Physical Exam Ankle

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

Illustration of ankle 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

• Ankle
  • Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis Posterior, Fibularis Longus
  • Dorsiflexion: Tibialis Anterior, Extensor Hallucis Longus, Extensor Digitorum Longus
  • Eversion: Fibularis Longus, Fibularis Brevis
  • Inversion: Tibialis Posterior
• Great Toe
  • Extension: Extensor Hallucis Brevis, Extensor Hallucis Longus
  • Flexion: Flexor Hallucis Longus, Abductor Hallucis, Flexor Hallucis Brevis
  • Abduction: Abductor Hallucis
  • Adduction: Adductor Hallucis
• Toes 2-4
  • Extension: Extensor Digitorum Brevis, Extensor Digitorum Longus, Lumbricals
  • Flexion: Flexor Digitorum Longus, Flexor Digitorum Brevis, Abductor Digiti Minimi, Quadratus Plantae, Lumbricals, Flexor Digiti Minimi Brevis
  • Abduction: Abductor Digiti Minimi, Dorsal Interossei
  • Adduction: Plantar Interossei

---

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:
  • Popliteal Artery
  • Dorsalis Pedis Artery
  • Posterior Tibial Artery
  • Capillary refill on toes

---

Special Tests

• General
  • Ottawa Ankle Rules
• Peroneal Tendon Injuries
  • Peroneal Tunnel Compression Test
• Achilles Tendon Rupture
  • Thompson Test
  • Matles Test
  • Hyper Dorsiflexion Sign
  • Copelands Test
  • Obriens Needle Test
  • Achilles Palpation Test
• Posterior Tibial Tendon Dysfunction
  • Too Many Toes Sign
  • Single Limb Heel Rise
• Lateral Ankle Sprain
  • Squeeze Test
  • Anterior Drawer Test Ankle
  • Talar Tilt Test
  • Anterolateral Drawer Test Ankle
• Medial Ankle Sprain
  • External Rotation Stress Test
  • Abduction Stress Test
  • Eversion Test
  • Anterior Drawer Test Ankle
• Syndesmotic Injury
  • Squeeze Test
  • External Rotation Stress Test
  • Cotton Test
  • Fibular Translation Test
  • Crossed Leg Test
  • Stabilization Test
  • Forced Dorsiflexion Test
  • Syndesmotic Palpation Test
• Peroneal Nerve Injury
  • Tinels Test
• Tarsal Tunnel Syndrome
  • Tinels Test
  • Dorsiflexion Eversion Test
  • Triple Compression Stress Test
• Hindfoot Deformity
  • Coleman Block Test
  • Dynamic Coleman Block Test
• Calf Strain
  • Silfverskiold Test
• Upper Motor Neuron Disease
  • Oppenheims Test
  • Babinskis Response
• Plantar Fasciitis
  • Windlass Test
• Anterior Ankle Impingement Syndrome
  • Ankle Impingement Sign
• Foot Pronation
  • Navicular Drop Test
• Posterior Ankle Impingement Syndrome
  • Plantar Flexion Test

---

See Also

• Internal
  • Physical Exam (Main)
  • Ankle Pain (Main)
  • Foot Pain (Main)
  • Foot And Ankle Anatomy (Main)
• External
  • Sports Medicine Review Ankle Pain: https://www.sportsmedreview.com/by-joint/ankle/
  • Sports Medicine Review Foot Pain: https://www.sportsmedreview.com/by-joint/foot/

---