Ankle & Foot Exam

Question 1

Lateral Landmarks

Answer 1

Lateral malleolus
Calcaneus
Cuboid
Lateral longitudinal arch (made up of calcaneus, cuboid, and metatarsals 4-5)
Anterior talofibular ligament
Calcaneofibular ligament
Posterior talofibular ligament

Question 2

Other Landmarks

Answer 2

Metatarsals/MTP Joints
Phalanges
Transverse distal tarsal arch (made up of navicular, cuboid, cuneiforms 1-3, and proximal metatarsals)
Dorsalis pedis pulse
Plantar fascia
Achilles' tendon
Anterior tibialis tendon
Posterior tibialis tendon
Flexor digitorum longus
Flexor hallucis longus
Extensor hallicus longus tendon
Extensor tendons
Peroneus (fibularis) tendon

Question 3

Capillary Refill

Answer 3

Compress digit between index and thumb to cause blanching, release pressure and note time to regain color

Normal = 3 secs or less

Question 4

Monofilament Test

Answer 4

Plantar aspect of foot
1st and 4th bad of toes, base of 1st 3rd and 5th plantar MTP joints

Positive = can’t feel monofilament

Important component off diabetic food exam

Question 5

ROM

Answer 5

Dorsiflexion: 15-20 degrees
Plantarflexion: 50-65 degrees
Subtalar inversion: 20-30 degrees
Subtalar eversion: 10-20 degrees
Metatarsalphalangeal flexion
Metatarsalphalangeal extension

Pronation = dorsiflexion, abduction, eversion of calcaneus
Supination = plantarflexion, adduction, inversion of calcaneus

Question 6

Strengthen Testing

Answer 6

Dorsiflexors:

• tibialis anterior (primary) - deep peroneal n. L4/5
• extensor hallucis longus - deep peroneal n. L5
• extensor digitorum longus - deep peroneal n. L5

Plantarflexors:

• gastrocnemius/soleus (primary) - tibial n. S1/2
• peroneus longus/brevis - superficial peroneal n. L5
• flexor digitorum longus - tibial n. L5
• tibialis posterior - tibial n. L5

Question 7

Anterior Drawer Test

Answer 7

Pain, no springing, excessive motion

Anterior/laxity = ATF ligament pathology/tear

Question 8

Talar Tilt Test

Answer 8

Laxity, increased ROM or pain

Calcaneofibular ligament pathology/tear and some ATF

Question 9

Eversion Test

Answer 9

Laxity, increased ROM or pain

Deltoid ligament

Question 10

Squeeze Test (High Ankle Sprain)

Answer 10

Pain at syndesmosis

Syndesmosis pathology

Question 11

Cross Leg Test

Answer 11

Pain at distal ankle

Syndesmodic injury

Question 12

Thompson Test

Answer 12

Absence of plantar flexion

Achilles’ tendon rupture

Question 13

Homan’s Sign

Answer 13

Pain with dorsiflexion

Venous thrombosis in the presence of edema, erythema, and increased warmth of the skin

Venous Doppler to rule out clot

Question 14

Moses Sign

Answer 14

Pain with anterior compression - NOT lateral compression

Deep vein thrombosis of posterior tibial veins

Question 15

Inversion Ankle Sprains (Lateral Sprains)

Answer 15

80-85% of all ankle sprains
Ankle inversion with plantarflexion
Anterior talofibular ligament (ATF = always tears first)
Calcanofibular ligament
Posterior talofibular ligament
Swelling and ecchymosis over involved area

Question 16

High Ankle Sprain

Answer 16

10% of all ankle sprains
Ankle eversion and rotation (sometime dorsiflexion)
Anterior inferior tibiofibular ligament
Syndesmosis
Pain more common on medial aspect with minimal swelling
Pain worse with weight bearing

Question 17

Plantar Fasciitis

Answer 17

Inflammation of origin of planter aponeurosis
Worse with first steps, improves through day
Point tenderness of calcaneus
Cause: tight calves, repetitive impact activities, high arches, obesity, new/changes in activities

Question 18

Morton’s Neuroma

Answer 18

Inflammation and thickening of tissue that surrounds the nerve between toes (most common between 3rd and 4th toes)
Feeling like walking on a marble
Palpable to web space, will replicate pain

Question 19

Turf Toe

Answer 19

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 joint capsule
Common due to activities performed on hard surface

Question 20

Achilles Tendonitis

Answer 20

Inflammation of 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 techniques

Question 21

Medial Landmarks

Answer 21

Medial malleolus
Navicular
Cuneiforms (1-3)
Deltoid ligament (primary stabilizer of medial ankle)
Medial longitudinal arch (made up of talus, navicular, cuneiforms 1-3, and metatarsals 1-3)
Posterior tibial artery pulse