Ankle & Foot Exam

Although this exam isn’t an FCM benchmark, foot and ankle concerns are common in primary care and emergency departments.  As with any musculoskeletal exam remember the approach of inspection, palpation, range of motion, strength testing and special maneuvers.

Key landmarks & structures

Inspection

Inspect the foot and ankle, observing carefully for swelling, erythma or ecchymosis. Also note:

• Alignment
• Muscle bulk
• Arch structure
• Appearance of first MTP joint

Palpation

Palpate the above structures systematically, noting any tenderness or swelling.

Range of motion

Tibiotalar Joint:

• Plantarflexion: 0 to -10 degrees
• Dorsiflexion: 30 to 40 degrees

Subtalar Joint

• Inversion: 30 degrees
• Eversion: 20 degrees

First MTP joint

• Flexion: 45 degrees
• Extension: 70 degrees

Strength testing

With the patient seated test:

• Plantar flexion of ankle
• Dorsiflexion of ankle
• Inversion of ankle
• Eversion of ankle

Stability and special tests

Thompson squeeze test

– Tests for the integrity of the Achilles tendon
– Pictures and drawing show two different versions of test
– The foot should rest in slight plantarflexion
– Compare to contralateral side
– Squeeze the gastroc muscles and foot should plantarflex
– Lack of plantarflexion with squeeze suggests Achilles tear

Anterior drawer test

Tests for stability of the ATFL
– One hand placed on tibia, held for stability.
– Opposite hand grips heel and distracts distally
– Note should be made of laxity and presence of clear end point

Lunge test

– Stresses tibiotalar joint and support structures
– Foot/heel kept on the floor
– Knee pushed forward to create dorsiflexion of the ankle
– Note should be made of pain and restricted motion