Ankle Examination

Question 1

Observation

Answer 1

Bumps/Bruises/Redness/Scars/Swelling/Muscle Wasting/Discoloration/Alignment

Foot deformities - Bunions, hallux valgus, ganglion cyst , athlete’s foot, toenail
infections, ingrown toenails, fractures, rheumatoid nodules.

Swelling Can be caused common by ligamentous sprains – Most common soft tissue injury is a lateral
ankle sprain (ATFL, also PTFL and CFL often involved). Fractures of metatarsals caused by trauma,
stamp. Achilles area posteriorly- possible reupture. Medial deltoid ligament swelling less common.

-Redness and Warmth – potential DVT’s in Calf
-Infections: such as cellulitis, can cause redness or other discoloration in the feet
- Redness with bruising = gout, arthritis).
-Poor circulation: When blood flow to the feet is reduced, the skin can take on a bluish or purple hue
-Raynauds disease: blood vessels narrow, leading to discoloration, sometimes Px & numbness.
-Peripheral artery disease (PAD): This condition causes the arteries in the legs and feet to narrow, which can lead to skin discoloration and other symptoms.
-Venous insufficiency: Inadequate blood flow in the veins can cause a darkening of the skin around the ankles and lower legs.
- Diabetes: Uncontrolled diabetes can cause a variety of complications, including changes in skin color or texture.
- Medications: Certain medications can cause changes in skin pigmentation, including discoloration of the feet.

Muscle Wasting → Indicates neuropathy (diabetes, Charcot-Marie-Tooth), arterial disease, or
chronic joint pathology.

Question 2

Palpation

Answer 2

-Calf musculature: muscle wastage (Lx spine or peripheral nerve link e.g. L5/S1 radiculopathy or
sciatic/tibial nerve entrapment such as piriformis), may be painful with DVT

• Medial Shin: shin splints & exertional compartment syndrome
• Distal fibula - Bump with fibula # (associated with high ankle sprain)
• Medial Malleolus:
• Navicular - Fx
• Post Tib Tendon insertion : just underneath medial malleolus (plantar flexion and inversion) and insertion onto medial navicular
• Lateral malleolus & ligaments: ATFL, CFL, PTFL. Lateral ankle sprain causing tenderness of LM & ligaments especially ATFL
• Achilles Tendon -
• Calcaneus (Heel tendernessSever’s/Plantar fasciitis)
• Plantar Fasciitis at Sole/Heel of Foot: Tender at medial calcaneal tuberosity
• Lateral Side Base of 5th Metatarsal : lateral side styloid process insertion for fibularis brevis & stress fx area
• Posterior Tibial Pulse ,Dorsalis Pedis Pulse,
• Tarsals and Metatarsals: Morton’s Neuroma: painful mass & pain on palpation between MT heads (2-3, 3-4)

Question 3

Active and Passive Range of Motion

Answer 3

DorsiFlexion (26-33 degrees)
Plantar Flexion (53-63 degrees)
Inversion
Eversion
Toe flexion/Extension/Abduction/Adduction

Question 4

RIMS

Answer 4

Resisted plantar flexion
Resisted dorsiflexion

Question 5

Special tests

Answer 5

Functional tests

Ligament sprain test
Anterior drawer test
Inversion stress/talar tilt test
Posterior drawer

High ankle sprain
Crossed leg test
Squeeze test
External rotation h test

Ankle Impingement
Forced dorsiflexion & Eversion
Hyperplantar flexion test

Tarsal tunnel syndrome
Tinels sign

Achillies tendon rupture
Thompson test
Single leg calf raise

Mortons neuroma
Foot squeeze test