Foot and Ankle Special Tests
Foot and Ankle Special Tests
- Anterior Drawer Test (Ankle)
- Babinski’s Test
- Deltoid Ligamentous Stress Test (Passive Relaxed)
- Functional Leg Length
- Functional or Structural Pes Planus Test
- Homan’s Sign
- Morton’s Neuroma
- Posterior Drawer Test ( Ankle)
- Ramirez’s Test
- Thompson’s Test (Achilles Tendon rupture)
- Tinel’s Sign (Ankle)
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