Ankle assessment Flashcards
Neutral position of the Talus (weight bearing)
Indication:
Subtalar neutral position in weight bearing
Procedure:
- standing
- palpate head of talus with thumb and index finger
- ask patient to rotate trunk left and right so that the tibia rotates and the talus supinates and pronates
Negative:
If talus does not bulge , subtalar joint will be in its neutral position in weight bearing
Neutral position of talus in non weight bearing position
Indication:
Subtalar neutral position
Procedure:
- supine or prone
- examiner gently dorsiflexes the foot until resistance is felt, then supinates and pronates the foot
Negative:
If talus doesn’t bulge to either side, then it is in its neutral position
Leg-heel alignment
Indication:
Leg heel alignment
Procedure:
- prone
- mark over midline of calcaneus at insertion of Achilles tendon
- 1 cm below it
- join the two points for calcaneal line
- another mark on lower 1/3 of leg midline for tibial line
- talus must be in neutral position
Normal: if lines are parallel or in slight varus 2-8 °
If INVERTED: hind foot varus
If EVERTED: hind foot valgus
Figure of 8
Indication:
Ankle swelling
Technique:
Figure of 8 around ankle joint
Compare both ankles
Anterior drawer test of ankle
Indication:
Anterior talofibular ligament ATFL
Procedure:
- supine or sitting
- ankle is relaxed in 10-20 ° of PF
- place thumb on ATFL to feel gapping
- examiner stabilizes distal leg with one hand and pull calcaneus forward
Positive:
Anterior displacement of talus on the tibia
Torn ATFL (dimple)
Varus stress test
Indication :
Assess the integrity of ALL lateral ligaments
Procedure:
- supine or sitting
- ankle relaxed in 10-20 ° of PF
- examiner stabilizes the lower leg and grips + inverts the calcaneus maximally
- palpate all 3 ligaments
Positive:
Lateral gapping indicates instability
Valgus stress test (Kleiger’s)
Indication:
Integrity of medial ligaments
Procedure:
- supine or sitting
- ankle is relaxed in 20° of PF
- Examiner stabilizes the lower leg and grips + everts the calcaneus maximally
- Palpate the deltoid ligament
Positive :
Medial gapping indicates instability
Talar tilt test
Indication:
Integrity of calcaneofibular ligament
Procedure :
- Supine or side lying
- talus is tilted into abduction and adduction
Positive :
Excessive tilting with adduction of the talus indicates laxity or tearing of the calcaneofibular ligament
Thompson’s test
Indication:
Achilles tendon rupture
Procedure :
- Patient is prone or sitting
- Examiner squeezes the calf muscles
Positive :
Passive plantarflexion indicates normal intact tendon
No plantarflexion indicates torn tendon
Squeeze test
Indication:
Syndesmosis injury (distal, tibial, fibular compression test)
Procedure :
- Supine
-Examiner squeezes the tibia and fibula together
Positive:
Pain
Peroneal tendon dislocation
Indication:
Peroneal tendon dislocation
Procedure :
- Prone with knee 90° flexion
- Postero lateral region is inspected for swelling
- Patient actively dorsiflexes
- PF and evert ankle against resistance
Positive :
If the tendon subluxates from behind the lateral malleolus
Tinel’s sign
Indication:
Suspected neuroma of the anterior tibial branch of the deep peroneal nerve, or the posterior tibial nerve
Procedure:
DEEP PERONEAL NERVE: tapping over the nerve on the dorsum of the ankl
TIBIAL NERVE: tapping over the nerve as it passes posterior to the medial malleolus.
Positive:
Tingling or paresthesia
Feiss line
Indication:
Assessing pronation (pes planus) of the foot
Procedure :
- Nonweightbearing
- Mark Apex of medial malleolus
- Mark the first MTP joint
- Palpate and mark the navicular tuberosity
- Draw a line from the tip of the medial malleoli to the first MTP
- Ask Patient to stand up
- repalpate the navicular tuberosity
Positive:
If navicular tuberosity falls far below the line . Indicates flat foot. (pes planus.)
NOTE:
This is for acquired flat foot . Not congenital as the navicular tuberosity will not drop in congenital.
Homan’s sign for thrombophlebitis
Indication:
Deep vein thrombophlebitis
Procedure :
The foot is passively dorsiflexed with the knee extended
Palpation of the calf
Positive:
Pain in the calf indicates a positive sign
