Ankle and Foot Evaluation

Question 1

Pathology based on location

Answer 1

• tenderness along anterior shin = medial tibial stress syndrome
• pain along calf muscle that increases w/stretch & push off of gait = achilles tendonopathy
• pain at heel w/first few steps in am = plantar fasciitis
• paresthesias & pain plantar surface of foot = tarsal tunnel syndrome
• pain b/w 3rd & 4th metatarsals = Morton’s neuroma

Question 2

Self assessments for the foot and ankle

Answer 2

• Lower extremity functional scale (LEFS)
• Foot and ankle outcomes questionnaire
• American orthopedic foot and ankle society scales (AOFAS)

Question 3

Observations

Answer 3

• gait analysis
• standing position: equal WB bilateral
• antalgic gait
• footwear
• navicular height
• forefoot position
• ankle swelling

Question 4

Figure 8 for ankle swelling

Answer 4

• patient seated or supine with ankle in resting position
• place endpoint of tape midway b/w tibialis anterior & lateral malleoi
• pull tape medially to plantar surface of foot to base of 5th MTP
• then pull tape distal to medial malleoi across achilles tendon to start point

Question 5

Functional screen for the foot and ankle

Answer 5

• single leg stance
• squat

Question 6

Calcaneal inversion and eversion joint mobilization

Answer 6

• Inversion: pt supine with foot slightly PF and ER, one hand placed above the medial malleoi and the other hand placed on the calcaneus, push toward the table
• Eversion: perform the opposite of inversion joint mob

Question 7

Tibiotalar anterior and posterior glide

Answer 7

• patient supine with foot hanging off of table
• place one hand above the malleoli and other hand on the talus with web space b/w thumb and index finger
• anterior glide improves plantar flexion
• posterior glide improves dorsiflexion

Question 8

MTP and IP dorsal and plantar glides

Answer 8

• patient supine with foot hanging off of the table
• one hand stabilizes the proximal bone while the other hand placed on the dorsal and plantar surface of the distal bone of desired joint
• Dorsal glide improves extension
• Plantar glide improves flexion

Question 9

Signs that a patient probably doesn’t need an x-ray

Answer 9

• they can walk on it nicely
• they don’t have tenderness on the malleoli or navicular

Question 10

Special tests for syndesmosis pain

Answer 10

• Dorsiflexion compression maneuver: pt seated, passively DF w/overpressure, Pos. = pain along tip fib syndesmosis
• Dorsiflexion compression test: pt WBing lung position, lunge into full DF, note location of pain & amount of DF, apply medial-lateral compression & retest, Pos. = less pain or increased ROM w/second maneuver
• Squeeze test: squeeze syndesmosis with one hand, Pos. = recreates pain

Question 11

Special tests for an ankle sprain

Answer 11

• Calcaneus tilt (LCL): pt supine, lower leg stabilized as you ADD calcaneus, Pos. = pain along lateral ankle
• Anterior drawer test (ATFL): pt supine with hip & knee flexed with foot on table & ankle in 10-20 degrees PF, stabilize tibia as you translate the heel forward, Pos. = asymmetry

Question 12

Test cluster for Achilles tendonopathy

Answer 12

• Tendon palpation: Pos.= painful on palpation
• Arc sign: actively DF and PF the ankle from a prone position, Pos. = swelling moves superior & inferior with active DF and PF of the ankle
• Royal London Hospital test: pt prone with foot off edge of table, palpate achilles tendon for tenderness, ask pt to DF, palpate tendon for tenderness, ask pt to PF, palpate tendon for tenderness, Pos. = no pain in max DF

Question 13

Special tests for Achilles rupture

Answer 13

• Matles test: pt prone with knee flexed to 90 degrees, Pos. = foot assumes neutral or slight DF
• Thompson test: pt prone, squeeze calf muscle, Pos. = ankle doesn’t PF when calf muscles are squeezed

Question 14

Special tests for plantar fasciitis

Answer 14

• Windlass test: pt seated with knee flexed to 90 degrees, stabilize ankle & passively extend the MTP joint while allowing IP to flex, Pos. = pain & limited ROM

Question 15

Special tests for anterolateral impingement

Answer 15

• Impingement sign: pt seated, hold calcaneus with one hand & place forefoot into PF, use other hand to place pressure over the anterolateral ankle, bring foot from PF into DF maintaining pressure, Pos. = more pain in DF than PF

Question 16

Special tests for tarsal tunnel

Answer 16

• Triple compression stress test: full inversion and PF while placing pressure on posterior tibial nerve for 30s

Question 17

Clinical features of Achilles tendonitis

Answer 17

• Achilles area pain
• recent increase in exercise dose/training
• feeling of calf stiffness following prolonged immobility
• limited ankle dorsiflexion ROM

Question 18

Clinical features of an ankle ligament sprain

Answer 18

• history of a sprain with swelling & tenderness
• difficulty weight bearing due to pain or edema
• pain with inversion stress (usually worse w/INV and PF)
• recurring episodes of ankle sprains
• feeling of instability in weight bearing
• proprioceptive deficits

Question 19

Clinical features of plantar fasciitis

Answer 19

• plantar medial heel pain (most noticeable w/first few steps after immobility)
• limited ankle dorsiflexion
• excessive pronation at loading response, mid stance, or terminal stance

Question 20

Clinical features of anterolateral impingement

Answer 20

• anterolateral ankle joint tenderness or swelling
• pain with forced dorsiflexion with eversion
• pain with single leg squat
• pain with activities (in end range DF)
• ankle instability