Lower limb injury
Ankle injury after a motor accident
An ankle claim can involve fracture, ligament rupture, tendon injury, deformity, stiffness or cartilage loss. The impairment method must match the permanent residual; pain, a boot, fixation or surgery does not create a percentage on its own.
Motor accident injury
How can this injury happen?
Car or passenger collision
Footwell intrusion can trap and rotate the ankle, causing malleolar fracture, syndesmosis injury or talar damage.
Motorcycle accident
A rider may twist the ankle under the motorcycle or strike the road, injuring bone, ligaments or tendons.
Pedestrian or cyclist impact
Vehicle impact and a twisting fall can fracture the ankle or rupture stabilising ligaments.
Injuries that can occur
- malleolar, pilon, talus or intra-articular fracture
- syndesmosis, lateral or deltoid ligament rupture
- Achilles, peroneal or other tendon injury
- post-traumatic stiffness, deformity or arthritis
- avascular necrosis of the talus or peripheral nerve injury
Symptoms and functional problems
- reduced dorsiflexion or plantar flexion
- instability on uneven ground
- swelling and reduced walking tolerance
- difficulty stairs, slopes, driving or standing
Seek urgent medical assessment
Open injury, deformity, threatened skin, absent pulse, rapidly increasing pain or neurological loss requires emergency assessment.
Clinical evidence
What findings matter?
The examination should distinguish ankle movement from hindfoot movement, record objective instability and identify fracture alignment or cartilage loss. Clause 6.100 also prevents a particular talus AVN diagnosis estimate being combined with the specified displaced intra-articular ankle or hindfoot fracture estimate.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| Weight-bearing X-ray and CT/MRI | Shows fracture, alignment, union, talar injury, cartilage interval and ligament/tendon pathology. | Imaging does not select or add methods by itself. |
| Active ankle and hindfoot ROM | Separates dorsiflexion/plantar flexion from inversion/eversion. | Passive movement and pain estimates do not set WPI. |
| Stability, gait and nerve examination | Records objective laxity, aid use, sensory loss and motor deficit. | Gait is a last resort, not an extra value. |
Movement in daily life
How movement affects real activities
Dorsiflexion helps clear the foot and descend stairs; plantar flexion provides push-off. Hindfoot inversion and eversion adapt the foot to uneven ground. Each movement must be measured in the correct joint.
Dorsiflexion and plantar flexion
Foot clearance, stairs, braking and push-off.
AMA4 Table 42 addresses active ankle movement.
Inversion and eversion
Balance and adaptation on slopes or uneven ground.
AMA4 Table 43 addresses hindfoot movement.
Ankle or hindfoot deformity
Foot placement, shoe wear and efficient walking.
Table 44 may apply where the verified deformity criteria are met.
Threshold injury is a separate question: verified fracture or partial/complete ligament, tendon or cartilage rupture may be non-threshold. An ankle sprain without rupture may remain threshold.
Part 6 permanent impairment
How is CTP WPI assessed?
Potential methods include Tables 42 to 44 for movement/deformity, Tables 55 to 59 for ankylosis, Table 62 for arthritis and Table 64 for diagnosis-based estimates. Clause 6.69 requires the most specific valid method.
Measurement rules that apply
- Clauses 6.69 and 6.70 require the method that most specifically addresses the lower-limb impairment. Gait should not replace a joint, nerve, fracture or replacement method that can be applied reliably.
- Clause 6.84 requires active range of motion, a goniometer where clinically indicated and consistent repetitions when reliability is uncertain. Passive movement may inform the examination but does not set the impairment value.
- Clause 6.85 says only the most severe deficit in one direction or axis from the same lower-limb ROM table is rated. Deficits from separate tables may be combined only as the Guidelines permit.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| Active movement or deformity | Clauses 6.84-6.85; AMA4 Tables 42-44 | Permanent ankle or hindfoot movement loss or verified deformity. | Use only the most severe deficit in the same direction/table. |
| Ankylosis | Clauses 6.86-6.87; Tables 55-59 and Guidelines Table 6.2 | A genuinely fixed ankle or foot joint. | Restricted movement is not automatically ankylosis. |
| Arthritis or diagnosis estimate | Clauses 6.88-6.100; Tables 62 and 64 | Proper radiographic cartilage loss or a listed residual diagnosis. | Clause 6.100 prevents the specified AVN/fracture double count. |
- Separate ankle from hindfoot motion.
- Apply the clause 6.100 AVN/fracture restriction where relevant.
- Convert lower-extremity impairment through Table 6.4.
What cannot be combined?
- arthritis with ROM, gait, atrophy or strength
- gait with another lower-limb evaluation
- the specified talus AVN estimate with the displaced intra-articular ankle/hindfoot fracture estimate
What does not establish WPI by itself?
- ankle pain
- brace or boot use
- hardware
- MRI ligament signal without verified rupture/residual
Motor accident examples
Pilon fracture with permanent stiffness
The assessor selects the valid fracture, movement, ankylosis or arthritis method without stacking the same consequence.
Ligament reconstruction with stable ankle
Surgery alone is not WPI; current stability, movement and other residual findings determine the method.
Claim file preparation
Evidence checklist
Assessment source
Ankle WPI assessment source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.68-6.75, 6.84-6.100; AMA4 Tables 42-44, 55-59, 62 and 64; Guidelines Tables 6.2, 6.4 and 6.5.
Threshold injury: Fracture or verified ligament/tendon/cartilage rupture may be non-threshold; sprain without rupture may remain threshold.
What the assessor checks
- active ankle/hindfoot ROM
- ankylosis
- arthritis radiology
- clause 6.100 restriction
What does not establish the result by itself
- pain
- boot
- hardware
- imaging alone
Official sources
Related NSW CTP guides
Free claim check
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Frequently asked questions
- Does ankle fixation have fixed WPI?
- No. The permanent residual and most specific valid method control.
- Is an ankle sprain non-threshold?
- Not necessarily. A sprain without verified rupture may remain a threshold injury.
- Are ankle and hindfoot movement the same?
- No. Table 42 addresses ankle movement and Table 43 addresses hindfoot movement.
- Can arthritis and ROM be combined?
- No where arthritis is used, because clause 6.91 prohibits that combination.
- Can gait be added?
- No. Gait is a last-resort method and cannot be combined with another lower-limb evaluation.