THE LEG and ANKLE

Question 1

palpate medial malleolus

Answer 1

patient half lying

laterally rotate the leg - identify the medial malleolus using index and middle fingers - palpate the full length

Question 2

palpate lateral malleolus

Answer 2

patient half lying

medially rotate the leg - palpate full extend of lateral malleolus using index and middle finger

Question 3

palpate tuberosity of navicular

Answer 3

patient sitting over side of plinth with foot on stool
foot at 90 degrees
identify the tip of medial malleolus
move down and forwards 1 inch until another bony prominence is palpable

Question 4

palpate the base of 5th metatarsal

Answer 4

patient sitting over side of plinth with foot on stool

index and middle finger proximally along the lateral border of the foot approx half way along length

Question 5

palpate the head of talus

Answer 5

patient sitting over side of plinth with foot on stool - slight plantar flexion
place middle and index on the lower end of tibia (medial)
slide fingers down and medial distal to the joint line.
inversion will increase prominence.
palpate the full extent

Question 6

palpate the head of 1st metatarsal

Answer 6

patient in half lying
ask model to flex toes
palpate over dorsal aspect of foot - medial side

then ask model to extend toes
palpate over plantar aspect of foot

Question 7

palpate the talocrural joint

Answer 7

patient in half lying
from tip of medial malleolus to the tip of the lateral malleolus
passively move the patients foot when palpating over tendon to make easier to see
mark the position of the mortise for completeness

Question 8

what type of joint is the talocrural joint?

Answer 8

uniaxial, compound, hinge joint

Question 9

demonstrate full ROM for ankle dorsiflexion

Answer 9

half lying with pillow under knee to reduce tension in gastroc
ask patient to bring toes to nose

Question 10

demonstrate full ROM for ankle plantarflexion

Answer 10

half lying with pillow under knee to reduce tension in gastroc
ask patient to bring toes to floor

Question 11

demonstrate full ROM for ankle inversion

Answer 11

half laying
place hand proximal to ankle to keep stable
ask to turn foot inwards fully

Question 12

demonstrate full ROM for ankle eversion

Answer 12

half laying
place hand proximal to ankle to keep stable
ask to turn foot outwards fully

Question 13

what is normal ROM for ankle dorsiflexion

Answer 13

0-15

Question 14

what is normal ROM for ankle plantarflexion

Answer 14

0-55

Question 15

what is normal ROM for ankle inversion

Answer 15

0-35

Question 16

what is normal ROM for ankle eversion

Answer 16

0-25

Question 17

limiting factors for ankle dorsiflexion

Answer 17

tension in gastroc and soleus
tension in posterior tibiotalar band of deltoid
calcaneofibular ligament
posterior capsule
articular surfaces

Question 18

limiting factors for ankle plantarflexion

Answer 18

tension in anterior tibiotalar band and tibionavicular bands of deltoid
tension in calcaneofibular ligament
anterior capsule

Question 19

limiting factors for ankle inversion

Answer 19

extend of articular surfaces

tension in opposing muscles (NAME)

Question 20

limiting factors for ankle eversion

Answer 20

extend of articular surfaces
tension in opposing muscles (NAME)
plantar calcanocuboid ligament

Question 21

how to perform the lateral ligament stress test?

Answer 21

half lying

fully passively invert the foot - feel for opening up at lateral joint line
in neutral for calacneofibular band
in plantar flexion for anterior talofibular band

Question 22

how to perform the medial ligament stress test?

Answer 22

half lying

fully passively evert the foot - feel for opening up at the medial joint line

Question 23

how to perform AP fibular @ inferior tibiofibular joint

Answer 23

prone lying with knee flexed to 90 degrees
plinth at mid thigh height

Elbows up!!
Heel of upper hand on anterior border of lateral malleolus.
Heel ofother hand on posterior border of medial malleolus.
Oscillatory movement on lateral malleolus away from patient.
TIBIA should be fixed.

Question 24

how to perform PA fibula @ inferior tibiofibular joint

Answer 24

prone lying with knee flexed to 90 degrees
plinth at mid thigh height

elbows up!!
Heel of lower hand on posterior border of lateral malleolus.
Heel ofother hand on anterior border of medial malleolus.
Oscillatory movement on lateral malleolus towards the patient.
TIBIA should be fixed.

Question 25

why would you perform PA fibular?

Answer 25

improve dorsiflexion

Question 26

why would you perform AP fibular?

Answer 26

improve plantarflexion

Question 27

how to perform AP talus at talocrural joint?

Answer 27

prone lying with knee flexed to 90 degrees
plinth at mid thigh height

Cup posterior tib and fib around both malleoli with lower hand. Use upper hand web around talus (ankle joint line).
Elbows up – push upper hand away from patient. Tib and Fib remain fixed.

Question 28

how to perform PA talus at talocrural joint?

Answer 28

prone lying with knee flexed to 90 degrees
plinth at mid thigh height

Cup anterior tib and fib around the malleoli with lower hand.
Use upper hand web around the talus (by the Achilles).
Elbows up apply pressure with upper hand towards the patient. Tib and fib remain fixed.

Question 29

why would you perform AP talus?

Answer 29

improve dorsiflexion

Question 30

why would you perform PA talus?

Answer 30

improve plantar flexion