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Patients Name

DOB
MRN
Date of Visit
Ankle Pain H & P
HPI KEY: Y = Yes(positive) N = No(negative) NE= Not Examined




History elements to ask:
- Mechanism of injury
- Acute traumatic, overuse, or spontaneous
onset
- Pop or tear with injury
- Location of pain
- Swelling (Y/N)
- Ability to ambulate immediately after injury
- Ability to ambulate at time of evaluation
- Provoking/alleviating factors
PMH/PSH
Prior ankle/foot injury or surgery
Other orthopedic history (surgeries, arthritis, trauma, injuries etc)

Physical exam
Inspection
Limping gait Y N NE
Weight bearing Y N NE
Swelling Y N NE
Ecchymosis Y N NE
Atrophy Y N NE
ROM
Plantarflexion Full Limited
Dorsiflexion Full Limited
Strength
Dorsiflexion Full Weak Painful
Plantarflexion Full Weak Painful
Inversion Full Weak Painful
Eversion Full Weak Painful
Special Tests
Effusion Y N NE
Special testing
Thompsons squeeze Y N NE
Anterior Drawer Y N NE
Talar Tilt Y N NE
Proprioception Y N NE
Tinels test (medial ankle) Y N NE
Squeeze test Y N NE
Passive external rotation test Y N NE
Lunge test (anterior impingement) Y N NE
Palpation
Achilles tendon Y N NE
Medial Malleolus Y N NE
Lateral Malleolus Y N NE
Peroneal tendons Y N NE
Base of the 5
th
metatarsal Y N NE
ATFL Y N NE
PTFL Y N NE
CFL Y N NE
Deltoid ligament Y N NE
Talus Y N NE
Navicular Y N NE
Cuboid Y N NE
Tibiofibular syndesmosis Y N NE
Neurovasc Exam
Sensation Y N NE
Pulses (DP & PT) Y N NE
OTTOWA ANKLE RULES - Consider X RAY if any one ore more
of the following:
- Inability to weight bear 4 steps immediately Y N
- Inability to weight bear 4 steps at evaluation Y N
- Tender on posterior half of medial malleolus Y N
- Tender on posterior half of lateral malleolus Y N
- Tender on posterior half of distal tibia or fibula Y N
- Tender at the base of the 5
th
metatarsal Y N
- Tender on cuboid Y N
EXCLUDE CHILDREN, PREGNANT WOMEN, THOSE NOT
CAPABLE OF PERFORMING EXAM FOR 2
o
REASONS

Asssessment (circle suspected diagnosis - all that apply)
Ankle sprain (grade I-III_____)
-- ATFL injury
-- Deltoid ligament
injury
-- CFL injury
-- PTFL injury
--Syndesmotic injury
(high ankle sprain)
Ankle fracture
Osteoarthritis
Medial malleolar fx
Lateral malleolar fx
Maisonneuve fracture
Ankle impingement syndrome
Peroneal tendinopathy
Tibialis posterior tendinopathy
Tibialis anterior tendinopathy
Flexor hallicus longus
tendinopathy
Tarsal tunnel syndrome
Sinus tarsi syndrome
Complex regional pain
syndrome
Achilles tendon rupture
Achilles tendinopathy
Retrocalcaneal bursitis
Haglunds deformity
Stress Fracture:
______________________
Other:
______________________

Plan:
1) Treatment (Circle all employed)
RICE (Rest, Ice, Compression, Elevation)
Exercises: (specify)_____________________________________
Crutches/reduced weight bearing
Ankle brace/Immobilizer
Aspiration/Injection
Casting
2) Medications
NSAIDs Y N Specify:________________________ Other:______________________________
3) Imaging
X-rays Y N MRI Y N If yes, specify test ordered:_____________________
4) Referral Sports Med Y N Orthopedics Y N Physical Therapy Y N
5) Follow up: ______ wks


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Palpation, continued
@ Ashwin Rao and J onathan Drezner, 2007

Ankle exam- Anatomy and Demonstration

























Images obtained via Google Images; Captions adapted from Brukner & Khan, Clinical Sports Medicine, revised ed. 2
Figure 1- Bones of the foot and ankle Figure 2- Ligaments of the Ankle

Figures 5: Ottowa Ankle rules, demonstrating zones for palpating the foot and ankle to assess for
potential bony disturbance/fracture.
Figure 3- Demonstration of the anterior drawer and talar tilt tests to assess for stablility of ankle
ligaments. The anterior drawer test (left), in which the ankle is grasped in the neutral position
and translocated forward, assesses for ATFL injury. The talar tilt test tests the Calcaneofibular
ligaments integrity. Both exams are assessed by comparing the injured and uninjured ankles.
Figure 4- Thompsons squeeze test to assess for Achilles tendon
rupture. Squeezing the leg at the level of the gastrocnemius
should cause the foot to plantarflex. Lack of foot motion suggests
an Achilles tendon rupture
Grading Ankle sprains
Grade I sprain: Strain, no ligamentous laxity, when comparing ankles

Grade II sprain: Partial tear, some degree of laxity, however with a stable endpoint, when
compared to uninjured ankle

Grade III sprain: Complete tear, gross laxity, when compared to the uninjured ankle, with no
discernable endpoint

Anterior drawer test Talar tilt test
Abbreviation Key
ATFL: Anterior Talofibular ligament

PTFL: Posterior Talofibular ligament

CFL: Calcaneofibular ligament
Figure 6: Squeeze test. This test, designed to evaluate for high
ankle sprains, is performed when squeezing the tibia and fibula
together at the proximal leg causes pain at the ankle tibiofibular
joint. A positive test suggests syndesmotic injury.