ANKLE CLINICAL EXAMINATION

Examination considerations

PHYT8001
OVERVIEW & LEARNING AIMS

• Develop knowledge of specific assessment

considerations for the ankle/foot
• Review of a case study to provide
framework of assessment structure
SUBJECTIVE ASSESSMENT
Body chart associated symptoms
• Giving way
• Clicks/clunks/catches
• Neurological symptoms
Behaviour
• Activity limitation (eg UTWB>walk>stairs>run>hop)
• Participation limitation (eg sport, work)
History
• Change in shoes/training/activities
• MOI critical if applicable
• Previous trauma
OBJECTIVE EXAMINATION
Observation
• Footwear wear pattern
• Orthotics
• Lower leg rotational profile
• Hallux valgus
• Medial arch
• flat (planus), high arched (cavus)
Gait
• Foot drop
• Reduced ROM/stiff ankle
• Antalgic

Davies, & Blundell. (2011). (vii) Clinical examination of the foot and
ankle. Orthopaedics and Trauma, 25(4), 287-292.
QUESTION
How would you describe the
difference between these two
feet?

Davies, & Blundell. (2011). (vii) Clinical examination of the foot and
ankle. Orthopaedics and Trauma, 25(4), 287-292.
OBJECTIVE EXAMINATION

• Foot posture is important!

• can be predictive/causative of foot and ankle problems
• some of these conditions covered shortly
• Foot posture is challenging to quantify
• One measure is the Foot Posture Index (FPI)
Foot Posture Index (FPI)
• Provide a measure of foot position
• Developed from literature review of
140 papers
• High clinical utility
• Measure 6 items
• Pronated/neutral/supinated
• Standing/static only
Foot Posture Index (FPI)
• Stand in neutral position
• Observe and palpate landmarks:
– Talar head position
– Supra and infra malleolar curvature
– Calcaneal position
– Talonavicular joint prominence
– Congruence of medial longitudinal arch
– Forefoot abd/adduction relative to
rearfoot
• Assign a value to each of these
• Further detail in prac
Chronic ankle instability case study

O'Driscoll, J., Kerin, F., & Delahunt, E. (2011). Effect of a 6-week dynamic neuromuscular training programme on ankle joint
function: a case report. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology, 3(1), 13.
Chronic ankle instability case study

Clinical scenario
• 19 year old athlete injured in line out playing rugby
union
• Undergraduate Physiotherapy student
• MOI was forced inversion from landing awkwardly
• Unable to continue game, went to ED
• Xray NAD
• D/C home with crutches WBAT
Chronic ankle instability case study

Clinical scenario
• Followed up with Physiotherapy
• Instability noted on anterior drawer
• Underwent a course of manual therapy (mainly passive
mobilisation) and simple static postural exercises (eg SLS
eyes open/closed)
• After 6 weeks, able to FWB, full ROM
• However ongoing functional limitation
• unable to perform at same level
• feeling of “giving way” and “weakness”
• repeated inversion injury resulting in inability to WB
Chronic ankle instability case study

Clinical scenario
• Further imaging (MRI):
• Near full ATFL tear
• Increased fluid in peroneal sheath
• Ceased sporting activity, mainly due to academic commitments
• Occasional RTS impaired by ongoing ankle pain/weakness
• Decided to undergo a “dynamic neuromuscular” rehabilitation
program
CAI case study – Subjective outcome
measures
Cumberland Ankle Instability Tool
(CAIT)
• Score < 25 indicates instability
• Result was 4 (score of 30 uninvolved side)
CAI case study – Objective outcome
measures
Y Balance Test
• Both impaired static and dynamic postural
stability associated with CAI*
• Test measures dynamic postural stability
• Measures for 3 directions taken both baseline
and post intervention
• Can also be used to compare involved vs
uninvolved sides (>4cm clinically concerning)
• Shortened version of the Star Excursion Balance
Test
(https://www.youtube.com/watch?time_contin
ue=36&v=4GMzE7NV3W0)

*Arnold BL, Ankle instability is associated with balance impairments: a meta-analysis. Med Sci Sports Exerc. 2009
Conclusion

• Subjective features
• Objective considerations:
• Foot Posture Index
• Lower limb outcome measures