Lower Extremity H&P: Foot/Ankle Exam Overview

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WEEK 1 ORTHO CURRICULUM
 
Lower Extremity H&P:
Foot/Ankle Exam
 
General Ortho Physical Exam Maneuvers
 
Inspection
Palpation
Range of Motion
Muscle Strength
Special Tests
Always think about the
joint above and below
where the pain is and
examine that joint
 
 
INSPECTION
 
Look for redness, swelling, warmth -> think septic
arthritis
Evaluate for effusion
Look for gross deformity
 
PALPATION
 
Medial and lateral malleoli
Palpate along the fibula to assess for tenderness, possible
fibular fracture
Anterior and posterior talofibular ligaments, deltoid
ligament, calcaneofibular ligament
Talar neck
Calcaneus
Mid-foot
5
th
 metatarsal
Consider Jones fracture – concern for avascular necrosis
Palpate the mid-foot, assessing for Lisfranc fracture
 
RANGE OF MOTION
 
Plantar flexion: 50 degrees
Dorsiflexion: 20 degrees
Foot inversion: 35 degrees
Foot eversion: 25 degrees
 
STRENGTH TESTING
 
Resisted plantar and dorsiflexion
Resisted inversion and eversion
 
SPECIAL TESTS
 
Anterior drawer
Assesses the anterior talofibular ligament
Have the patient sit with the knee flexed over the edge of
the table
Stabilize the distal lower extremity with one hand and
apply an anterior force to the heel with the other hand,
attempting to subluxate the talus anteriorly
Talar tilt
Evaluates for talar instability
With the patient seated and with the ankle and foot
unsupported in approx 15 degrees of plantar flexion,
stabilize the medial aspect of the distal lower extremity
and apply an inversion force to the hindfoot with the other
hand
Thompson test
Evaluates for Achilles tendon rupture
With the patient prone, flex the knee to 90 degrees and
squeeze the calf
The foot should plantar flex – if it does not, suspect
tendon injury
 
Anterior drawer
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The lower extremity H&P for foot/ankle examination in orthopedic curriculum involves various steps such as general ortho physical exam maneuvers, inspection for redness and deformities, palpation of specific areas for tenderness and fractures, range of motion assessment, muscle strength testing, and special tests like anterior drawer and Thompson test. It is crucial to consider the joints above and below the painful area. Images provided aid in visualizing the examination techniques and findings.


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  1. Lower Extremity H&P: Foot/Ankle Exam WEEK 1 ORTHO CURRICULUM

  2. General Ortho Physical Exam Maneuvers Inspection Palpation Range of Motion Muscle Strength Special Tests Always think about the joint above and below where the pain is and examine that joint

  3. INSPECTION Look for redness, swelling, warmth -> think septic arthritis Evaluate for effusion Look for gross deformity

  4. PALPATION Medial and lateral malleoli Palpate along the fibula to assess for tenderness, possible fibular fracture Anterior and posterior talofibular ligaments, deltoid ligament, calcaneofibular ligament Talar neck Calcaneus Mid-foot 5thmetatarsal Consider Jones fracture concern for avascular necrosis Palpate the mid-foot, assessing for Lisfranc fracture

  5. RANGE OF MOTION Plantar flexion: 50 degrees Dorsiflexion: 20 degrees Foot inversion: 35 degrees Foot eversion: 25 degrees

  6. STRENGTH TESTING Resisted plantar and dorsiflexion Resisted inversion and eversion

  7. SPECIAL TESTS Anterior drawer Assesses the anterior talofibular ligament Have the patient sit with the knee flexed over the edge of the table Stabilize the distal lower extremity with one hand and apply an anterior force to the heel with the other hand, attempting to subluxate the talus anteriorly Talar tilt Evaluates for talar instability With the patient seated and with the ankle and foot unsupported in approx 15 degrees of plantar flexion, stabilize the medial aspect of the distal lower extremity and apply an inversion force to the hindfoot with the other hand Thompson test Evaluates for Achilles tendon rupture With the patient prone, flex the knee to 90 degrees and squeeze the calf The foot should plantar flex if it does not, suspect tendon injury Anterior drawer

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