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