Special Tests: Foot And Ankle Flashcards
Anterior drawer
Condition Tested
Atf ligament
Anterior Drawer
Position
Patient is positioned on edge of table so leg is 90° (to prevent gastroc contraction) and foot is slightly plantar flexed
Examiner is in front of patient stabilizing distaltibia and fibula and the other hand on the calcaneous anteriorly gliding the calcaneus and talus
Anterior Drawer
Positive test
ROM is greater bilaterally and you’ll hear a clunk. The talus moves anteriorly away from ankle mortise
Remember inflammation will reduce translation so have patient lie supine
Bump test
Condition tested
Used to test tibia or fibula fracture
Bump test
Position
Patient position is lying supine with foot Off table and dorsiflexed
Examiner position is to stand to the side of the patients affected ankle one hand holding the top of the foot and slightly tapping the patients heel
Bump test
Positive test
If pain in injury site there could be a fracture
the vibration of tap will increase pain
Dorsal glide test
Condition tested
Dorsal (anterior) movement of metatarsals or phalanges
Dorsal glide test
Positions
Patient is seated with foot over the end of the table
Examiner is at patient’s feet. one hand stabilizing rearfoot and ankle mortis one foot cups base of metatarsal
A plantarly directed force is applied on the metatarsals
Dorsal glide test
Positive test
Hypo mobility(joint adhesions), hyper mobility (ligamentous and/or capsular laxity), pain
Dorsiflexion eversion Test
Condition
Tarsal tunnel syndrome
Posterior tibial nerve
Dorsiflexion Eversion test
Position
Patient is supine with felt over end of table
Examiner is at patient’s feet with one hand on medial side of heel and one hand on head on metatarsals passively evert the need and dorsiflex the foot and toes holding for 5-10 seconds
Dorsiflexion eversion test
Positive test
Pairs radiating onto the foot
TTS the pain is along me medial portion of the heel and arch
Thompson test
Condition
Achilles Tendon rupture
Thompson test
Position
Patient position is prone with legs extended and feet hanging off the edge of table
Examiner position is standing next to the patient with their hand on their calf
Squeeze mid-muscle belly on affected side
Thompson test
Positive
Absence of planter flexion in the patient’s foot
A false positive will result if pressure isn’t deep enough
Plantar glide test
Condition tested
Posterior (plantar) movement of metatarsal or phalanges
Plantar glide test
Position
Patient is seated or lying with foot oven the end of the table
Examiner is at patients feet with hand stabilizingthe metatarsal head and the other cups the phalynx
A plantarly directed force is applied on the metatarsal
Plantar glide test
Positive test
Same as dorsal glide test
Navicular drop
Condition tested
Extent of midfoot pronation
Medial longitudinal arch function
Navicular drop test
Continue later
Morton’s test
Condition tested
Intermetatarsal neuromas
Morton’s test
Patient is seated with foot available
Examiner is standing at the patient’s feet, grasp-forefoot just behind the head of the 1st and 5th mt. With opposite hand, place index finger and thumb of the opposite hand dorsal and plantar to the web space (as if to pinch)
Compress the transverse arch and vise the thumb and forefinger to apply pressure Over the symptomatic interspace between the metatarsals
Feiss line
Condition
Pes Planus or Pes Cavus
Position of the navicular drop
Feiss line
Continue later
Kleiger test
Condition
Damage to deltoid lig or distal tib-fib syndesmosis
Kleiger test
Positions
Patient sits with legs hanging Off table
Examiner is kneeling in front and stabilizes the leg without compressing the distal tib-fib syndesmosis, the other grasps the medial aspect of foot while supporting ankle in neutral
Foot and talus are externally rotated while maintaining a stable leg. To stress the syndesmosis, place the foot in dorsiflexion and to stress the deltoid ligament place the foot in neutral or slight plantar-flex
Kleiger’s test
Positive test
Deltoid ligament: medial joint pain can feel displacement of talus away from Medial malleous
Syndesmosis: pain at anterolateral ankle at the site of dis tib-fib syndesmosis
Posterior Drawer test
Condition
Posterior Talofibular ligament and capsule, deltoid ligament
Posterior Drawer test
Position
Patient supine with the foot over end of table
Examiner stabilizing hand on distal leg and the mobilizing hand grasp the talus and midfoot to maintain the joint in loose position
Apply an anteroposterior force to the talus perpendicular to the tibias long axis as you examine the amount of quality of movement and end feels
Posterior Drawer test
Positive test
The talus slides posteriorly from under the ankle mortise compared with the opposite side. There may be a “clunk” as talus sublaxates and relocates, or the patient may experience pain. If dorsiflexion is limited, this movement is likely to be restricted.
Eversion stress test (taler tilt)
Condition
The integrity of the deltoid ligament and the tibiocalcaneal ligament.
Eversion stress test
Positions
Patient Position: Sitting or lying in a supine position with both legs over the edge of the table.
Examiner Position: Stand in front of the patient. One hand should be grasping the calcaneus and the talas, with the thumb on the deltoid ligament. The other hand should stabilize the leg.
Forces Applied: Roll the calcaneus laterally which causes the talas to tilt.
Eversion stress test
Positive
Positive Test: Indication of deltoid ligament sprain or a Tib-Fib sprain
Intermetatarsal glide
Condition
Trauma in deep transverse MT ligaments and the
interosseous ligaments which secure the MT heads
Forces causing an abnormal amount of glide between the
1st and 2nd MT heads
Intermetatarsal glide
positions
Patient Position: Supine or sitting on the table with knees extended
Examiner Position: Standing in front of the patient’s feet
One hand grasping the first MT head
The other hand grasping the second MT head
Forces Applied: Stabilize one of the MT heads while moving the other in
opposite, plantar and dorsal direction
Repeat procedure by moving to the lateral MT heads until all four intermetatarsal joints have been evaluated
Inter-metatarsal glide
Positive
Positive Test: Pain or increased glide compared with opposite extremity
Toe collateral stress test (vagus/varus test)
Condition
MCL/LCL sprains, avulsion fracture, and adhesions of the IP, DIP, PIP joints
Toe collateral stress test
Positions
Patient Position: The patient can be supine or seated with the feet off the edge of the table.
Examiner Position: One hand is stabilizing the proximal bone close to the joint being tested. The other hand is grasping the bone distal to the joint being tested near the middle of its shaft
Forces Applied: Valgus testing is moving the distal bone laterally to open up the joint on the medial side.
Varus testing is moving the distal bone medially to open up the joint on the lateral side.
Toe collateral stress test
Positive
Positive Test: Pain
Increased laxity when compared bilaterally
Inversion stress test (Talar tilt)
Conditions
Calcaneofibular ligament, anterior and posterior talofibular ligaments, subtalar joint instability
Inverse stress test
Positions
Patient Position: supine or sitting with legs over the edge of a table.
Examiner Position: In front of the patient, one hand grasps the calcaneus and talus, the opposite hand stabilizes the leg 10 degree of dorsiflexion. the thumb or forefinger is place along the calcaneofibular ligament so that any gapping of the talus away from the mortise can be felt.
Forces Applied: the hand holding the calcaneus provides an inversion stress
Inversion stress test
Positive
Positive Test: The talus tilts or gaps excessively (i.e., greater than 10 degrees) compared with the uninjured side, and/or pain is produce.
Squeeze test
Conditions
fibular/tibial fractures or syndesmosis sprains
Squeeze test
Positions
Patient Position: Lying supine with knee extended
Examiner Position: Standing next to, or in front of the injured leg, with hands cupped behind tibia and fibula away from the site of pain
Forces Applied: Gently squeeze (compress) the tibia and fibula, gradually adding more pressure if no pain or other symptoms are elicited. Progress toward the injured site until pain is elicited
Squeeze test
Positive
Positive Test: Pain is elicited, especially when it is away from the compressed area
Homan’s test
Conditions
Deep Vein Thrombosis (DVT)
Homan’s test
Positions
Patient Position: Supine laying on a table with knee fully extended
Examiner Position: Examiner is at end of table, stabilization hand is on distal portion of tibia and fibula and examining hand is on plantar portion of foot being tested
Forces Applied: Foot is passively dorsiflexed by the examiner on the side being tested with the knee fully extended
Homan’s test
Positive
Positive Test: Pain in the calf that brought upon passive stretch of the foot into a dorsiflexed position is a positive sign for thrombophlebitis
