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Physical Exam Ankle

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Other Names

  • Physical exam ankle
  • Physical exam foot

Introduction

  • Physical exam should be performed with shoes and socks removed
  • Ideally, there is a weight bearing component and a seated component

Introduction

  • Follows the IP-PASS examination methodology
    • Inspection
    • Palpation
    • Passive Range of Motion
    • Active Range of Motion
    • Strength & Neurovascular
    • Special Tests

Inspection

  • Skin
    • Color: erythema, ecchymosis, white, black
    • Trophic changes (altered hair growth, sweat production)
    • Scars
    • Pressure sores, calluses, blisters
    • Bunions, hammer toes, claw toes, calluses
  • Toenails
  • Swelling or Joint effusion
  • Muscle tone: atrophy, hypertrophy
  • Deformity: asymmetry, rotation, amputation
  • Areas of emphasis for foot and ankle exam exam
    • Look at patients shoes (wear pattern, arch support, etc)
    • Gait examination and evaluation (consider normal, walking on insides and outsides of feet, heel and toe-walk, tandem, running)
    • Arch (Pes Cavus or Pes Planus)
    • Ankle alignment (posteriorly)
    • Knee alignment

Palpation

  • Palpate for
    • Effusion
    • Clicking
    • Snapping
    • Crepitus
    • Tenderness
    • Temperature
    • Masses
  • Ankle Areas of Emphasis
    • Posterior aspect of medial and lateral malleolus
    • Lateral Ankle Ligaments: ATFL, CFL, PTFL
    • Medial Ankle Ligaments: Deltoid Ligament
    • Achilles Tendon and insertion
  • Foot Areas of Emphasis
    • Navicular
    • Lisfranc Joint
    • Base of 5th metatarsal

Range of Motion

  • Ankle
    • Dorsiflexion: 20-30°
    • Plantarflexion: 40-50°
    • Pronation: 30°
    • Supination: 60°
  • Foot
    • Inversion: 35°
    • Eversion: 25°
  • Metatarsophalangeal joints
    • Flexion: 30°
    • Extension: 80°
  • Interphalangeal joints of toes
    • Flexion: 50°
    • Extension: 50°

Strength


Neurovascular

  • Sensory Nerves
    • L4: Lateral thigh, anterior knee, medial leg
    • L5: Lateral leg, dorsal foot
    • S1: Posterior Leg
    • S2: Plantar foot
  • Dermatome
    • Needs to be updated
  • Reflexes
    • Patellar (L3, L4)
    • Achilles (S1, S2)
  • Myotomes:
    • L4: Knee Extension, Dorsiflexion
    • L5: Hip Abduction, Hip Extension, Toe Dorsiflexion, Foot Inversion, Dorsiflexion
    • S1 Foot Version, Plantarflexion
    • S2: Toe Plantar Flexion
  • Vascular:

Special Tests


See Also


References

Created by:
John Kiel on 22 August 2021 06:40:14
Authors:
Last edited:
7 March 2024 15:17:34
Categories: