TIS

Chapter 4
Evaluation of the Ankle and Foot


  1. Subjective Portion:

    1. Is there a position, movement, or activity which either relieved or intensified the symptoms?
    2. Are you awakened at night with pain?
    3. What are the symptoms like when you first arise versus during the day with activity?
    4. Do symotoms increase with activity?
    5. Have x-rays been taken? Were they weightbearing or non-weightbearing?
    6. Have you had any recent injuries related or non-related to the present symptoms?
    7. History of medications: How do you rate your GENERAL HEALTH? Significant recent weight loss?
    8. If child, has there been a growth spurt recently?
    9. Family History:

      Rheumatoid Arthritis
      Diabetes Mellitus
      LE weaknness
      Flat Feet
      High Arches
      Special Shoes
      Sprained Ankles
      Orthotic Devices
      Osteoarthritis
      Neurological Problems
      Circulatory Problems
      (Frequent or unhealed ulcers, cold feet,
      burning feet, sweaty feet, nail problems)

    IF EVALUATING OVERUSE INJURY (RUNNER/JOGGER or ATHLETE)

    1. Type of workout: distance, interval, etc.
    2. Terrain (e.g., hill, level, track)
    3. Surface (e.g., paved road, sidewalk, packed sand)
    4. Time of day you workout?
    5. Shoe style (e.g., tennis, flats, training, high-tops)
    6. Socks vs. No Socks?
    7. Workouts per week? Miles/week, miles/workout?
    8. How long have you been running?
    9. Participation in Races: 5K, 10K, marathon?
    10. Warm-up Time, warm-down time, is stretching included?
    11. How do you classify your foot structure?
    12. Have orthotics been used, currently using, type (rigid vs flexible) for what purpose, DO THEY HELP?
    13. When was the last time you bought a new pair of workout shoes?
    14. What brand of shoe(s) do you buy most often?

    REMEMBER: IF OVERUSE TYPE INJURY MUST DETERMINE IF MECHANICAL OR NON-MECHANICAL IN ORIGIN!!

  2. OBJECTIVE EXAMINATION

    1. Observation
      1. Patients overall appearance
      2. Posture
      3. Willingness to move
      4. Foot Deformities
        1. hallux valgus
        2. claw toe
        3. hammer toe
        4. pes planus or cavus
      5. Gait Analysis

    2. Screening
      1. Lumbar spine
      2. Sacroiliac joint
      3. Hip Joint
      4. Knee Joint

    3. Functional Tests

      1. Active & Resistive Motions of the Ankle
        1. Dorsiflexion
        2. Plantarflexion
        3. Inversion
        4. Eversion

      2. Passive motion
        1. Dorsiflexion - Knee Extended and Flexed
        2. Plantarflexion
        3. Inversion
        4. Eversion
        5. Midtarsal joint - Oblique Axis
        6. Midtarsal joint - Longitudinal Axis
        7. First MTP

      3. Mobility testing

        1. Talocrural Joint
          1. Distraction
          2. Posterior
          3. Anterior

        2. Subtalar
          1. Distraction (Calcaneal Rock)
          2. Medial - Lateral Glides

        3. Intertarsal


        4. Intermetatarsal

          1. Sweeping
          2. Dorsal - Plantar Glides

        5. HTP, PIP, DIP
          1. Anterior
          2. Plantar
          3. Distraction

    4. Palpation

        Bony - Med. & Lat. Malleoli, Head of Talus, Navicular Tuberosity, First Metatarsocuneiform Joint, First MTP joint. Sustentaculum Tali, Base of Fifth Metatarsal, Plantar aspect of ALL Metatarsal Heads.
        Callus - Observe pattern
        Arterial - dorsalis pedis, psoterior tibiai

    5. Neurological Exam

      1. Myotomes
      2. Reflexes
      3. Sensory

    6. Special Tests - Acute Injury
      1. Anterior Drawer Test
      2. Inversion Stress Test
      3. Eversion Stress Test
      4. Side-to-Side Test
      5. Thompson's Test - Continuity test for tendo achilles
      6. Compression Test (stress fracture/reaction)

    7. Special Tests - Overuse Injury
      1. First Ray and First MTP ROM
      2. Malleolar Torsion
      3. Hip Joint ROM - Knee Flexed
      4. Talocrural Joint ROM
        • Subtalar Joint Placed in Neutral
        • Test with Knee Extended (gastrocnemius)
        • Test with Knee Flexed (soleus)
      5. RCSP (in dynamic angle and base of walking)
        1. Angle and base template made for future measurements
        2. Visual observation of calcaneal, talar, & foot positions
        3. Determine if patient can compensate for deformity and if pronated by palpating talar head
        4. Measurement of navicular height from the floor
        5. Measurement of tibiofibular varum
      6. NCSP (in same position as RCSP)
        1. while positioned on the angle and base template, patient placed in subtalar neutral bilaterally.
        2. Visual observation of calcaneal, talar, & foot positions
        3. Note whether calcanei are inverted or everted
        4. Measurement of navicular height from the floor

    8. Assessment and Treatment Planning

        Assessment Goal 1: To determine from the evaluation findings if the clients complaint is related to a MECHANICAL or NON-MECHANICAL PROBLEM.
        Assessment Goal 2: If client's problem is MECHANICAL, then are the client's symptoms or tissue stresses related to:
          1. pronatory or excessive mobility foot type
          2. supinatory or limited motion foot type
          3. Lack of shock attenuation
          4. Excessive tibial internal rotation

    9. Treatment Plan - A PRIMARY GOAL OF TREATMENT in clients with lower extremity overuse injuries is to reduce tissue stress to a tolerable level.

      Based on the outcome of Assessment Goal 2, the following treatment scheme can be used.


    PAIN REFERRAL PATTERN IN THE ANKLE AND FOOT


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