Foot and Ankle Special Tests – Flashcards

Purpose: assess structural and functional alignment of talus Procedure: pt. stands with feet in a relaxed position, Examiner palpates head of talus on dorsal aspect of test foot with the thumb and forefinger of one hand as pt. slowly rotates to the R and L until the talar head is equally non-prominent + Result: position indicates neutral position of the talus

Purpose: assess structural and functional alignment of talus Procedure: pt. lies supine with feet over the end of the table. Examiner grasps foot over the 4th and 5th metatarsals using the thumb and index fingers of one hand. Palpate both sides of the talus on the dorsum of the foot with thumb and forefinger of the other hand. Move foot through arc of supination and pronation until talus is equally non-prominent, then gently DF the ankle until resistance is felt. + Result: position indicates neutral position of the talus

Purpose: assess structural and functional alignment of talus Procedure: pt. lies prone with feet over the end of the table. Examiner grasps foot over the 4th and 5th metatarsals using the thumb and index fingers of one hand. Palpate both sides of the talus on the dorsum of the foot with thumb and forefinger of the other hand. Move foot through arc of supination and pronation until talus is equally non-prominent, then gently DF the ankle until resistance is felt. + Result: position indicates neutral position of the talus

Purpose: assess alignment of hindfoot in relation to the leg Procedure: pt. lies prone with feet over the end of the table. Examiner places a mark over the midline of the calcaneus at intersection of Achilles tendon and over midline of lower leg. Place subtalar joint in prone neutral position. + Result: calcaneal and tibial lines should be parallel or in slight Varus (2-8 degrees). Valgus = heel inverted; Varus = heel everted.

Purpose: assess tibial torsion Procedure: pt. sits with knees flexed over end of the table. Examiner places one thumb over apex of one malleolus and index finger over the other. Visualize the axes of the knee and ankle. + Result: normal is 12 - 18 degrees of lateral torsion

Purpose: assess tibial torsion Procedure: pt. lies prone with the knee flexed to 90 degrees. Examiner views the angle formed by the foot and thigh from above after subtalar joint has been placed in neutral. + Result: ankle should be in 12 - 18 degrees of lateral rotation

Purpose: tests integrity of the anterior talofibular ligament (ATFL) Procedure: pt. lies supine with the foot relaxed while examiner stabilizes the tibia and fibula. Examiner holds foot in 20 degrees PF and draws the talus forward in the ankle mortise to test ATFL. Add inversion to test calcenofibular ligament. + Result: abnormal anterior translation of talus; may dimple over ATFL

Purpose: tests integrity of calcaneofibular ligament Procedure: pt. lies supine or side-lying with foot relaxed. Examiner holds foot in neutral while talus is tilted from side to side into adduction (calcaneofibular) and abduction (abduction). + Result: hypermobility in direction of adduction (indicating calcaneofibular injury) or abduction (indicating deltoid ligament injury)

Purpose: tests for high ankle sprain (syndesmosis) Procedure: pt. lies supine while examiner grasps lower leg at midcalf and squeezes the tibia and fibula together. Then apply same load at more distal locations toward the ankle. + Result: pain indicates syndesmosis injury, as long as fracture, contusion and compartment syndrome are ruled out.

Purpose: tests for high ankle sprain (syndesmosis) Procedure: pt. seated with leg hanging over the examining table. Examiner stabilizes leg with one hand while the other holds the foot in plantigrade. Apply passive lateral rotation stress to the foot and ankle. + Result: 1) pain produced over anterior or posterior tibiofibular ligaments and interosseous membrane, indicating syndesmosis 2) pain medially with talar displacement from medial malleolus, indicating deltoid tear.

Purpose: tests for injury to Achilles tendon Procedure: pt. lies prone while examiner squeezes the calves + Result: absence of PF, indicating rupture of the Achilles Tendon

Purpose: tests for flatfoot Procedure: Examiner marks apex of medial malleolus and plantar aspect of 1st MTP while pt is NWB. Palpate navicular tuberosity on medial aspect of foot, noting where it lies relative to the line joining other two marks. Pt. then stands with feet 8 - 15 cm apart and examiner palpates the navicular again. + Result: navicular tubercle drops in weight bearing; 1st degree = 1/3 distance to floor; 2nd degree 2/3 distance to floor; 3rd degree rests on floor.

Purpose: tests for flatfoot Procedure: Examiner finds neutral talar position in standing, then asks pt to relax. Observe change in position of navicular tubercle. + Result: navicular drops > 1 cm

Purpose: tests for nerve injury Procedure: Percuss nerves at various locations around the ankle. Deep peroneal: front of ankle. Posterior tibial: behind medial malleolus. + Result: distal tingling or paresthesia

Purpose: tests for neuroma Procedure: pt. lies supine while examiner grasps foot around the metatarsal heads and squeezes them together. + Result: pain indicates stress fracture or neuroma

Purpose: tests for DVT Procedure: pt. foot is passively DF with the knee extended + Result: pain in calf, indicating DVT; may also find calf tenderness, redness, swelling in leg and loss of dorsal pedis pulse