Foot and Ankle
Evaluation
History
A
thorough history MUST be taken
Mechanism
Pain
Sounds/
Changes
Past
Sensations
Observation
 Deformity
 Discoloration
 Sounds
 Gait
Heel
Strike
Midstance
Heel
Toe
off
off
 Shoe
Wear
 Arches
Pes
Planus – flat
arch
Shin splints
Pes Cavus – high
arch
Metatarsal fx
Turf toe
Arches
•
Structural Deformities
•
•
Pes Planus = flat
footed/ no arch
Pes Cavus = high arch
The Gait Cycle
Heel Strike – shock absorption
Toe-off – propel forward
Palpation
Used to confirm or deny
assessments.
Start away from the injury and move
toward the site of pain (about 2-3
inches when appropriate)
Palpate Bilaterally (both sides)
Start w/ light pressure then move to
deeper palpation
Notice
Point Tenderness
Trigger Points
Crepitus
Density
Symmetry/
Deformity
Temperature
Palpation
Special Tests
1st Special Tests
– Fracture
Tests
Bump
____________
Lever
____________
____________
Compression
Range
of
– ________
___
motion
____________
Active
____________
Resistive
Passive
____________
or ____________
•
•
•
•
•
Sprain
• Strain
• tear of a ligament
• tear/ pull of a muscle
“-itis”
(Overuse 0r Overstretch)
• irritation of
• Tendonitis – irritation of a tendon (joins
muscle to bone)
• Bursitis – irritation of a bursae (fluid filled sac
under tendons)
Fracture
– break of a bone (complete or incomplete
Dislocation
• Joint pops out and stays out
Subluxation
• joint pops out and goes back in
Types of Injuries
•
Stretching or slight tear
– Mild pain
–
Little to no disability/ loss of function
Grade 2
–
Moderate tear
Moderate pain and disability
Trouble weight bearing (PWB)
Swelling and Bruising may occur
Grade 3
Severe/Total tear of the ligament
– Often causes ankle to subluxate
–
Disabling
Cannot weight-bear (NWB) – put weight/ pressure on it.
Grading
Injuries
Grade 1
Sprains
1.
Anterior Talo-fibular Ligament
a. Closely followed by Calcaneofibular
2.
Anterior Tibio-fibular ligament
- “high” ankle sprain or syndesmotic sprain
3.
Deltoid
Anterior Talo-fibular
sprain
Caused by Inversion
*Most common
first sprain
*2nd lig to go is
Calcaneofibular
- Pain on lateral
side under fibula
Positioning
Specific Special
Tests
Anterior Drawer
–Have the athlete sit with their leg off the table .
–Grasp calcaneus w/ one hand
–Let foot lie on your forearm
–Other hand on tibia
Test
–Dorsiflex foot slightly
–Pull Calcaneus forward while push tibia
backward
http://www.youtube.com/watch?v=kbqzRWhirOI
Anterior Drawer cont
• Positive
– Foot
slides forward (laxity)
– Makes
– Pain
Test
a clunking sound/ sensation
Caused by
Eversion
Deltoid
sprain
Caused by Dorsiflexion
and Eversion
• Tibio-fibular sprain
(syndesmotic/ high)
Tilt
Athlete
sit or lie on table with the
feet hanging over the edge
Hold the heel and stabilize the lower
leg
Invert the foot (Deltoid) OR Evert
the foot (Tibfibs)
Positive Test = pain and/or laxity
Specific Special
Tests
Talar
https://www.youtube.com/watch?v=1IrI6Bks6hY
RICE – Rest Ice Compression Elevation
METH – Mobility Elevation Traction
Heat
Inversion Ankle Sprains
 Light
Compression with Horseshoe
 Massage
 Begin ROM exercises
Syndesmotic Sprain
Takes MUCH longer to heal
– Rest/ Immobilize for at least 6-10 days
before beginning ROM exercises
–
Management of
Ankle Injuries
Swelling Management
Achilles Injuries
Tendonitis – irritation of the tendon
Initially
slight pain
Only hurts after practice/ activity
As it progresses pain lasts longer and gets
irritated with even regular walking
Hurts to dorsiflex (stretch/ lengthen the
tendon)
Painful to the touch
Achilles Tendon Rupture
(complete tear)
– *Common
w/ athletes 30+
– Cannot “see” the tendon
– Gastroc/ Soleus recoil (ball
up) towards knee
– Athlete cannot plantarflex
the foot/ push off
– Positioning
Athlete prone with leg off the table
Both hands on the calf
– Test
Squeeze calf at proximal 1/3
of lower leg
– Positive
Foot does not plantarflex
TRY
IT!!
http://www.youtube.com/
watch?v=HPkaNdG2uus
Special Test –
Achilles Rupture
Thompson Test
Tendinitis sites
Foot Injuries
Bunion
– Caused
shoes
by poorly fitting
Hammertoe
– Flexion
toes
contracture of
Turf Toe
– Hyperextension
Management of Ingrown Toe Nail
In-Grown Toe Nail
Soak in hot water for 10-15 minutes
Lift edge of nail and put small piece
of cotton under to elevate the nail
Apply antiseptic and cover with a
sterile dressing
Or cut a “v” into middle of nail
(grows and pulls toward center)
If pus present, refer to MD for
antibiotics
Other Conditions/ Injuries
Shin splints
– Catch-all
term for anterior pain
Stress fractures, muscle strains and chronic
compartment syndrome
Medial Tibial Stress Syndrome
– Due
to repetitive microtrauma
– Weak muscles
- Poor shoes
– Overtraining
-Running surface
– Malalignment
Grades of MTSS
Grade 1
– pain
after activity
Grade 2
– pain during and after activity
– No performance affects
Grade 3
– Before during and after
– Affects performance
Grade 4
– Activity
impossible/ too painful