OSCE: Ankle and Foot

Question 1

What is the normal ROM for ankle dorsiflexion?

Answer 1

15-20^o

Question 2

What is the normal ROM for ankle plantarlexion?

Answer 2

55-65^o

Question 3

What is the normal ROM for ankle eversion?

Answer 3

10-20^o

Question 4

What is the normal ROM for ankle inversion?

Answer 4

20^o

Question 5

What is the normal ROM for the first metatarsophlangeal flexion?

Answer 5

45^o

Question 6

What is the normal ROM for the first metatarsophlangeal extension?

Answer 6

70-90^o

Question 7

What structures compose the medial longitudinal arch?

Answer 7

Higher Arch

• Calcaneus
• Talus
• Navicular
• Cuneiforms 1-3
• Metatarsals 1-3

Question 8

What structures compose the lateral longitudinal arch?

Answer 8

Lower Arch

• Calcaneus
• Talus
• Cuboid
• Metatarsals 4-5

Question 9

What structures compose the transverse tarsal arch?

Answer 9

Lower Arch

• Navicular
• Cuboid
• Cuneiforms 1-3
• Proximal Metatarsals

Question 10

What does the S1 deep tendon reflex test?

Answer 10

Achilles Tendon

Question 11

What dermatome test for the patella and medial side of the big toe?

Answer 11

L4

Question 12

What dermatome test for the anterior leg, ankle, and big toe?

Answer 12

L5

Question 13

What dermatome test for the lateral leg and lateral phalanges?

Answer 13

S1

Question 14

Anterior Drawer Test

How do you peform this test?

What does a positive test indicate?

Answer 14

1. Grasp posterior calcaneus with one hand and distal tibia/fibula with the other hand.
2. Monitor anteriorly at the anterior talus.
3. Provide anterior force on calcaneus while stabilizing the distal tibia/fibula.
4. Normal springing of calcaneus back to neutral should occur.

Positive test (pain) indicates ATF ligament pathology/tear (lateral ankle sprain)

ATF = Always tears first

Question 15

Talar Tilt Test

How do you peform this test?

What does a positive test indicate?

Answer 15

1. Grasp distal tibia/fibula with one hand and inferior calcaneus with the other, blocking motion of the calcaneus on the talus.
2. Invert the talus to evaluate ROM.

Positive test (laxity/pain) indicates Calcaneofibular ligament pathology/tear, also tests some ATF (lateral ankle sprain)

Question 16

Eversion Test

How do you peform this test?

What does a positive test indicate?

Answer 16

1. Grasp distal tibia/fibula with one hand and plantar surface of the mid-foot with the other hand.
2. Evert the talus to evaluate ROM.

Positive test (laxity/pain) indicates Deltoid ligament pathology (medial ankle sprain)

Question 17

Squeeze Test

How do you peform this test?

What does a positive test indicate?

Answer 17

1. Wrap hands around leg proximal to the ankle, contacting distal tibia/fibula with both thenar eminences.
2. Squeeze for 2-3 seconds, then rapidly release.

Positive test (pain) indicates Syndesmosis pathology (high ankle sprain)

Question 18

Thompson Test

How do you peform this test?

What does a positive test indicate?

Answer 18

1. Patient prone with foot off the table.
2. Squeeze the patient’s calf.
3. Observe for plantarflexion.

Positive test (absence of plantar flexion) indicates Achilles Tendon Rupture.

Question 19

Homan’s Sign

How do you peform this test?

What does a positive test indicate?

Answer 19

1. Patient laying or seating with knee extended.
2. Dorsiflex the patient’s foot.
3. Can apply lateral compression to calf.

Positive test (pain with dorsiflexion) indicates DVT or thrombophlebitis.

Not always a good idea to peform this test incase of embolus.