Ortho Lower Extremity: Foot/ankle Specialized Physcial Exam Tests Flashcards
Anterior Drawer (ankle)
o Detects excessive anterior displacement of the talus on the tibia
o If anterior talofibular lateral ligament is torn by an inversion stress, the talus will sublux anteriorly and laterally out of the mortise
o Test performed with the patient’s foot in the neutral position (slightly plantar flexed and inverted)
External Rotation Stress Test (Ankle)
o Clinician stabilizes the leg proximal to the ankle joint while grasping the plantar aspect of the foot and rotating the foot externally relative to the tibia
o Positive test: pain is elicited in the region of the anterior tibiofibular ligament (anterior to the lateral malleolus and proximal to the ankle joint)
o Helps to identify a syndesmotic ankle sprain
Matles Test
Patient lies prone with knees flexed to 90 degrees
Observe whether the affected foot is dorsiflexed or neutral (both are abnormal)
Compare to uninjured side (foot should be plantar flexed)
Metatarsal compression test
Squeeze the metatarsals together with one hand and using the thumb and index finger of the other hand to compress the affected area to reproduce the pain/symptoms
Can indicate presence of metatarsalgia
Mulder’s sign
Clicking sensation when palpating the interspace and simultaneously squeezing the metatarsal joints
Can indicate presence of interdigital neuroma (Morton’s neuroma)
“Piano Key” test
Useful to assess for Lisfranc injury
Grasp toes and move them up and down to determine if pain results
Puts stress on midfoot and will cause pain if injury
Single limb heel rise
Stand on one foot and come up on “tip toes”
This places significant stress across midfoot
Results in pain if Lisfranc injury present
Squeeze test (ankle)
Compression of the fibula against the tibia at the mid-calf level
Positive test: pain is elicited in the region of the anterior tibiofibular ligament when a syndesmotic sprain has occurred
Stress examination of the midfoot
Grasp heel and twist the front of your foot to determine whether there is pain at the midfoot
Causes pain with Lisfranc injury but not with ankle injury
Talar Tilt Test
Detects excessive ankle inversion
If ligamentous tear extends posteriorly into the calcaneofibular portion of the lateral ligament, the lateral ankle is unstable and talar tilt occurs
With ankle in neutral position, gentle inversion force is applied to the affected ankle
Degree of inversion is observed and compared with the uninjured side
Limited usefulness in acute injury when pain, muscle spasm and swelling are present
More important in evaluating chronic ankle instability
Thompson test (calf squeeze test)
Patient either lie prone w/ feet hanging of the end of table or kneels on a chair
Clinician squeezed the gastrocnemius muscle belly while watching for plantar flexion
Absence of plantar flexion when squeezing the gastrocnemius muscle marks a positive test for rupture
More reliable than ability to plantar flex b/c this can also be done w/ accessory muscles
Tinel’s sign (tarsal tunnel)
Symptoms (paresthesias) are elicited by tapping over the path of the tibial nerve
Useful for assessing presence of tarsal tunnel syndrome
