1. Ankle and Foot Assessment
Chapter 20 – page 401

2. Anatomy of the foot/ankle
Bones of the ankle joint
_________________
_________________ *
Bones of the foot
_________________ (14)
_________________ (5)
_________________ (3)

3. Anatomy of the foot/ankle
Muscles
Anterior-
Lateral – What action? ______________
Tibialis anterior-What action? __________
Extensor digitorum- What action? _________
Peroneus longus
Peroneus brevis – Insertion =_________
Peroneus tertius

4. Anatomy of the foot/ankle
Muscles (cont.)
Posterior- What action? ______________
Deep Posterior-What action? __________
Gastrocnemius
Soleus
Plantaris
Flexor Hallicus Longus
Flexor Digitorum
Tibialis Posterior

5. Anatomy of the foot/ankle
Arteries
Nerves
Tibial (ant.)
Tibial (post. or deep)
Peroneal (sup.)
Peroneal (deep)
Dorsal pedis
Tibial = _______
Peroneal = _________

6. Anatomy of the foot/ankle
Ligaments
Deltoid (med.)
Anterior talofibular (lat) – Abbrev: ______
Posterior talofibular (lat) – Abbrev: _____
Calcaneofibular (lat)- Abbrev: _________
Anterior Tibiofibular (ant)
Posterior Tibiofibular (post)
Spring Ligament (med) –Purpose: _____

7. Anatomy of the foot/ankle
Joints
Distal Tibiofibular
Talofibular
Calcaneofibular
Talotibial
Tarsal joints
Metatarsal-tarsal
Metatarsal phalangeal
PIP = __________
DIP = __________

8. Anatomy of the foot/ankle
Arches-How many are there?
What would
you name them?

9. History Acute vs. Chronic-What question? Mechanism-What question?
Tear or fracture-What question?
Location of injury-What question?
History-What question?
Age?
Activity?

10. Observation Shoes Gait Foot position Callus Bunions Blisters Hot Spots
Limp
Arch
What might each show/indicate?

11. Palpation Bony Tendons Medial Malleolus Lateral Malleolus
Base of the 5th metatarsal
Tendons
Tibialis anterior
Peroneus longus and brevis
Achilles

12. Palpation Ligaments Anterior talofibular (ATF) Calcaneofibular (CF)
Posterior talofibular (PTF)
Spring
Deltoid
Anterior tibiofibular ligament
Posterior tibiofibular ligament

13. Palpation
Plantar fascia
Retrocalcaneal bursa
Dorsal pedal pulse

14. Special Tests Range of motion Remember! Dorsiflexion Plantar flexion
Inversion
Eversion
Remember!
Passive
Active
Resistive

15. Special Tests Test for the ATF: Anterior Drawer test _______________
Test for the PTF: Posterior Drawer test

16. Special Tests Test for the CF and deltoid ligaments: Talar tilt test
_______________

17. Special Tests Tests for the tibiofibular ligaments:
Side-to-side test, and squeeze test
Ankle mortise
_______________
Test for syndesmosis injury: Kleiger test

18. Special Tests Test for Achilles Tendon Rupture: Thompson test
_______________
Test for heel fracture: Tap/Percussion test

19. Ankle/Foot injuries Fractures Dislocations Contusions Sprains Strains
Compartment syndrome
Overuse/inflammations
Tendinitis
Hematoma/Neuroma
Abnormal arches/deformities

20. Fractures Tibia Fibula-a _________ bearing bone Dome of talus-
Mechanism: _______________
Evaluate: Tib palpation, ___________
Care: Non-weight bearing, don’t move if displaced
Fibula-a _________ bearing bone
Dome of talus-
Mech: inversion-dome hits _____________ or
____________
Metatarsals and phalanges

21. Jones Fracture
Peroneus ________ pulls away from base of 5th breaking off part of bone=___________
Mechanism of injury- What do you think?
___________________________
Signs and symptoms:
Swelling and tenderness over base of 5th
Pain and weakness in eversion-Why? ______
Pain with walking-DUH!

22. Dislocations 1st Cuneiform (Lisfranc Fx) Talus-which part?_________
Fibular head

23. Sprains Affect Ligaments ONLY 1st degree (grade 1): __________________
2nd degree (grade 2):
3rd degree (grade 3):

24. Inversion Sprain Over 80% of sprains are from inversion
Ligaments damaged (in order of occurence): ________ and __________ and ________
Often accompanied by one or more of these:
Talar dome fx,
Subluxation of peroneal tendon,
Jones Fracture
Peroneal strain

25. Eversion Sprain Relatively uncommon Damage to deltoid ligament
Sometimes tender over lateral malleolus and lateral surface of calcaneus-Why?

26. Strains Affects muscles and tendons ONLY Grading similar to sprains
Mechanisms: overstretch or
quick explosive contraction against significant resistance
Most common:
Peroneal group
Gastrocnemius/Soleus
Achilles tendon,
Flexor Hallicus aka ___________________
Extensor digitorum

27. Tendinitis Inflammation of tendon Mechanism: Overuse
Burning after warmup
Tx: decrease inflammation, stretch, rest, support with taping or orthoses
Look for it in:
Achilles tendon,
Tibialis Ant. tendon,
Peroneal tendon, T
ibialis Post. tendon

28. Rupture of Gastroc. Or Achilles
Forced lengthening and contraction
-what joints/positions?
Feels like ____________
____________________
“Hey! Who threw something at me?”

29. Contusions
Common places: heel, tibia, gastrocnemius, tibialis anterior
Range: mild bruise to serious injury
Can lead to compartment syndrome: bleeding into compartment that compresses nerves and arteries
Can be prevented in some cases with I & E of RICE

30. Hematoma Blood clot/pooling Under toenail = “Subungual hematoma”
Danger of infection

31. Abnormal Arches Pes Cavus (High Arches)
Absorbs shock poorly
Often calluses on heel and ball of foot-Why?
Pes Planus (Flat feet/low arches)
From unsupportive shoes, ligament laxity, or overweight

32. Bunions aka “Hallux Valgus” Gradual because of poor footwear
Often irritation on medial surface of 1st met head
Tailor’s Bunion: varus 5th digit

33. Bursitis Inflammation of bursa Most commonly retro-calcaneal bursa
Swelling and pain

34. Morton’s Neuroma Compressed nerve between 3rd and 4th metatarsal heads
Causes pain, numbness and tingling

35. Ingrown toenail
Recommendation: cut toenails straight across and not too short!
Tx: Soak, prevent infection, lift toenail

36. Plantar Fasciitis Mechanisms Key symptom: first-step pain
Acute: step on something,
like a rock
Chronic: walking without
arch support
Key symptom:
first-step pain
Pain on medial
plantar calcaneus
and in arch