Ankle & Foot

Question 1

Ankle & foot movement

Answer 1

• dorsal flexion (about 20°) foot flexing upwards (toe towards ceiling)
• plantar flexion (about 50°) foot flexing downwards (toe towards floor)
• inversion (about 5°) (foot rotating inward.
• eversion (about 5°) (foot rotating outward).
  midfoot and forefoot:
  -pronation (about 5°): medial side of foot raising upward
  -supination (about 5°): lateral side of foot raising upward
• toes flexion (downwards) and extension (upwards)

Question 2

Inspection

Answer 2

Ask patient to uncover legs
Assess spontaneous position
Then ask to stretch knees and have feet slightly apart
assess ventral and medial/lateral and dorsal
Bones and joints
- toes (hallux valgus (bunion), hammer toes, claw toes, curved toes)
- feet (transverse arch, pes planotransversus, shifting of weight over the feet?)
- lateral malleolus
- lower leg (rotation abnormalities)
- knees (patella, genu valgum, genu varum)
NB: To assess any genu valgum or varum present ask the patient to place the legs
and/or the feet next to each other.

Soft tissues
- skin of toes, feet and lower legs (callus, corn, ingrown toenail, mycosis between the
toes)
- muscle contours of the:
o extensors or dorsal flexors
o eversors
- tendons of the:
o extensors
o eversion muscles

Bones and joints
- metatarsophalangeal joint I (hallux valgus/bunion)
- feet (assess longitudinal arch: do this by sliding your fingers under the longitudinal
arch if possible; usually you should be able to slide your fingers at least 1.5 cm under
the sole of the foot. If necessary ask the patient to place the foot to be examined in
front of the other foot, and to put weight on the foot)

Gait pattern
Next, ask the patient to walk and note:
- symmetry/asymmetry
- stride length
- distribution of body weight over the left and right leg and foot (equal?)
Can the patient do the following without problems:
- walk on their toes (plantar flexors)?
- walk on their heels (dorsal flexors)?
- walk on the inside of their feet (eversion muscles)?
- walk on the outside of their feet (inversion muscles)?

Plantar side
Ask the patient to sit on the examination table (with lower legs dangling down and no
weight bearing on the feet) and inspect the shape and position of the following structures:

Bones and joints
- (loosely hanging) feet (compare with standing situation when body weight is
distributed over feet, influence of contractures)

Soft tissues
- skin (callous formation, hyperkeratosis, verrucas)
NB. if there are clear abnormalities on the soles of the feet, the patient should
preferably lie in the prone position on the examination table with feet hanging over
the edge so that the soles of the feet can be examined more carefully.

Question 3

Active Examination

Answer 3

Inspect the movements on the ventral side and assess:
o the course of the movement
o the maximum range of motion
o the occurrence of pain
o the occurrence of crepitations.

Ask patient to sit on table with legs hanging. Feet in neutral position (90°)
Then ask:
dorsal and plantar flexion (Talocrural joint)
inversion and eversion (subtalar joint). hold patient knees when doing this
flexion extension toes

Question 4

Passive movement examination

Answer 4

The passive examination should only cover those movements in the active
movement examination that were painful and/or limited and/or for which the course of the movement was disrupted.
pronation and supination can only be tested passively !!
patient sit on table
Hold back of ankle
dorsal and plantar flexion by pushing on feet
inversion and eversion by puting sole of foot on forearm
pronation and supination by rotating forefoot and holding ankle in place
big toe flexion by holding forefoot in place

Question 5

Muscle test

Answer 5

The patient sits on the examination table with the lower legs dangling
Hand holds back of the ankle in place
Use other hand to apply conterpressure
dorsal and plantar flexion
inversion and eversion

selective test
ask to point foot upward. apply conterpressure inward
ask to point foot downward apply conterpressure inward and then outward
flexion and extension toes

lay on stomach with feet over the table. press calf and conterpressure on sole

Question 6

Thompson test

Answer 6

Test if there is an achille tendon rupture

Ask the patient to kneel on an easy chair or on the examination table with the feet dangling
over the edge.
Next, squeeze the muscle belly of both the left and right triceps surae muscles

In the case of an intact Achilles tendon, plantar flexion of the foot will occur. However, in the
case of a completely ruptured Achilles tendon this movement will be absent.

Question 7

Hubscher manoeuvre

Answer 7

test flexibility of flat foot person

• Ask the patient to stand with their legs slightly apart and squat behind the patient so that you can observe the dorsomedial side of the foot concerned.
• From this position perform passive dorsal flexion of the MTP I joint in both the left and the right foot
  see if longitudinal arch restored

Question 8

Morton’s metatarsalgia test (shooting pain toes)

Answer 8

The patient should sit on the examination table with the lower legs dangling down (knees in
90° flexion) and no weight on the feet.
Hold the forefoot with one hand and use this hand to exert lateral and medial compression

positive if shooting pain

Question 9

Stability tests

Answer 9

The following tests should be performed in the case of an inversion trauma:
- The patient sits on an examination table with the lower legs dangling down (knees in
90° flexion) and no weight bearing on the feet.
- Stabilise the distal lower leg with one hand just above the talocrural joint and
preferably place the thumb at the height of the sinus tarsi [Figure 140].
- With the other hand take hold of the calcaneus in the neutral position and apply
inversion pressure

Anterior Drawer Sign (ADS) test:
same but apply pressure by pulling foot towards you