Limitation of motion refers to a point or line beyond which motion is restricted, and cannot progress normally (i.e., range of motion of joints). In this case, the limitation involves the ankle.

Flexion is the process of bending or the state of being bent and refers to dorsiflexion (moving the toes up when standing only on the heels) or plantar flexion moving the toes down when standing on the toes) of the ankle.

Motion of the ankle may be limited by sprains; fractures; injury to the tendons or ligaments; tendon dislocation; bone or joint disease; by surgery; medications; fibromyalgia; chronic illnesses (e.g. venous insufficiency, irritable bowel disorders); cancer; overuse; degenerative processes; or inflammation of the bursa.

Signs and symptoms of the limitation may include: pain; swelling; inflammation; hemarthrosis; crepitus; decreased mobilization and weight bearing; decreased range of motion (normal ROM for the ankle for ankle plantar flexion is 0 to 45°, and for ankle dorsiflexion 0 to 20°.); a sensation of giving way; or instability. Other signs and symptoms include redness or cyanosis of the skin; edema; fever with pain and/or swelling.

Measure the level of pain, weakness, stiffness and physical limitation using one of many functional measures. Include physical examination, range of motion testing; tests of the ligaments; x-ray; computed tomography (CT) scan; magnetic resonance imaging (MRI); ultrasonography or arthroscopic examination. Laboratory tests may be performed for certain joint diseases (e.g., arthritis). Perform complete blood count (CBC) with white blood count (and WBC differential), and acute phase reactant tests such as the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) to determine if the condition is inflammatory or non-inflammatory. Aspiration and analysis of synovial fluid from the ankle can aid in diagnosing the condition as inflammatory or non-inflammatory.

Treatment may depend on the nature of injury. The treatments may include: immobilization, bracing, surgery, oral medications, intra-articular injections with steroids, anti-inflammatory and/or analgesic medications; and rehabilitation.

Sprains may result in persistent, long-term symptoms lasting for months or years. However, most patients resume normal activity in about one month. Rehabilitation for fractures may be prolonged.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• To properly rate disability, accurate measurement of range of motion is required and must be reported in degrees. The use of a goniometer in the measurement of ankle ranges of motion is indispensable. 38 CFR 4.46 [Accurate measurement]

• Do not assign separate elevations for loss of motion and instability of the ankle.

• None.