Examination Ankle And Foot Flashcards
What are the dorsiflexors of the ankle ?
Extensor digitorum longus, extensor hallucis longus, tibialis anterior
What are the plantar flexors of the ankle ?
Triceps surae, tibialis posterior muscles
What are the invertors of the ankle ?
Tibialis anterior, tibialis posterior, flexor digitorum longus
What are the evertors of the ankle ?
Fibularis (peroneus) longus and brevis, tibialis anterior
What are the lateral and medial ligament of the ankle ?
Lateral :
- posterior talofibular ligament
- anterior talofibular ligament
- calcaneofibular ligament
Medial = deltoid ligaments
What do you inspect on the anterior side of the feet ?
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
What do you inspect on the medial side of the foot ?
Skin : inside of feet, callosity, corns, wounds
Soft tissue : medial arch
Bones and joints : position of MTP1 joint, navicular bone, flat foot
Medial malleolus
How do you assess longitudinal arch ?
Slide 1 finger under it. Should be able to 1.5 cm underneath sole
Pes planus = Hubscher test = jack test
What do you inspect on the lateral side of the foot ?
Skin : outside feet, callosity, corns, wounds
Soft tissue : lateral edge, MTP5
Bones and joints : position of MTP5, lateral malleolus
What do you inspect on the posterior side of the feet ?
Skin : callosity, corns, wounds
Soft tissue : attachment of Achilles tendon, contour of gastrocnemius
Bones and joints : varus/valgus, malleolus
What do you inspect in the plantar side of the foot ?
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
What do you observe in gait ?
Symmetry
Stride length
Loading on the side
What are the movement of the ankle and foot ?
Talocrural joint :
- dorsiflexion
- plantar flexion
Subtalar joint :
- inversion
- eversion
- pronator : only on passive
- supinator : only on passive
MTP, PIP, DIP, IP
- flexion
- extension
What do you pay attention to during palpation ?
Swellings and characteristics
Muscle tone
Abnormal mobility
Abnormal structures
Discontinuity
What are the palpable structures in the foot and ankle ?
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
What are the acute inversion injury of the ankle ?
Ankle sprains
Rupture of lateral ankle ligament
Bone disorder = fractures
What are the the specific test of the ankle and foot ?
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
What are the Ottawa rules of the ankle and foot ?
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
What does the anterior drawer sign test ?
The laxity of lateral ligament.
- increased mobility on lateral side : rupture of especially ATFL
-not very useful in acute situation because of pain
Interpretation of talar-tilt text ?
Increased range of motion : due to rupture
- abnormal mobility of talocrural joint : ATFL
- abnormal mobility of subtalar joint
Interpretation of Hubscher’s test ?
Longitudinal arch is restored ==> flexible flat foot
Longitudinal arch is not restored ==> rigid flat foot
What is tarsal tunnel syndrome ?
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.