The approach to evaluation of lower extremity impairments in the Guides 4th edition differs from previous editions. Using case studies, this article describes practical applications of the Guides—current approach. Readers also may wish to review the “Lower Extremity Impairments—Knee and Hip” article in the January/February 1999 issue of The Guides Newsletter, which discusses the three lower extremity rating methods (anatomic, diagnostic, and functional) and other general evaluation principles.

Ankle Impairments

Anatomic methods for rating ankle impairments include evaluations of muscle atrophy (4th ed., 76) and limb length discrepancy (4th ed., 75). The “Diagnosis-based Estimates” section (4th ed., p. 84–88) provides ratings for both ligamentous laxity of, and displaced fractures about, the ankle. The “Arthritis” section (4th ed., 82–83) contains ratings for this radiographically-determined and graded diagnosis. Functional methods for rating ankle impairments include assessing gait derangement (4th ed.,...

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