OSCE 5 - Ankle/ foot exam competency

Question 1

skin checks

Answer 1

Texture
 Color Changes i.e. ecchymosis
 Scaling
 Swelling
 Callouses
 Corns
 Plantar Warts

Question 2

Boney Landmarks (medial)

Answer 2

First MTP
 Navicular
 Cuneiform
 Talar Head
 Medial Malleolus
 Deltoid ligament—vital to foot & ankle stability
 Medial Longitudinal Arch

Question 3

Boney Landmarks (lateral)

Answer 3

5th MTP
 5th metatarsal w/styloid processs
 Cuboid
 Calcaneous
 Lateral Malleolus

Question 4

Circulation

Answer 4

Dorsalis pedis pulse
 Posterior Tibial pulse
 Capillary refill
monofilament test on plantar aspect of the foot

Question 5

PROM and AROM check and strength testing

Answer 5

Ankle plantarflexion/dorsiflexion
Subtalar invertion/evertion
Toe flexion/extension

Question 6

tests involved in evaluating a patient for an inversion ankle sprain and
name the structures involved

Answer 6

a. Anterior Drawer Test – Anterior talofibular ligament (ATF)
b. Talar Tilt Test – Calcaneofibular ligament and some ATF

Question 7

tests specific for evaluating a high ankle sprain and name the structures
involved.

Answer 7

• Squeeze test
• Cross leg test
• Structures – syndemosis (and anterior inferior tibiofibular ligament)

Question 8

structure involved in thompson test

Answer 8

achilles tendon

Question 9

thompson test

Answer 9

patient prone
squeeze calfs
check for plantarflexion response

Question 10

primary stabilizer of medial ankle

Answer 10

deltoid ligament

Question 11

medial longitudinal arch made up of

Answer 11

talus
navicular
cuneiforms 1-3
metatarsals 1-3

Question 12

lateral longitudinal arch made up of

Answer 12

calcaneus
cuboid
metatarsals 4-5

Question 13

transverse distal tarsal arch made up of

Answer 13

navicular
cuboid
cuneiforms 1-3
proximal metatarsals

Question 14

Compress digit between index and thumb to cause
blanching; release pressure and note time to regain color.
Normal is three seconds or less.

Answer 14

capillary refill test

Question 15

monofilament test

Answer 15

important component of diabetic foot exam
monofilament placed on:
1st and 4th pad of toes
base of first, third and fifth plantar MTP joints

Question 16

foot ROM

Answer 16

dorsiflexion 15-20
plantarflexion 50-65
subtalar invesion 20-30
subtalar eversion 10-20

Question 17

pronation a combination of

Answer 17

dorsiflexion
abduction
eversion of calcaneous

Question 18

supination a combination of

Answer 18

plantar flexion
adduction
inversion of calcaneous

Question 19

dorsiflexors muscles and nerves

Answer 19

tibialis ant. (primary, deep fibular L4/5)
EHL (Deep fibular, L5)
EDL (Deep fibular, L5)

Question 20

plantar flexors muscles and nerves

Answer 20

gastroc/ soleous (primary, tibial S1/2)
peroneus longus/ brevis (superficial fibular, L5)
FDL (tibial nerve, L5)
Tibialis post. (Tibial n., L5)

Question 21

achilles tests this segment of spinal cord

Answer 21

S1

Question 22

anterior drawer test

Answer 22

Doc grasps posterior calcaneus with one hand and cups
distal tibia/fibula with the other hand, monitoring anteriorly
at the anterior talus. Provide anterior force on calcaneus
while stabilizing the distal tibia/fibula. Normal springing of
calcaneus back to neutral should occur.
(+) test = pain, no springing, excessive motion
anterior/laxity = ATF ligament pathology/tear

Question 23

Talar tilt test

Answer 23

Doc grasps distal tibia/fibula with one hand and the inferior
calcaneus with the other, blocking motion of the calcaneus
on the talus. Invert the talus to evaluate ROM.
(+) test = laxity, increased ROM or pain =
Calcaneofibular ligament pathology/tear and some ATF

Question 24

eversion test

Answer 24

Doc grasps distal tibia/fibula with one hand and grasps the
midfoot from the plantar surface of the foot with the other
hand. Doc everts the foot to evaluate ROM.
(+) test = laxity, increased ROM or pain = deltoid
ligament

Question 25

Squeeze Test (High Ankle Sprain)

Answer 25

Doc wraps hands around leg proximal to the ankle,
contacting the distal tibia/fibula with both thenar
eminences. Squeeze for 2-3 seconds – rapidly release.
(+) test = pain at syndesmosis = syndesmosis pathology

Question 26

Cross Leg Test

Answer 26

For evaluation of high ankle sprain
o Patient seated
o Patient crosses affected leg over opposite knee
o Patient then applies pressure to proximal fibular of
affected leg
(+) test = pain at distal ankle = syndesmotic injury

Question 27

Thompson test

Answer 27

Pt Prone with foot off the table. Doc squeezes the calf.
(+) test = absence of plantar flexion = Achilles tendon
rupture

Question 28

Homan’s sign

Answer 28

Indicates thrombophlebitis or acute venous thrombosis
o Pt laying or seated with knee extended. Doc
dorsiflexes the foot. (Some add lateral compression of
calf as well)
o A positive test is pain with dorsiflexion.
o Suggestive of venous thrombosis in the presence of
edema, erythema, and increased warmth of the skin of
the lower leg
o Need to get a Venous Doppler to rule out clot

Question 29

Moses Sign

Answer 29

Indicates deep vein thrombosis of the posterior tibial veins
o Pt seated or supine
o Physician induces an anterior compression on the
gastrocnemius muscle into the posterior aspect of the
tibia (compresses the calf towards the tibia)
o A positive test is pain with anterior compression – not
lateral compression.

Question 30

Achilles Tendonitis def., presentation, etiology, DM

Answer 30

• Inflammation at Achilles tendon
• Presents as sharp heel pain and stiffness at mid-achilles tendon to
  insertion
• Worse with strenuous exercising, better with walking
• Micro tears in tendon causes swelling and thickening
• Causes: tight calf muscles, sudden change in activity, poorly fitting
  shoes, incorrect running technique

Question 31

Turf toe

Answer 31

• Inflammation and Pain at base of 1st MTP
• Presents as pain and bruising at base of great toe
• Caused by hyperextension of great toe causing damage to the joint
  capsule.
• Severe cases can damage sesamoids and flexor tendon
• Common due to activities performed on hard surface

Question 32

Morton’s neuroma

Answer 32

• Inflammation and thickening of tissue that surrounds the nerve
  between toes.
• Most commonly between 3rd and 4th toes.
• Patient reports feeling like they are walking on a marble
• Palpable in web space, which will replicate pain

Question 33

Plantar Fasciitis

Answer 33

• Inflammation of origin of plantar aponeurosis
• Worse with first steps, improves through day
• Pt will complain pain is worst when they get out of bed in morning
• Point tenderness of calcaneous
• Causes: tight calves, repetitive impact activities, high arches, obesity,
  new/changes in activities
• You already know a way to treat this!!

Question 34

High Ankle Sprain

Answer 34

• Accounts for 10% of all ankle sprains
• Ankle Eversion and rotation (some dorsiflexion)
• Ligaments Involved:
• Anterior Inferior tibiofibular
• Syndesmosis
• Pain more common on medial aspect with minimal swelling
• Pain worse with weight bearing

Question 35

Inversion Ankle Sprain

Lateral sprains

Answer 35

• Accounts for 80-85% of all ankle sprains
• Ankle inversion with plantar flexion
• Ligaments Involved:
• Anterior talofibular (ATF=always tears first)
• Calaneofibular
• Posterior talofibular
• Swelling and ecchymosis over involved area

Question 36

dermatomes tested in foot

Answer 36

L4, L5, S1