Ankle Examination Flashcards
State the 8 stages of your ankle examination
- Introduction
- General inspection
- Closer inspection
- Gait
- Feel
- Movement (active & passive)
- Special tests
- Completing the examination
What should you do in the introduction stage of your ankle examination?
- Wash hands
- Introduce yourself
- Gain consent
- Ask if in any pain
- Expose pt
- Position pt
How do you need your pt to be exposed in ankle examination?
From knee downwards
How you want your pt position for the ankle examination?
- Initially standing
- Then can lie on couch or sit on coach with legs hanging off
What should you do in the general inspection stage of your ankle examination?
General inspection of pt
- Body habitus
- Scars
- Swelling
- Deformity
- Wasting muscles
Inspection of surroundings
- Walking aids
- Footwear
- Prescriptions
What should you do in the closer inspection stage of your ankle examination?
Look at angle from all angles getting pt to turn 90 degrees each time.
Anterior: scars, swelling, bruising, psoriasis plaques, hallux valgus, fixed flexion deformity of toes
Lateral: foot arch
Posterior: scars, muscle wasting posteiror compartment of leg, heel misalignment, achilles tendon
****NOTE: MUST complete feel part of ankle examination when pt on coach and can see plantar surface of foot & in between toes. Look for calluses & e.g. athletes foot.
What should you do in the gait stage of your ankle examination?
- Ask pt to walk normally
- Ask pt to put hands against wall and do bilateral heal raise (to assess calf muscles achilles tendon)
- Ask pt to do a few single heel raises (tests that posterior tibialis function; pathology in this tendon is most common cause of flat foot)
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What should you do in the feel stage of your ankle examination?
- Feel temperature
- Feel pulses (posterior tibial, dorsalis pedis)
- Feel joints and bones of foot
- Feel achilles tendon
What joints and bones in the ankle should you be feeling in the ‘feel’ part of your ankle examination?
REMEBER: always look at pt to see if in pain. Leave painful part till last.
- Distal fibula
- Lateral malleolus
- Ankle joint
- Tendons of anterior compartment
- Medial malleolus
- Posterior tibialis tendon
- Achilles tendon (can do later)
- Subtalar joint
- Calcaneum
- Plantar fasciitis tender point (anteromedial heel)
- Talnavicular joint/subtalar joint (tumbs breadth down from lateral ankle joint)
- Tarsal bones & joints
- Tarsometatarsal joints
- 1st metatarsolphalangeal joint (hallux valgus)
- Mortons neuroma pain (between 2nd & 3rd or 3rd & 4th metatarsal on forefoot)
- Feel metatarsophalangeal & phalangeal joints
When feeling the achilles tendon what should you note?
- Any tenderness
- Any discontinuity
What should you do in the movement stage of your ankle examination?
- Active movement
- Plantarflexion
- Dorsiflexion
- Ankle/foot inversion
- Ankle foot eversion
- Toe flexion
- Toe extension
- Passive movement (all above movements)
- Plantar flexion
- Dorsiflexion
- Subtalar inversion (must stabilise anke joint)
- Subtalar eversion (must stabilise ankle joint)
- Midtarsal inversion
- Mid tarsal eversion
- Halux flexion
- Hallux extension
- Toe flexion
- Toe extension
What should you do in the special tests stage of your ankle examination?
Simmonds test
- Ask pt to kneel on charir with feet hanging over the edge
- Squeeze each of the calfs in turn and look for plantar flexion of foot
What should you do in the completing your examination stage of the ankel examination?
- Thank patient
- Dispose PPE and wash hands
- Summarise your findings
- State further assessment & investigations:
- Neurovascular examination of both limbs
- Examination of knee & hip joint
- Further imaging e.g. x-ray
