Ankle & Foot Exam Flashcards
Lateral Landmarks
Lateral malleolus Calcaneus Cuboid Lateral longitudinal arch (made up of calcaneus, cuboid, and metatarsals 4-5) Anterior talofibular ligament Calcaneofibular ligament Posterior talofibular ligament
Other Landmarks
Metatarsals/MTP Joints Phalanges Transverse distal tarsal arch (made up of navicular, cuboid, cuneiforms 1-3, and proximal metatarsals) Dorsalis pedis pulse Plantar fascia Achilles' tendon Anterior tibialis tendon Posterior tibialis tendon Flexor digitorum longus Flexor hallucis longus Extensor hallicus longus tendon Extensor tendons Peroneus (fibularis) tendon
Capillary Refill
Compress digit between index and thumb to cause blanching, release pressure and note time to regain color
Normal = 3 secs or less
Monofilament Test
Plantar aspect of foot
1st and 4th bad of toes, base of 1st 3rd and 5th plantar MTP joints
Positive = can’t feel monofilament
Important component off diabetic food exam
ROM
Dorsiflexion: 15-20 degrees Plantarflexion: 50-65 degrees Subtalar inversion: 20-30 degrees Subtalar eversion: 10-20 degrees Metatarsalphalangeal flexion Metatarsalphalangeal extension
Pronation = dorsiflexion, abduction, eversion of calcaneus Supination = plantarflexion, adduction, inversion of calcaneus
Strengthen Testing
Dorsiflexors:
- tibialis anterior (primary) - deep peroneal n. L4/5
- extensor hallucis longus - deep peroneal n. L5
- extensor digitorum longus - deep peroneal n. L5
Plantarflexors:
- gastrocnemius/soleus (primary) - tibial n. S1/2
- peroneus longus/brevis - superficial peroneal n. L5
- flexor digitorum longus - tibial n. L5
- tibialis posterior - tibial n. L5
Anterior Drawer Test
Pain, no springing, excessive motion
Anterior/laxity = ATF ligament pathology/tear
Talar Tilt Test
Laxity, increased ROM or pain
Calcaneofibular ligament pathology/tear and some ATF
Eversion Test
Laxity, increased ROM or pain
Deltoid ligament
Squeeze Test (High Ankle Sprain)
Pain at syndesmosis
Syndesmosis pathology
Cross Leg Test
Pain at distal ankle
Syndesmodic injury
Thompson Test
Absence of plantar flexion
Achilles’ tendon rupture
Homan’s Sign
Pain with dorsiflexion
Venous thrombosis in the presence of edema, erythema, and increased warmth of the skin
Venous Doppler to rule out clot
Moses Sign
Pain with anterior compression - NOT lateral compression
Deep vein thrombosis of posterior tibial veins
Inversion Ankle Sprains (Lateral Sprains)
80-85% of all ankle sprains
Ankle inversion with plantarflexion
Anterior talofibular ligament (ATF = always tears first)
Calcanofibular ligament
Posterior talofibular ligament
Swelling and ecchymosis over involved area
High Ankle Sprain
10% of all ankle sprains
Ankle eversion and rotation (sometime dorsiflexion)
Anterior inferior tibiofibular ligament
Syndesmosis
Pain more common on medial aspect with minimal swelling
Pain worse with weight bearing
Plantar Fasciitis
Inflammation of origin of planter aponeurosis
Worse with first steps, improves through day
Point tenderness of calcaneus
Cause: tight calves, repetitive impact activities, high arches, obesity, new/changes in activities
Morton’s Neuroma
Inflammation and thickening of tissue that surrounds the nerve between toes (most common between 3rd and 4th toes)
Feeling like walking on a marble
Palpable to web space, will replicate pain
Turf Toe
Inflammation and pain at base of 1st MTP
Presents as pain and bruising at base of great toe
Caused by hyperextension of great toe causing damage to joint capsule
Common due to activities performed on hard surface
Achilles Tendonitis
Inflammation of Achilles’ tendon
Presents as sharp heel pain and stiffness at mid-Achilles tendon to insertion (worse with strenuous exercising, better with walking)
Micro tears in tendon causes swelling and thickening
Causes: tight calf muscles, sudden change in activity, poorly fitting shoes, incorrect running techniques
Medial Landmarks
Medial malleolus
Navicular
Cuneiforms (1-3)
Deltoid ligament (primary stabilizer of medial ankle)
Medial longitudinal arch (made up of talus, navicular, cuneiforms 1-3, and metatarsals 1-3)
Posterior tibial artery pulse