Foot and Ankle Special Tests

Foot and Ankle Special Tests

 

Ankle Orthopedic Testing & Foot Orthopedic Testing

Foot and Ankle Special Tests / Orthopedic Test:

Anterior Drawer Test (Ankle)

Testing for:

Anterior Talofibular Ligament injury and/ or ligamentous instability

Procedure:

•Patient is supine with foot relaxed

•Examiner stabilizes tibia and fibula with one hand

•With the Patient’s foot plantar flexed to 20 degrees, the Examiner holds the patient’s calcaneus with other hand then distracts the calcaneus from the tibia and fibula ( by slowly pulling the calcanues inferiorly)

•Therapist places an anteriorly directed pressure on the calcaneus and talus, applying overpressure at the end of the passive range ( stressing the Anterior Talofibular ligament)

Positive Sign:

Ligamentous laxity or rupture with Presence of sulcus and pain, and/ or Excessive anterior translation of the talus, sometimes accompanied by audible thunking

 

Foot and Ankle Special Tests / Orthopedic Test:

Babinski’s Test

Testing for:

•Spasticity present with Central Nervous System Lesions:

Procedure:

• Patient is supine

• Therapist runs a pointed object along the plantar aspect of the patient’s foot

Positive Sign:

Positive for CNS lesion = Extension of the big toe and abduction of the other toes. ( Babinski Tests positive for infants up to a few weeks old and is negative after 5– 7 months.)

Foot and Ankle Special Tests / Orthopedic Test:

 Deltoid Ligamentous Stress Test (Passive Relaxed)

Purpose:

To assess the deltoid ligament using 3 separate passive movements:

Procedure:

• Patient is seated with their leg flexed at the knee and hanging over a table

• Therapist stabilizes the anterior surface of the tibia and fibula proximal to the ankle ( with one hand)

• Assess Anterior Fibers of the Deltoid Ligament:

Therapist uses their other hand to graps the dorsal surface of the foot, combining eversion and plantarflexion of the foot and applying overpressure.

• Assess Middle Fibers of the Deltoid Ligament:

Therapist repositions their hand so the calcaneus is grasped ( still stabilizing the anterior surface of the tibia and fibula proximal to the ankle with their other hand). Hindfoot is taken into eversion with overpressure

• Assess Posterior Fibers of the Deltoid Ligament:

Therapist repositions their hand so the calcaneus is grasped ( still stabilizing the anterior surface of the tibia and fibula proximal to the ankle with their other hand). Therapist combines eversion and dorsiflexion of the foot with overpressure

Note: to perform a general assessment of the deltoid ligament, evert the hindfoot only

Positive Sign:

•Pain and Hypermobility local to the ligament

•Muscle spasm end feel may be present with a subacute injury

Foot and Ankle Special Tests / Orthopedic Test:

 Functional Leg Length

Testing for:

•Functional Leg length difference resulting from hip, knee or ankle and foot problems

Procedure:

•Patient stands in normal relaxed stance

•Examiner palpates ASIS and PSIS and notes any differences

•Examiner then positions the patient so that subtalar joints are neutral, toes pointed forward and the knees are straight

•Examiner re-evaluates ASIS and PSIS

Positive Sign:

•Difference in leg length disappear

 

Foot and Ankle Special Tests / Orthopedic Test:

 Functional or Structural Pes Planus Test

Purpose:

•To determine whether a pes planus is functional or structural

Procedure:

•Therapist observes ( and compares) the orientation of the client’s medial longitudinal arch while doing each of the following:

a. Patient stands straight with both heels and toes on the ground

b. Patient stands with just the toes on the ground

c. Patient sits on the table

Positive Sign:

• Functional Pes Planus = if medial longitudinal arch is restored when the client is either standing on the toes or seated = due to muscle or ligament weakness

•Structural Pes Planus = if medial longitudinal arch remains flat when the client is standing on toes and when seated.

Foot and Ankle Special Tests / Orthopedic Test:

 Homan’s Sign

Testing for:

•Deep Vein Thrompophlebitis / Deep Vein Thrombosis

Procedure:

*patient supine with the knee extended

*patient’s foot is passively dorsi flexed

Positive Sign:

•pain deep in the calf during dorsi flexion

also:

•tenderness elicited on palpation of the calf

•pallor and swelling in leg,

•loss of dorsalis pedis pulse

* massage is contraindicated with a positive test; refer patient

 

Foot and Ankle Special Tests / Orthopedic Test:

 Morton’s Neuroma

Testing for:

The presence of Morton’s Neuroma

Morton’s Neuroma (is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces (between 2nd-3rd and 3rd-4th metatarsal heads). This problem is characterised by pain and/or numbness, sometimes relieved by removing footwear.

Procedure:

• Patient is seated

• Compress the foot by applying pressure to the medial and lateral aspects of the foot at the metatarsophalangel joints

Positive Sign:

Sharp pain at the location of the neuroma. Pain is worsend by activity.

Foot and Ankle Special Tests / Orthopedic Test:

 Posterior Drawer Test ( Ankle)

Testing for:

•Posterior Talofibular ligament injury and/or ligamentous instability

Procedure:

•Patient is supine with foot relaxed

•Examiner stabilizes tibia and fibula with one hand

•With the Patient’s foot plantar flexed to 20 degrees, the Examiner holds the patient’s calcaneus with other hand then distracts the calcaneus from the tibia and fibula ( by slowly pulling the calcanues inferiorly)

•Therapist places an posteriorly directed pressure on the calcaneus and talus, applying overpressure at the end of the passive range

 

Positive Sign:

Ligamentous laxity or rupture with Presence of sulcus and pain, and/ or

Excessive posterior translation of the talus.

Foot and Ankle Special Tests / Orthopedic Test:

 Ramirez’s Test

Testing for:

• Deep Vein Thrombosis

Procedure:

• Patient is supine, affected Knee in flexion ( foot flat on the table)

• Wrap a blood pressure cuff around the thigh and inflate it to 40mm Hg

• Maintain the pressure for at least 2 minutes

Positive Sign:

•Increase in pain as the cuff is inflated and inability to tolerate cuff inflation and sustained pressure for 2 minutes

* massage is contraindicated with a positive test; refer patient

Foot and Ankle Special Tests / Orthopedic Test:

 Thompson’s Test (Achilles Tendon rupture)

Testing For:

•3rd degree strain or rupture of the Achilles tendon

Procedure:

•Patient is prone , feet over the edge of the table, legs relaxed

•Squeeze the affected gastrocnemius and soleus muscles

Positive Sign:

•Absence of plantarflexion when the muscles are squeezed

Foot and Ankle Special Tests / Orthopedic Test:

 Tinel’s Sign ( Ankle)

Testing for:

•Anterior or Posterior Tibial Nerve entrapment or dysfunction

Procedure:

•Anterior tibial branch of deep peroneal nerve is tapped in front of the ankle

•The Posterior tibial nerve tapped as it passes behind the medial malleolus

Positive Sign:

•Tingling or Paresthesia felt distally