Podcast
Questions and Answers
When palpating the lateral ankle for tenderness, what is the recommended starting point?
When palpating the lateral ankle for tenderness, what is the recommended starting point?
- The peroneus tendons
- The calcaneofibular ligament (CFL) footprint
- Up the lateral malleolus
- The tip of the fibula or lateral malleolus (correct)
When checking for any increase in local temperature of the feet and ankles, palpation should start at tender regions.
When checking for any increase in local temperature of the feet and ankles, palpation should start at tender regions.
False (B)
During the ankle examination, what specific structure is assessed using the anterior drawer test?
During the ankle examination, what specific structure is assessed using the anterior drawer test?
ATFL
A positive Silfverskiold test, indicated by increased ankle dorsiflexion when the knee is flexed, suggests tightness in the ______ muscle.
A positive Silfverskiold test, indicated by increased ankle dorsiflexion when the knee is flexed, suggests tightness in the ______ muscle.
What is the normal range of motion (in degrees) expected during active ankle plantarflexion?
What is the normal range of motion (in degrees) expected during active ankle plantarflexion?
Match the area of the foot with what you are palpating for tenderness.
Match the area of the foot with what you are palpating for tenderness.
If a patient demonstrates normal active range of motion in the ankle, which of the following should be assessed passively?
If a patient demonstrates normal active range of motion in the ankle, which of the following should be assessed passively?
When performing the anterior drawer test, the ankle should be positioned in 30 degrees of dorsiflexion.
When performing the anterior drawer test, the ankle should be positioned in 30 degrees of dorsiflexion.
During the initial 'look' assessment of a lower limb, what specific observation helps identify potential alignment issues?
During the initial 'look' assessment of a lower limb, what specific observation helps identify potential alignment issues?
During gait assessment, observing a patient for normal toe-off, swing, heel strike, and stance phases is essential. It is unnecessary to note any abnormal lateral or medial loading of the foot, or varus thrust of the ankle joint.
During gait assessment, observing a patient for normal toe-off, swing, heel strike, and stance phases is essential. It is unnecessary to note any abnormal lateral or medial loading of the foot, or varus thrust of the ankle joint.
In the second 'look' assessment, aligning the lower limbs with the patellae facing forward enables focused examination of the foot and ankle. Name three specific anterior observations to be made in this position.
In the second 'look' assessment, aligning the lower limbs with the patellae facing forward enables focused examination of the foot and ankle. Name three specific anterior observations to be made in this position.
The 'too many toes' sign, observed from a posterior view, indicates forefoot ______.
The 'too many toes' sign, observed from a posterior view, indicates forefoot ______.
What is the expected normal response during a double heel raise test?
What is the expected normal response during a double heel raise test?
A single heel raise test is performed to assess for general ankle instability, rather than a specific tendon deficiency.
A single heel raise test is performed to assess for general ankle instability, rather than a specific tendon deficiency.
Match the following deformities with their descriptions:
Match the following deformities with their descriptions:
Upon inspection, a patient's lower limbs exhibit bilateral genu valgum. What specific observation would confirm this condition?
Upon inspection, a patient's lower limbs exhibit bilateral genu valgum. What specific observation would confirm this condition?
Flashcards
Palpation techniques
Palpation techniques
Methods to feel for tenderness in ankle regions.
ATFL footprint
ATFL footprint
Location where the anterior talofibular ligament attaches near the ankle.
CFL footprint
CFL footprint
Area indicating where the calcaneofibular ligament is located.
Silfverskiold test
Silfverskiold test
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Active range of motion
Active range of motion
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Passive range of motion
Passive range of motion
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Anterior drawer test
Anterior drawer test
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Dorsiflexion in ankle
Dorsiflexion in ankle
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Professionalism in Examination
Professionalism in Examination
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Patient Positioning
Patient Positioning
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Gait Assessment
Gait Assessment
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Lower Limb Inspection
Lower Limb Inspection
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Foot Deformities
Foot Deformities
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Double Heel Raise Test
Double Heel Raise Test
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Single Heel Raise Test
Single Heel Raise Test
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Hindfoot Assessment
Hindfoot Assessment
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Study Notes
Foot & Ankle Examination (UMMC Video)
- Professionalism:
- Wash hands and introduce yourself
- Obtain patient consent
- Expose the patient's lower limb, including the sound limb for comparison
- If unable to stand, place patient in a recumbent or seated position.
Look (General)
- Inspection (Lower Limb):
- Assess lower limb alignment (genu valgus/varum, varus, external rotation)
- Inspect skin for changes (bruising, redness, dryness, ulcers, scars, swelling, muscle wasting)
- Examine the anterior and lateral aspects of the limb. (Posterior aspect inspection also recommended, but not demonstrated in the video)
Gait
- Gait Assessment:
- Observe gait for normal phases (toe off, swing, heel strike, stance)
- Look for abnormal loading patterns (lateral/medial) or ankle thrust.
- Note examples of abnormal gaits (antalgic, short limb, high stepping)
Look (Second Time - Foot & Ankle)
-
Standing Position:
- Patient should stand with their lower limbs aligned and patella facing forward before evaluating foot and ankle.
-
Anterior View:
- Look for medial longitudinal arch deformities, hallux valgus, lesser toe deformities, ankle deformities, peek-a-boo heel sign
-
Posterior View:
- Evaluate for hindfoot varus or valgus deformities, too many toes sign (forefoot abduction).
-
Foot Deformities:
- Examples: Pes planovalgus, clawing of toes, hindfoot valgus, overriding toes
-
Heel Raises:
- Perform double heel raise to assess medial longitudinal arch and hindfoot varus, during this test the patient stands up on their toes.
- Perform single heel raise test to assess posterior tibialis tendon (if suspected deficiency).
- Note hindfoot varus and medial longitudinal arch reconstitution.
Feel
- Local Temperature:
- Examine the plantar surfaces of the feet for any increased local temperature.
- Palpation (Ankle/Foot):
- Begin palpation at non-tender areas.
- Evaluate for tenderness in the following areas: lateral ankle, anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), peroneal tendons, medial ankle, deltoid ligament, medial joint line, talocrural joint, posterior ankle (Achilles tendon and retrocalcaneal bursa), midfoot (talonavicular joint, tarsometatarsal joints), plantar area (metatarsal heads, plantar fascia, heel fat pad).
Move
- Active Range of Motion:
- Evaluate dorsiflexion (up to 20 degrees) and plantarflexion (up to 45 degrees).
- Assess supination and pronation of the foot.
- Passive Range of Motion: -Assess subtalar joint motion if needed.
Further Tests
- Silverskiold Test: Used to assess gastrocnemius tightness.
- Anterior Drawer Test: Used to assess lateral ankle instability (ATFL and CFL laxity).
- Thompson Test: Assesses integrity of the Achilles tendon.
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Description
This lesson covers the key steps in a foot and ankle examination, including assessing lower limb alignment, skin condition, and gait. It emphasizes the importance of observing normal gait phases and identifying abnormal loading patterns. Proper patient positioning and exposure techniques are also highlighted.
