Ankle-and-foot Flashcards
(23 cards)
What is the first step in the Ankle and Foot Examination?
Greet the patient and explain your role. Confirm the patient’s identity.
What is required before proceeding with the examination?
Clarify the nature of the task and seek consent to proceed.
What should be done to prepare the patient for the examination?
Remove socks and shoes to adequately expose the patient’s ankles.
What should be compared during the examination of the ankles?
Compare both ankles for any pre-existing site of pain.
What should be examined in the patient’s footwear?
Look for orthosis and evidence of wear and tear.
What observations should be made when the patient is standing?
Check for swelling, nail changes, bruising, or deformity (e.g., hallux valgus, pes planus, pes cavus).
What indicates a potential fracture or tendon issue when observing the patient on tip toes?
Inability to perform the action may indicate a fracture, tendon rupture, or tibialis posterior insufficiency.
What should be observed when the patient is sitting?
View the sole for ulcers and callosities, which are thickened skin at sites of repeated pressure.
What gait abnormalities should be noted?
Inability to weight bear, pace, symmetry, and any gait abnormalities (e.g., antalgic gait, slapping foot).
What areas should be palpated during the ‘Feel’ examination?
Palpate the lateral malleolus, anterior joint line, medial malleolus, Achilles tendon, base of the 5th metatarsal, and metatarsal heads.
What should be included in a neurovascular assessment?
Check pulses (dorsalis pedis and posterior tibial) and sensation.
What range of movement should be calculated?
Dorsiflexion (15°), plantarflexion (45°), inversion (20°), and eversion (10°).
What special test is used for suspected metatarsophalangeal joint pathology?
Grind Test: The first MTPJ is axially loaded and the proximal phalanx is rotated.
What indicates a positive Grind Test?
Pain and stiffness at the MTPJ is exacerbated.
What is the procedure for the Anterior Drawer Test?
With the patient sitting, apply force in an anterior direction while stabilizing the hind foot.
What indicates a positive Anterior Drawer Test?
Instability is demonstrated by the foot moving forward on the symptomatic side compared to the other side.
What is the Mulder’s Click Test used for?
Suspected Morton’s neuroma.
What indicates a positive Mulder’s Click Test?
The patient experiences pain over the interdigital space and paraesthesia in the affected toes.
What is Simmond’s Test used for?
Suspected Achilles tendon rupture.
What indicates a positive Simmond’s Test?
Absent or reduced plantar flexion when squeezing the calf.
What are the Ottawa ankle rules used for?
To help decide if an x-ray should be offered for traumatic foot or ankle pain.
Where can you find demonstrations of special tests?
On the Dundee University clinical skills novice foot and ankle video: https://www.youtube.com/channel/UChkNlLd3PbEPueiAQgufCqg
What should be done at the conclusion of the examination?
Thank the patient, discuss findings, offer help for dressing, and perform hand hygiene.
