(a) Active movement—plantarflexion/dorsiflexion

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Lower Extremity H&P: Foot/Ankle Exam

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The Foot, Ankle, and Lower Leg

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Presentation transcript:

(a) Active movement—plantarflexion/dorsiflexion (a) Active movement—plantarflexion/dorsiflexion. Assessment of dorsiflexion is important as restriction results in a functional deficit. Range of motion can be compared with the uninjured side. Tight calf muscles may restrict dorsiflexion. This can be eliminated by placing the knee in 70–90° flexion (b) Passive movement—inversion/eversion. Inversion is frequently painful and restricted in lateral ligament injury, while eversion is painful following injuries to the medial ligament. Increased pain on combined plantar flexion and inversion suggests ATFL injury (c) Resisted eversion—this can be difficult in the acute setting. In cases of persistent pain, weakness of the evertors (peroneal muscles) should be assessed (d) Functional test—lunge test. Assess ankle dorsiflexion compared with the uninjured side. Note any pain. Other functional tests may be performed to reproduce the patient’s pain if appropriate (e.g. single-leg standing, hopping) (e) Palpation—lateral ligament (f) Ligament testing—anterior drawer test. The ankle is placed in slight plantarflexion and grasped as shown. Pressure is exerted upwards and the degree of excursion (anterior drawer) is noted and compared with the uninjured side. This test assesses the integrity of the ATFL and CFL. Pain on testing should also be noted; if painful it may indeed mask injury to the ligament. Then the test should be repeated after five days. The optimal time to test the integrity of the lateral ligaments is on the fifth post-injury day (g) Ligament testing—talar tilt. This tests integrity of the anterior talofibular and calcaneofibular ligaments laterally and the deltoid ligament medially. The ankle is grasped as shown and the medial and lateral movement of the talus and calcaneus are assessed in relation to the tibia and fibula. Pain on this test must also be noted (h) Special test—proprioception. Single-leg standing with eyes closed may demonstrate impaired proprioception compared with the uninjured side Source: Acute ankle injuries, Brukner & Khan’s Clinical Sports Medicine: Injuries, Volume 1, 5e Citation: Brukner P, Clarsen B, Cook J, Cools A, Crossley K, Hutchinson M, McCrory P, Bahr R, Khan K. Brukner & Khan’s Clinical Sports Medicine: Injuries, Volume 1, 5e; 2017 Available at: https://csm.mhmedical.com/DownloadImage.aspx?image=/data/books/1970/bru61384_4103_new.png&sec=168696158&BookID=1970&ChapterSecID=168696118&imagename= Accessed: January 03, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved