1. Ankle and Foot
Examination

2. Inspection
• Observe the individual walking and standing.
• Assess the gait.
• Foot drop may be noticed as a steppage gait.
• Assess alignment of the heel (valgus/varus).
• Assess the arch of the foot:
• Pes cavus (exaggerated arch)
• Pes planus (flat foot)

3. • Examine for:
• Swelling/deformity:
• Bunion (lateral deviation of the 1st
metatarsophalangeal joint)
• Swelling of the 1st metatarsophalangeal joint may
indicate gout.
• Redness/swelling of the nail bed(s) may indicate
ingrown toenail.
• Ecchymosis
• Scars
• Callous
• Wounds/ulcers (especially in the diabetic foot)
Inspection

4. Palpation and percussion
• Palpatory techniques of the following structures is
performed, looking for tenderness, temperature,
and swelling:
• Proximal fibula (fibular head fracture)
• Lateral malleolus (and surrounding ligaments)
• Medial malleolus and (surrounding ligaments)
• Tarsal bones
• Base of the 5th metatarsal (5th metatarsal fractures
common)

5. • 1st metatarsophalangeal joint (gout, bunyon,
arthritis, capsulitis)
• Anterior calcaneus (tender at this point → plantar
fasciitis)
• Posterior calcaneus/Achilles tendon (tender at this
point → Achilles tendinitis)
• Compress the distal tibiofibular joint for
syndesmotic injury (indicates high ankle sprain)
• Palpate the distal lower-extremity pulses at the:
• Dorsalis pedis artery
• Posterior tibial artery
Palpation and percussion

6. Motor strength
• Dorsiflexion:
• L4 nerve root
• Assess strength in dorsiflexion against examiner’s
resistance (weakness leads to foot drop).
• Normal range: 20–30 degrees
• Plantar flexion:
• L5 and S1 nerve roots
• Assess strength in plantar flexion against
examiner’s resistance.
• Normal range: 40–50 degrees

7. • Inversion:
• Resisted inversion: tests the integrity of the
posterior tibial tendons
• Normal range: 0–60 degrees
• Eversion:
• Resisted eversion: tests the integrity of the fibular
tendons
• Normal range: 0–30 degrees
• Achilles reflex: tests the reflex arc involving the L5
and S1 segments of the spinal cord
Motor strength

8. Special tests
• Calf-squeeze test (Thompson test):
• Assesses for rupture of the Achilles tendon
• May be carried out with the individual sitting on
the edge of the examining table or lying prone with
feet hanging over the edge
• The calf (gastrocnemius–soleus complex) muscle is
squeezed by the examiner.
• Observe for plantar flexion of the ipsilateral foot.
• If complete rupture → the foot will remain neutral
or dorsiflexed.
• If partial rupture → incomplete plantar flexion.

9. Thompson test

10. Special tests
• Anterior drawer test:
• Assesses the stability of the anterior talofibular
ligament (ATFL)
• One of the examiner’s hands stabilizes the lower
leg and the other applies an anterior force at the
heel.
• Excessive laxity indicates ATFL rupture.

11. Anterior drawer test

12. Special tests
• Windlass test:
• Examiner passively dorsiflexes the toes.
• Heel pain with passive dorsiflexion of the toes
indicates presence of plantar fasciitis.
• Talar tilt test:
• Tests the integrity of the ATFL
• Performed by applying a gentle passive inversion
motion at the ankle
• A lack of a hard stop (laxity) suggests a tear to the
ATFL.

13. Windlass test

14. Tamara tilt test

15. Vascular exam of the ankle
• The dorsalis pedis pulse can be palpated at the
mid-dorsal foot.
• The posterior tibial pulse can be palpated posterior
to the medial malleolus.

16. Thank you