Examination Ankle And Foot

Question 1

What are the dorsiflexors of the ankle ?

Answer 1

Extensor digitorum longus, extensor hallucis longus, tibialis anterior

Question 2

What are the plantar flexors of the ankle ?

Answer 2

Triceps surae, tibialis posterior muscles

Question 3

What are the invertors of the ankle ?

Answer 3

Tibialis anterior, tibialis posterior, flexor digitorum longus

Question 4

What are the evertors of the ankle ?

Answer 4

Fibularis (peroneus) longus and brevis, tibialis anterior

Question 5

What are the lateral and medial ligament of the ankle ?

Answer 5

Lateral :
- posterior talofibular ligament
- anterior talofibular ligament
- calcaneofibular ligament

Medial = deltoid ligaments

Question 6

What do you inspect on the anterior side of the feet ?

Answer 6

Skin and nails : scars, discoloration, oedema
Soft tissues : contour of extensor and perineal muscles
Bones and joint : shape and position
Feet : transverse arch, weight bearing
Malleolus : position of foot relative to lower leg

Question 7

What do you inspect on the medial side of the foot ?

Answer 7

Skin : inside of feet, callosity, corns, wounds
Soft tissue : medial arch
Bones and joints : position of MTP1 joint, navicular bone, flat foot
Medial malleolus

Question 8

How do you assess longitudinal arch ?

Answer 8

Slide 1 finger under it. Should be able to 1.5 cm underneath sole

Pes planus = Hubscher test = jack test

Question 9

What do you inspect on the lateral side of the foot ?

Answer 9

Skin : outside feet, callosity, corns, wounds
Soft tissue : lateral edge, MTP5
Bones and joints : position of MTP5, lateral malleolus

Question 10

What do you inspect on the posterior side of the feet ?

Answer 10

Skin : callosity, corns, wounds
Soft tissue : attachment of Achilles tendon, contour of gastrocnemius
Bones and joints : varus/valgus, malleolus

Question 11

What do you inspect in the plantar side of the foot ?

Answer 11

Skin : plantar callus due to pressure wound
Soft tissue : skin covering calcaneus, plantar fibroma
Bones and joints : contractures, talocrural and subtalar joint, position of mid foot and forefoot

Question 12

What do you observe in gait ?

Answer 12

Symmetry
Stride length
Loading on the side

Question 13

What are the movement of the ankle and foot ?

Answer 13

Talocrural joint :
- dorsiflexion
- plantar flexion

Subtalar joint :
- inversion
- eversion
- pronator : only on passive
- supinator : only on passive

MTP, PIP, DIP, IP
- flexion
- extension

Question 14

What do you pay attention to during palpation ?

Answer 14

Swellings and characteristics
Muscle tone
Abnormal mobility
Abnormal structures
Discontinuity

Question 15

What are the palpable structures in the foot and ankle ?

Answer 15

Attachment of tendon :
- tendon tibialis anterior
- tendon fibularis brevis
- Achilles tendon

Plantar fascia
Medial and lateral malleolus
Ankle ligaments : lateral and medial
Talocrural joint
Talonavicular joint

Question 16

What are the acute inversion injury of the ankle ?

Answer 16

Ankle sprains
Rupture of lateral ankle ligament
Bone disorder = fractures

Question 17

What are the the specific test of the ankle and foot ?

Answer 17

Test for twisted/sprained ankle

Test for ankle stability :
- anterior drawer test
- talar tilt test

Thompson’s test

Test for pes planus = Hubscher test = Jack test

Test for tarsal tunnel syndrome :
- tinel’s test
- dorsiflexion - eversion test

Question 18

What are the Ottawa rules of the ankle and foot ?

Answer 18

Inability to walk 4 steps immediately after trauma / during examination

Malleoli : local pressure pain on posterior edge or tip for around 6 cm vertical line

Midfoot : local pressure pain in navicular bone, base of 5th

Question 19

What does the anterior drawer sign test ?

Answer 19

The laxity of lateral ligament.
- increased mobility on lateral side : rupture of especially ATFL
-not very useful in acute situation because of pain

Question 20

Interpretation of talar-tilt text ?

Answer 20

Increased range of motion : due to rupture
- abnormal mobility of talocrural joint : ATFL
- abnormal mobility of subtalar joint

Question 21

Interpretation of Hubscher’s test ?

Answer 21

Longitudinal arch is restored ==> flexible flat foot
Longitudinal arch is not restored ==> rigid flat foot

Question 22

What is tarsal tunnel syndrome ?

Answer 22

Compression of the tibial nerve in the tarsal tunnel behind the medial malleoli.
Cause : burning pain, tingling in sole of foot/toes/heels especially at night.