Joint Exam: Ankle/Foot Compentency Flashcards
Which tests are performed regarding an inversion ankle sprain?
1) Anterior Drawer Test
2) Talar Tilt Test
Which tests are performed to evaluate a high ankle sprain?
1) Squeeze Test
2) Cross Leg Test
Name the bony landmarks on the medial aspect of the ankle/foot.
- First MTP (sesamoids)
- Navicular
- Cuneiform
- Talar Head
- Medial Malleolus
- Deltoid Ligament
- Medial Longitudinal Arch
Name the bony landmarks on the lateral aspect of the ankle/foot.
- 5th MTP
- 5th metatarsal w/ styloid process
- cuboid
- calcaneous
- lateral malleolus
How do you check the circulation of the ankle/foot?
- Dorsalis pedis pulse (lateral to extensor hallucis tendon, 2-3 cuneiforms)
- Posterior Tibial Pulse (posterior to medial malleolus)
- Capillary refill
How can you perform strength testing for the ankle/foot?
- resistance added to AROM testing
- toe walk
- heel walk
How can you perform neurologic testing for ankle/foot?
Sensation by:
- monofilament test (pads of 1st and 4th digits) [plantar]
- dermatomes (L4,L5,S1-medial to lateral)[dorsum]
Which segments are involved during dorsiflexion?
L4,L5
Which segments are involved during plantarflexion?
S1,S2
Which segments are involved during inversion?
L4,L5
Which segments are involved during eversion?
L5,S1
How do you perform the “Anterior Drawer Test”? What is regarded as a positive test?
- tests Anterior Talofibular Ligament.
- grasp calcaneous with 1 hand/ tib-fib with the other.
- -move the calcaneous anterior, while stabilizing the tib-fib.
Positive test:
+Pain -indicative of a “sprain”
+gapping -indicative of a “tear”
How do you perform the “Talar Tilt” test?
- Grasp calcaneous and tib/fib to isolate the talus.
- gently invert
- -evaluates “Calcaneofibular ligament” & “Anterior Talofibular”
How do you perform the “eversion test”?
- Grasp midfoot & tib/fib to isolate the talus
- -gently evert/pronate foot
- –evaluates “Deltoid ligament”
What are the special tests regarding ankle/foot?
- Squeeze Test
- Thompson Test
- Cross Leg Test
- Homan’s Sign
- Moses Sign
Explain the Squeeze Test.
- squeeze tibia and fibula just proximal to ankle
- -rapid release
- –pain indicates a high ankle sprain or syndesmosis injury
Explain the Cross Leg Test.
- Cross affected leg onto opposite knee
- -Positive = pain
- –indicates high ankle sprain
Explain the Thompson Test.
- With patient’s prone, foot off the table, squeeze calf
- -Absence of plantarflexion of the foot indicates Achilles tendon rupture.
Explain the Homan’s Sign.
- Forcible dorsiflex foot with knee extended.
- -pain can indicate deep vein thrombosis
- –unilateral swelling and redness of calf increases suspicion for DVT.
Explain the Moses Sign.
- Pt supine/seated
- -induce anterior compression of gastrocnemius
- –positive test = pain with anterior compression
- —more specific for posterior tibial vein DVT
Explain some key points about “inversion ankle sprains”.
- accounts for 80-85% of all ankle sprains
- ankle inversion with plantarflexion
- Ligaments involved:
- anterior talofibular
- calcaneofibular
- posterior talofibular
- swelling and ecchymosis over the involved area
- both are more prevalent with increasing severity of injury
Explain some key points involving a “high ankle sprain”.
- accounts for 10% of sprains
- eversion & rotation injury (and dorsiflexion)
- pain commonly on the medial side
- minimal swelling or ecchymosis
- pain with weight bearing
- most common in football and downhill skiing
- ligaments involved:
- anterior inferior tibiofibular ligament
- syndesmosis
Explain “Plantar Fasciitis”.
- inflammation of the origin of the plantar aponeurosis from stretching during walking/standing
- worse with first steps, improves through day
- point tenderness of calcaneous
- no relationship to heel spurs
- causes:
- tight calf muscles
- repetitive impact activities
- high arches
- obesity
- new/change in activities
Explain “Morton’s Neuroma”.
- inflammation and thickening of the tissue that surrounds the nerve between the toes
- most commonly between the 3rd and 4th toes
- patient reports it feels “like they are walking on a marble”.
- palpable in the web space replicating pain
