Ankle/Foot Exam

Question 1

% of all injuries that are to ankle and foot

Answer 1

10-15% to ankle
3-15% to foot

Ankle sprains most common injury in sports and most common diagnosis in US ERs (over 1 mil visit Dr for sprained ankle each year)

Question 2

How many major bones in foot

Answer 2

26, each has a corresponding joint and function

Question 3

Purpose of foot arches

Answer 3

Act as springs for energy absorption and dissipation

Question 4

Where do tensile strength and elastic properties of arch come from?

Answer 4

Both dynamic (muscles) and static (ligaments and fascial) components

Question 5

What creates the solid platform necessary for ambulation and propulsion?

Answer 5

Plantar fascia
*it keys the structural chgs in ligaments and joints to allow proper, efficient ambulation

***is also electrically connected to the musculature of the calf; when plantar fascia is stretched the nerves send signals to fire the musculature of the gastrocnemius/soleus muscles to complete the gait cycle

Question 6

What is plantar fasciitis?

Answer 6

Degeneration of the plantar fascia where it attaches at the calcaneus (heel bone)
One of the most common overuse injuries in the foot

Question 7

Describe ankle joint

Answer 7

Basically a hinge joint

Tibia and fibula form the fork of the hinge (the “plafond”)
Dome of the talus fits inside this fork

Talus rocks back and forth in plantar flexion/ dorsiflexion, w/ limited side-to-side twisting
*if it twists too far to the side, that is an ankle sprain

Question 8

Where do most ankle sprains occur

Answer 8

Lateral ankle; 85% occur to anterio talofibular ligament (ATFL); the calcaneofibular ligament (CFL) is most vulnerable normally, but most injuries occur during plantar flexion and in this position the ATFL is most vulnerable

Lateral ligaments are thin and weaker so have more sprains occur

Medial ankle (deltoid ligament) is possible to tear but is very hard

Question 9

Key elements of history

Answer 9

Mechanism of Injury
Acute or gradual onset of pain
Pop or tearing sensation w/ injury
Location of pain
Swelling
Able to bear weight after injury
Can they bear weight now
What makes pain better/worse
What have you tried (meds, rest, etc)

PMH/PSH

Question 10

Inspect for:

Answer 10

 Observe gait: normal, limping (antalgic), shuffling, or
won’t walk
 Weight bearing
 Swelling: soft tissue or effusion
 Ecchymosis
 Atrophy
 Arches – Normal, Pes Planus, Pes Cavus, Too Many Toes
vs Normal Heel Motion

Question 11

Palpate in FOOT for:

Answer 11

Try to Pinpoint Patient’s Area of Pain!

Key Areas in Foot
 Metatarsal shafts & bases
o 5th Metatarsal base
o 2—4thMetatarsal base,plantar aspect(Lis Franc Injuries)
 Anterior Navicular
 Achilles Tendon – Insertion on Calcaneus and Mid—Substance
 Medial tubercle of Calcaneus – Plantar Fascia insertion

Question 12

Palpate in ANKLE for:

Answer 12

Lateral Ankle (Figure 8A)
 Ligaments:
o Anterior TaloFibular Ligament (ATFL)
o CalcaneoFibular Ligament (CFL)
o Posterior TaloFibular Ligament (PTFL)
 Posterior part of Lateral Malleolus
 Peroneal tendons (lateral leg fibularis muscles)

Medial Ankle (Figure 8B)
 Deltoid Ligament
 Posterior part of Medial Malleolus

Anterior Ankle (Figure 7A)
 Anterior Tibiofibular Syndesmosis (between
tibia and fibula) — squeeze tibia and fibula together at shin and see if pt has pain at syndesmosis where tibia and fibular join at the ankle (indicates possible high ankle sprain)

Question 13

Range of Motion

Answer 13

Plantarflexion (40-50 degrees)

Dorsiflexion (15-20 degrees)

Question 14

Strength/ Neurovascular

Answer 14

Strength
 Plantarflexion
 Dorsiflexion
 Eversion
 Inversion 

Sensation

Pulses
 Dorsalis Pedis
 Posterior Tibial

Question 15

Special Tests

Answer 15

Thompson’s Squeeze Test (for achilles rupture)
Ankle Anterior Drawer Test (for ATFL integrity)
Talar Tilt/ Varus Stress Test (for CFL integrity)

Question 16

What constitutes positive test for each of the special tests?

Answer 16

Thompson’s Squeeze Test (for achilles rupture)
is a + test if reduced, but may not be completely absent, plantar flexion

Ankle Anterior Drawer Test (for ATFL integrity)
excessive laxity or differences from unaffected leg is a + test

Talar Tilt/ Varus Stress Test (for CFL integrity)
excessive laxity or differences from unaffected leg is a + test

Question 17

Ottawa Ankle Rules

Answer 17

CONSIDER X-RAY if any one or more of the following:

• Inability to weight bear 4 steps immediately
• Inability to weight bear 4 steps at evaluation
• Tender on posterior half of medial malleolus
• Tender on posterior half of lateral malleolus
• Tender on posterior half of distal tibia or fibula
• Tender at the base of the 5th metatarsal
• Tender on navicular

EXCLUDE CHILDREN, PREGNANT WOMEN,THOSE NOT CAPABLE OF PERFORMING EXAM FOR 2° REASONS