Foot and Ankle

Question 1

General ROM of foot

Answer 1

10-20 degrees dorsiflexion
40-55 degrees plantarflexion
30 degrees inversion
18 degrees eversion

Question 2

Thompson’s Test

Answer 2

in prone with foot over bed

squeeze mid calf muscle belly

positive if there’s no passive plantarflexion on squeezing the muscle

Good specificity and sensitivity

Question 3

Royal London Hospital Test (Achilles)

Answer 3

Assessing for achilles tendinopathy

High specificity

Patient in prone, foot over bench. ankle in neutral/slight plantarflexion. Palpate achilles for tenderness. Patient moves ankle into max dorsiflexion and palpate at previously tender spots. Patient moves ankle into max plantarflexion and palpate tender spots.

Test is positive if pain on palpation is absent in max dorsiflexed position

Question 4

Plantarflexion/Dorsiflexion goniometer alignment and patient position

Answer 4

Patient position: sitting on edge of bed with feet hanging and knees at 90 degreees

Fulcrum: lateral malleolus
Measuring arm: 5th metatarsal
Stationary arm: head of fibula

Goniometer should be sitting at 90 degrees at start

End feel: firm

Question 4

Anterior Drawer ankle

Answer 4

Testing ATFL laxity/integrity

Good Specificity and sensitivity

Grasp heel, foot along forearm
Stabilise tibia close to joint line

positive test: increased anterior translation compared to unaffected ankle and may observe a dimple on anterolateral aspect of talus

Question 5

Talar Tilt Test

Answer 5

ATFL, CFL, Deltoid Ligament laxity

patient seated, foot over table
ATFL - Slight plantarflexion grab calcaneus and perform inversion

CFL - neutral, grab calcaenus and perform inversion
deltoid: neutral, grab calcaneus and perform eversion

positive if patient complains about pain or if there is excessive gapping/movement compared with unaffected side

Question 5

Inversion ROM prompt for patient

Answer 5

point toes inwards

Question 6

Eversion ROM prompt for patient

Answer 6

point toes outwards

Question 7

although thompson test has good specificity and sensitivity, what other test could you use to test for achilles integrity

Answer 7

Gap palpation
Matles test

Question 8

Inversion/Eversion goniometer alignment and patient postion

Answer 8

Patient position: sitting on edge of bed with feet hanging and knees at 90 degreees

Fulcrum: at joint line in between malleoli
Measuring arm: 2nd metatarsal
Stationary arm: tibial tuberosity

End feel: firm

Question 9

Squeeze test

Answer 9

used to determine if there is a syndesmosis sprain

mechanism of injury is dorsiflexion and eversion

patient in supine, with knee flexed and foot over bed

place one hand on tibia and other on fibula and compress/squeeze down the leg. looking for and noting pain reproduction at any point

High specificity but low sensitivity

Question 10

mechanism of injury for a syndesmosis sprain

Answer 10

dorsiflexion and eversion

Question 11

Arc test

Answer 11

assess for achilles tendinopathy

patient in prone with foot over edge of bed

therapist palpates achilles tendon 2-6cm above insertion at calcaneus, looking for thickening and swelling of tendon. Keep fingers pinched where swelling/thickening is and get patient to plantarflex and dorsiflex.

Positive result if swelling moves up and down finger with plantar and dorsiflexion

Question 12

Why might you use arc test for achilles tendinopathy

Answer 12

in a patient with a thickened tendon. This would be more common in high load athletes

Question 13

Differential diagnosis for ankle sprain

Answer 13

fracture –> rule out with ottawa ankle rules

Question 14

Differential diagnosis for achilles tendinopathy

Answer 14

Achilles rupture –> rule out with thompson test
Plantar fasciopathy –> windlass test

Question 15

Tinel’s sign (Ankle)

Answer 15

poor clinical test (bad sensitivity/specificity)

elicited in two places around ankle. Tapping the tibial nerve as it goes through the tarsal tunnel

anterior tibial branch of the deep peroneal nerve - tap anterior to medial malleolus

posterior tibial nerve - tap behind medial malleolus

Positive sign: tingling and parasthesia felt distally is a positive sign

Question 16

Windlass Test

Answer 16

Assessing for plantar fasciopathy

patient stands on stool and positions metatarsals over edge of stool

physio passively extends big toe

positive test: heel pain reproduced with passive extension of toes

High specificity

Can be done in non-WB, seated, knee flexed at 90 degrees

Question 17

What is tarsal tunnel syndrome

Answer 17

Compression of posterior tibial nerve through tarsal tunnel

Question 18

What is in the tarsal tunnel

Answer 18

• Tibialis posterior tendon
• Flexor digitorum longus tendon
• Posterior tibial artery & vein
• Tibial nerve
• Flexor hallucis longus tendon

Question 19

What action would be weak in tarsal tunnel syndrome

Answer 19

Weakness in toe flexion, particularly flexor hallucis longus and flexor digitorum longus, which are innervated by branches of the tibial nerve which is in the tarsal tunnel

Question 20

Goniometer alignment for toe flexion/extension

Answer 20

Fulcrum: over the dorsal aspect of the MTP joint.
Stabilising arm: over the dorsal midline of the metatarsal.
Measuring arm: over the dorsal midline of the proximal phalange.

Question 21

Apart from a Windlass test, what assessments could you perform to diagnose plantar fasciopathy

Answer 21

AROM/PROM of toe extension/flexion
Will be pain in active toe extension
Normal ROM and normal MMT (might have weak intrinsic muscles) otherwise.

Can rule out other conditions –> Tarsal tunnel with tinels sign or achilles tendinopathy with royal london hospital test