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23 - Examination of the ankle

from Section 5 - Orthopaedic surgery

Published online by Cambridge University Press:  05 July 2015

James Pegrum
Affiliation:
Queen Mary University of London Sports & Exercise Department
Chris Lavy
Affiliation:
University of Oxford
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
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Summary

Checklist

WIPER

• Patient standing in shorts or underwear; ankles and feet exposed with shoes and socks removed.

• Access is required to the spine, hip and knees to carry out a full biomechanical assessment.

Physiological parameters

Gait

• Antalgic gait

• Walking aids or orthotics

• Observation of footwear

Look

Skin: scars, erythema, corns and callosities, skin or toe nail changes

Soft tissues: swelling, proximal disuse muscle atrophy

Bone:

• foot: deformity, asymmetry, pes cavus, pes planus, equinus ankle, everted foot

• heel: calcaneal valgus/varus

• toes: toes number and alignment, overriding toes, hammer toes, hallux valgus, bunions

Feel

Skin: temperature, tenderness, sensation

Soft tissues:

• anterior: extensor tendons, pulses, capillary refill time

• sides: lateral and medial tendons and ligaments; sinus tarsi

• posterior: Achilles tendon

• plantar aspect: plantar fascia

Bone:

• bone and joint contours: proximal fibular head and neck; talus and calcaneum

• Ottawa ankle rules for suspected ankle fractures

Move

Active:

• plantarflexion/dorsiflexion

• eversion/inversion

Passive:

• plantarflexion/dorsiflexion

• eversion/inversion

Resisted:

• ankle plantarflexion/ankle dorsiflexion

• big toe flexion/big toe dorsiflexion

• inversion/eversion

Special tests (* = essential tests)

• Coleman block test*

• Anterior drawer test*

• Talar tilt – medial and lateral tilt of talus while holding the heel (test medial and lateral ligaments)*

• Neuroma squeeze test (for Morton's neuroma)*

• Tinel's sign

• Simmonds – Thompson test

To complete the examination

• Examine the joint above (knee) and the joint below (mid and forefoot).

• Check full neurovascular status of the lower limb.

• Order appropriate radiographs and further imaging.

Examination notes

What changes are inspected in the skin?

The quality of the skin around the foot and the presence and site of any ulcers will point the examiner towards underlying neuropathic, venous or arterial pathology.

  1. • Scars from previous ankle open reduction and internal fixation will be sited over their respective malleoli.

  2. • Anterior ankle approaches are used in trauma surgery, ankle replacement or fusion operations.

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
, pp. 190 - 202
Publisher: Cambridge University Press
Print publication year: 2015

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