Foot and Ankle exam

Question 1

Where do 85% of ankle sprains occur and which ligament do they involve?

Answer 1

Sprains mainly occur to the lateral ankle and involve the Anterior Talo-Fibular Ligament (ATFL).

Question 2

In which type of flexion are you most likely to experience an ankle sprain?

Answer 2

Plantar flexion (when you’re up on your toes). This is because your talus is smaller in the front than in the back so it is more unstable, AND that side-to-side instability leads to ATFL tears.

Question 3

Define pes cavus

Answer 3

high arch

Question 4

Define pes planus

Answer 4

flat arch (flatfoot)

Question 5

Key areas in the foot to palpate:

Answer 5

5th metatarsal base (Jones region), 2-4th metatarsal base (LisFranc region), anterior navicular, medial tubercle of calcaneus–plantar fascia, achilles (insertion on calcaneus and mid)

Question 6

Key areas in ankle to palpate:

Answer 6

Anterior talofibular ligament (ATFL), calcaneo Fibular ligament (CFL), Posterior Talofibular ligament (PTFL), lateral malleolus, deltoid ligament, medial malleolus, anterior syndesmosis (between tibia and fibula)

Question 7

Special tests for the ankle and foot

Answer 7

Thompson’s squeeze test (tests for achilles rupture), Ankle anterior drawer test (tests for ATFL integrity), Talar tilt/Varus Stress test (tests for CFL integrity)

Question 8

Talar Tilt/Varus Stress test

Answer 8

Tests for CFL (calcaneo fibular ligament) integrity, patient is seated, examiner uses one hand to stabilize distal tibia and other hand to invert the foot until the motion is stopped by CFL. Excessive laxity or differences from unaffected leg is a positive test.

Question 9

Ankle Anterior Drawer test

Answer 9

Tests for Anterior talofibular ligament (ATFL) integrity. (NOT usually done in an acute setting because pain invalidates test). Patient is seated with flexed knee to 90 degrees, examiner stabilizes distal tibia with one hand and uses the other hand to pull calcaneous anteriorly, Normally, ankle should move forward a few millimeters, then come to a firm endpoint (intact ATFL). Excessive laxity or differences form unaffected leg is a positive test.

Question 10

Thompson’s sqeeze test

Answer 10

Tests for achilles rupture. Examiner squeezes calf of leg and observes foot plantarflexion. If Achilles is completely ruptured, there will be reduced, but may not be completely absent plantar flexion (plantaris muscle may be intact).