loss of motion, pain, and swelling are sequelae in this type of injury. Measuring joint swelling daily will enable the therapist/ trainer to base a treatment program on objective rather than subjective observations. Additionally, range of motion measurements and functional testing should be used to evaluate the progress and performance level of the patient. Swelling may be divided into two categories: intracapsular and extracapsular. The former is joint effusion, either hemorrhagic or synovial in nature; the latter is edema in the intercellular tissue spaces at and around the site of injury caused by extravasation of serum, blood, and lymph.' The method of measuring swelling presented here cannot differentiate between effusion and edema. Therefore, both of these terms will collectively be referred to as swelling. Circumferential measurement of the joints in extremities has been done on fingers with jewelers' rings, and on knees with a tape measure.* Swelling at the ankle joint has been measured by tape measure and by using calipers across the malleoli. These methods do not usually measure swelling resulting from ankle sprains because the measuring device does not cross the injured structure. The figure of 8 method allows the therapisthrainer to measure swelling across the several common sites of ankle sprains: the anterior talofibular ligament, calcaneofibular ligament, and anterior tibiofibular ligament. The procedure is easily reproduced by using boney landmarks about the ankle.
From the Rainbow Sports Medicine Center. Cleveland, Ohi o. t Director of Sports Medicine Center for Sports Medicine. National Orthopaedic and Rehabilitation Hospital, 2455 Army Navy Drive, Arlington, Virginia 22206.

PROCEDURE
The following is the protocol for measuring swelling about the talar and subtalar joints using a tape measure in a figure of 8.

Position 1) The ankle is maintained in a neutral position for eversion and inversion while flexed to 90 degrees (if range of motion permits), 2) the patient is in a long sitting position. Landmarks
Mark the following landmarks with a skin pencil (Figs. 1 and 2): 1) tuberosity of the navicular; 2) base of the 5th metatarsal; 3) distal tip of the medial malleolus; 4 ) distal tip of the lateral malleolus; and 5) tibialis anterior tendon.

Placement of the tape measure

SUBTALAR JOINT 1) The beginning of the tape is placed midway between the tibialis anterior tendon and lateral malleolus; 2) the tape is drawn medially across the instep and placed just distal to the tuberosity of the navicular; 3) pull the tape across the arch and up just proximal to the base of the 5th metatarsal; and 4 ) cross the tibialis anterior tendon. TALAR JOINT 1) Continue the tape around the ankle joint just distal to the distal tip of the medial malleolus; 2) pull the tape across the achiHes tendon; 3) place the tape just distal to the distal tip of the

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Vol. 1 , No. 1

Fig. I . Medial view of figure 8.

Fig. 2. Lateral view of figure 8

lateral malleolus; and 4 ) end the measurement at the start of the tape. The talar joint protocol may be altered to measure swelling - . resent at the anterior tibiofibular ligament. In this Case, the tape encircles the rnalleoli proximal to the distal tip at the level of the sprained ligament. All measurements are recorded in centimeters.

REFERENCES:
1. Klafs CE, Arnheim DD: Modern Principles of Athletic Tra~ning. st. Louis, cv M O S ~ YCompany, 1977. p 180-181 2. Nicholas JJ. Taylor FH, Buckingham RB. et al: Measurement of Circumference of the Knee with Ordinary Tape Measure. Ann Rheumat Dis 35:282-284.1976