Ankle Flashcards
Normal Ranges of Motion
Plantarflexion: 45
Dorsiflexion: 20
Inversion: 30
Eversion: 20
PROM End Feels
Dorsiflexion: ST stretch
Plantarflexion: ST stretch
Inversion: ST stretch
Eversion: St stretch
Palpation Structures
Fibula (Start at lateral malleolus and palpate upwards through boney structure OR start at head of fibula proximally to feel bone OR start at either end and meet at middle)
Tibia (Start at tibial tuberosity and palpate downwards to medial malleolus where it should be thicker)
Dome of talus (thumb goes in between tendons of flexor digitorum and tibias anterior in between malleoli, feel boney prominence as they are in dorsiflexion)
Calcaneus (Cup heel with fingers and can isolate by slightly moving heel)
Metatarsals 1-5 (start at phalanges and palpate through from top to bottom until you feel joint into foot bones)
Head of first metatarsal (Find prominence at MTP joint)
Base of 5th metatarsal (Start at MTP joint and palpate down to find prominence at base)
MTP Joints 1-5 (Brace/Cup metatarsal bone with one hand and palpate)
Phalanges (Palpate through all toes)
Anterior talofibular ligament (On lateral ankle superior to lateral malleolus)
CFL (On lateral ankle, In line with fibula)
Tibialis Anterior (Go into dorsiflexion and inversion and feel muscle belly up and tendon pop up into foot)
Extensor Hallucis Longus (Isolate thumb toe and see tendon pop up as you resist, palpate tendon up)
Extensor digitorum longum (isolate toe and flex up into hand to see tendons pop up and palpate upwards)
Tibialis posterior (lying prone, ask them to plantar flex and invert, brace at gastrocnemius and ask them to contract and feel through mid muscle belly, tendon is closest to medial malleolus)
Flexor hallucis longus (Lying prone, Have hand on muscle and isolate big toe, ask to flex and relax to feel muscle belly contract)
Flexor digitorum longus (Lying prone, isolate toe and feel for contraction through calf)
Fibularis (Lying prone, Go into eversion and palpate laterally for tendons up into muscle belly)
Gastrocnemius (Lying prone, ask to point toes and feel muscle belly in posterior calf)
Soleus (Lying prone, bend knee and pint toes to feel soles over gastrocnemius)
Achilles tendon (From calcaneus move upwards and follow between the malleoli in the middle)
Dorsal pedal pulse (Lying supine, in between tendons of extensor digitorum and tibias anterior, palpate with index belly, check that pulse is present/circulation)
Ankle Plantarflexion
AROM: “Can you point your toes all the way to the floor as far as you can?”
PROM: Stabilize above ankle joint, Brace around mid foot (not metatarsals/toes), push down into plantarflexion.
RROM: Brace above ankle joint, cup heel with other hand and forearm stabilizes rest of foot, “Can you meet my resistance and try to point your toes like you are pushing into a gas pedal?”
Ankle Dorsiflexion
AROM: Sitting upright with just ankles hovering off table. “Can you pull your toes to your nose?. can compare bilaterally at same time
PROM: Stabilize above ankle joint, cup heel of foot with other hand, support rest of foot with forearm, pull up through hand into dorsiflexion.
RROM: Brace both hands on top of foot, “Can you meet my resistance and pull your toes to your nose?”
Ankle Inversion
AROM: “Keeping your ankles neutral, try to touch the soles of your feet together (note degrees from middle of ankle joint)
PROM: Stabilize above ankle joint, cup heel of foot with other hand, support rest of foot with forearm, move into inversion.
RROM: Brace above ankle joint, cup heel and forearm supports medial side of foot, “Can you meet my resistance and push into my arm without letting me pull you out?”
Ankle Eversion
AROM: “Keeping your ankles neutral, can you point the soles of your feet to the side wall?”
PROM: Stabilize above ankle joint, cup heel of foot with other hand, support rest of foot with forearm, move into eversion.
RROM: Brace above ankle joint, cup heel and forearm supports lateral side of foot, “Can you meet my resistance and push into my arm without letting me push you in?”
MMT: Soleus VS Gastrocnemius
Gastrocnemius
-Lying prone with straight legs
-Brace above ankle joint and cup toes with forearm supporting foot, ask them to point foot into arm
Soleus
-Lying prone and bend knee to 90 degrees
-Brace above ankle joint and cup heel with forearm supporting foot, ask them to point foot into arm
MMT: Tibialis Anterior VS Extensor Digitorum
Tibialis Anterior
-Lying supine, ask to dorsiflex and invert, feel tibias anterior and feel up into tendon and muscle belly
Extensor Digitorum
-Lying supine
-Isolate the toes and brace above ankle joint
-Ask to pull toes up and back into fingers and palpate tendons
Functional Movement: Squat
“Feet shoulder width apart in a comfortable position, can you bend down into a squat to the best of your ability”
Anterior View:
-Foot movements
-Arch
-How ankles line up with knees
-Weight shift through toes
-Shifting to lateral foot, toes, etc
Functional Movement: Walking on toes
“Can you lift up onto your toes and walk towards me?”
Anterior view:
-How ankles bend
-Heel slipping in one direction more
Lateral view:
-Weight back into heels or too far forward on toes to project forwards
Functional Movement: Walking on heels
“Lifting your toes off of the ground can you walk on your heels towards me?”
Anterior view:
-Direction of toes pointing (Cavus/planus)
-Compensation
Lateral view:
-Weight shifts
-More weight on one side
