Ankle Flashcards
Talar tilt test - ATFL
Pt seated, knee hanging off table.
Bring pt’s foot into plantar flexion, so that ATFL is perpendicular to movement.
Grab calcaneus and perform inversion.
+’ve test = pain or excessive gapping compared to unaffected side
Talar tilt test - CFL
Pt seated with knee hanging off table.
Bring pt’s foot into anatomical position, so ligament is perpendicular to long axis of talus.
Bring foot into inversion.
+’ve test = pain or excessive gapping compared to unaffected side.
Talar tilt test - PTFL
Patient seated with knee hanging off table.
To put most stress on posterior talofibular ligament, bring foot into maximal dorsiflexion and perform inversion.
+’ve test = pain or excessive gapping compared to unaffected side
Talar tilt test - deltoid ligament
Pt seated with legs hanging off bed.
Bring pt’s foot into anatomical position, so that ligament is perpendicular to the long axis of the talus.
Bring foot into eversion (stresses deltoid ligament complex on medial side)
+’ve test = pain or excessive gapping compared to unaffected side
Anterior drawer’s test - ATFL
Pt in supine.
1. Knee joint slightly flexed and ankle held at 10-15 degrees of plantar flexion.
Grasp pt’s heel with contra lateral hand, while pt’s foot lies on the anterior aspect of the forearm.
Other hand fixates the pt’s tibia close to the joint line.
Draw foot anteriorly.
- Place pt’s foot on towel at 10-15 degrees plantarflxion.
Fixate foots position.
Grasp tibia with other hand and push it posteriorly.
+’ve test = increased anterior translation compared to unaffected ankle.
Might observe dimple on anterolateral aspect of talus.
Ottawa’s ankle rules
1st = palpate tenderness on posterior edge of lateral and medial malleolus. Start distally and move 6cm upwards.
2nd = palpate for pain or tenderness over navicular bone and 5th metatarsal.
3rd = ask pt to walk 4 consecutive steps.
1/3 positive = 25-50% chance there is a fracture - pt should get x-ray.
If all 3 -‘ve = closed to 100% chance of no fracture.
Thompson/ Calf squeeze test
Pt in prone, feet hanging off bed.
Squeeze calf a couple times.
Observe for plantar flexion.
Plantarflexion absent = rupture to Achilles’ tendon.
Tinel’s sign
Can be elicited in 2 places.
1st = anterior tibial branch of deep peroneal nerve - assess by tapping.
2nd = tapping behind medial malleolus (to elicit sign for posterior tibial nerve)
+’ve sign = tingling and parenthesis felt distally.
Squeeze test
Pt in supine.
Squeeze the proximal fibula and tibia together.
Apply the same compression at more distal places down to the malleolus.
More proximal the pain = more severe the injury.
Pain = syndesmosis rupture.
Cotton test
Patient in supine.
Stabilise distal tibia and fibula with one hand.
Apply lateral translation force to the foot with the other hand.
+’ve for syndesmosis = translation of more than 3-5mm or if a clank is heard or felt.
Dorsiflexion external rotation stress test
Test reproduces the mechanism of injury to the syndesmosis.
Pt in sitting knees hanging from table in 90 degrees.
Bring pt’s talocrural joint into maximum Dorsiflexion and apply an external rotation stress to the injured foot and ankle.
+’ve test = pt’s lateral pain over the syndesmosis is reproduced.
Lower limb pulses
Tibial a.
o
o
o
Runs posterior to the medial malleolus and then down into the foot. So we will palpate it
just posterior to the medial malleolus and
slightly superior using the pads of our middle 2 fingers
If you dorsiflex the foot, that puts tension on the tibial artery and it makes the blood not flow as well. So you want the
patient in a relaxed plantarflexion position when palpating the tibial pulse.
Find the medial malleolus (as a bony landmark) and go posterior to that, if don’t feel it there, can come slightly superior
- Dorsalis pedis a.
o Best palpated on the dorsal side of the foot between the
extensor hallucis longus tendon and the extensor digitorum tendon. It will be directly on the dorsum of the foot over the cuneiforms.
o If the foot is plantarflexed, the dorsalis pedis artery is stretched and a lot of the time will include this artery. So we want to put the foot at least in the neutral position to take any tension forces off the dorsalis pedis artery.
o Get pulse by simply extending pt’s big toe and finding the extensor hallucis longus, going just
lateral to that and directly over the dorsum of the foot.
- Popliteal a.
o
o
Pt in hook lying position, palpate more on the tibia between the 2 heads of the gastrocnemius, bringing all fingers behind and pulling (almost lifting) the leg off of the mat; because it is deep.
Will be able to feel the pulse with one of your fingers and apply pressure as the artery is deep.
- Femoral a.
o o o
Landmarks are the rectus femoris on the lateral side and midway at the inguinal ligament but inferior to that ligament.
If put pt in hook lying position it will take any stress or tension off of the artery. Ask patient to lift their foot up off the mat to find the muscles and then ask them to relax.
Tx then goes to the medial side of that muscle below the inguinal ligament and find the femoral pulse.
Homans test
DVT
o o
Pt in supine with the knee of the involved side
fully extended. The tx will passively dorsiflex the pt’s foot
In a positive finding = there is a production of pain in the calf brought upon by the passive stretching of the foot into a
dorsiflexed position. The positive sign is indicative of thrombophlebitis which is a life-threatening condition that should be addressed immediately.
