Biomechanics of Ankle joint- intended to share the powerpoint with first year undergraduate students at Kathmandu University School of Medical Sciences, Nepal.

1. Ankle and Foot
Assessment
Saurab Sharma, MPT
Lecturer

2. Contents
 History
 Observation
 Palpation
 Examination
•ROM
•Muscle strength
•Girth
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3. Background
TALOCRURAL JOINT:
 Is meant for stability rather than mobility
 Closed pack position: Maximum dorsiflexion
 Capsular pattern: Plantar flexion >
dorsiflexion
 Resting Position: 10° plantar flexion
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4. History
 What is patient’s usual activity or pass
time?
 Gives idea about the stress placed on the
lower limb
 Occupation?
 Previous injury?
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5. History contd…
 Any history of systemic condition like DM,
Gout, Psoriasis etc
 What type of the shoes the patient wears?
•high heels
•Flat shoes
•Any special shoes
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6. History contd…
 Walking surface?
•Graveled road
•Grass surface
•Sandy surface
 Any activity that alters pain?
•Aggravating factors
•Relieving factors
 Pain after activity: over use
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7. History contd…
 Pain during activity: Stress on the injured
structure
 Site of pain?
 Any specific boundary of pain? or If the pain
is in dermatomal pattern or in the course of
a peripheral nerve
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8. History contd…
 Symptoms? e.g. pain:
•Improving?
•Worsening?
•Same?
 At injury time, did the patient notice any
deformity or abnormal position of the foot?
 Was there any locking of the joint?
•Presence of loose body in the joint
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9. History contd…
 After injury was patient able to walk? Or
continue his/her work/activity? Or did the
patient limp?
 Any swelling at the time of injury? or
bruising or any ecchymosis?
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10. History contd…
 Was the swelling immediate? 
haemarthrosis
 Delayed swelling?  synovitis
 Site of swelling?
•localized extracapsular
•Generalised Intracapsular swelling
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11. For sports person/Runner/ Jogger?
 How long he/she’s been jogging?
 Surface of jogging?
 Distance, time and speed of jogging or
running?
 Any warm up or stretching before and after
the jogging?
 What type of shoes worn during the activity?
•Does it fit? Cushioning?
•How old are the shoes?
•Use of socks? Type of socks, how many?
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12. OBSERVATION
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13. Observation
 Exposure – at least upto knee
 Built
 Posture
 Gait: Initial contact
 Weight bearing: equal on both sides?
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14. Observation contd…
 Compare weight bearing and non weight
bearing position of the foot in:
•Anterior view
•Lateral view
•Posterior view
 See for the contour of the foot
•Soft tissue swelling
•Bony callosities (spur) over prominence of the
bone
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15. Observation- Deformities
 Fore-foot varus:
•Mid tarsal joint inversion
•Subtalar joint Neutral
 Fore-foot Valgus:
•Fore foot eversion
•Subtalar joint Neutral
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16. Observation- Deformities …..
 Talipes Equinus:
•Plantar flexed foot
•Contracture of tendoachilis
•Structural and bony
deformity
•Can cause plantar fascitis,
calcaneal spur,
metatarsalgia etc
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17. Observation- Deformities …..
 Claw toes:
•MTP jointHyper extended
•IP joint  Flexed
 Hammer toes:
•MTP jointHyper extended
•PIP joint  Flexed
•DIP joint  Hyper extended
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18. Observation- Deformities …..
 Hallux Rigidus:
•Stiffness of great toe at MTP joint
•Dorsi flexion or extension of great toe
•May be due OA of 1st MTP joint
•Feature: Pain and stiffness of great toe
 Hallux Valgus:
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19. Observation- Deformities …..
Flat foot/Pes planus: Pes cavus:
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20. Observation- Deformities …..
 Splay foot:
•Spread out foot (Spreading
of the metatarsals)
 Rocker bottom foot:
•Forefoot is in dorsi flexion
on the hind foot
•Arch may be absent
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21. Standing And Weight Bearing:
Anteriosuperior View
 Weight bearing?
•Equal on both the feet and forefoot/hindfoot?

 Position of the foot?
•Supination/ pronation
 How does the patient stand or walk?
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22. Standing And Weight Bearing:
Anteriosuperior View
 Ask patient to walk on the toes and heels.
•Gives idea about the muscle power or functional
ROM
 Does the patient use the cane or the stick?
•Use of cane on the opposite side can decrease
the load on the ankle by 1/3rd of the body
weight)
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23. Standing And Weight Bearing:
Anteriosuperior View
 Check the toes.
•If the are parallel/ straight or not
•See the movements of the toes
 Gait:
•Check for phases of gait
•Any pathological gait?
 Check for the spurs or the exostoses.
 Check for the deformities of the foot.
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24. Standing And Weight Bearing:
Anteriosuperior View
 Check the fore foot:
•Index plus type: meta tarsal 1>2>3>4>5
•Index plus minus type: Meta tarsal 1=2>3>4>5
•Index minus type: 1<2>3>4>5
 Check for swelling?
•Is it within the ankle (intra capsular)
•Localized (extra capsular)
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25. Standing And Weight Bearing:
Anteriosuperior View
 Check for the tibia, knees, thigh
 Hip and trunk
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26. Standing And Weight Bearing:
Lateral View
 Observe longitudinal arches of the foot with
one foot forward and the other little
backward.
•Medial Longitudinal Arch should be a higher than
the lateral longitudinal arch
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27. Standing And Weight Bearing:
Posterior View
• Bulk of calf: compare on both the sides
• Achilles tendon: vertical on both sides?
• Observe Calcaneum for:
• Shape
• Position
• Any callosities
 Position of the malleolus
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28. FOOT PRINT PATTERN:
 Light film of baby oil on patient’s foot and
apply a powder
 Ask the patient to step on a piece of
coloured paper.
 Observe for the pattern of foot print
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29. PALPATION
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30. Bony structures (medially)
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31. Bony structures (medially)
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32. Bony structures (medially)
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33. Bony structures (medially)
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34. Bony structures (medially)
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35. Bony structures (medially)
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36. Bony structures (medially)
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37. Bony structures (medially)
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38. Bony structures (Laterally)
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39. Bony structures (Laterally)
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40. Bony structures (Laterally)
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41. Bony structures (Laterally)
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42. Bony structures (Anteriorly)
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43. Bony structures (Anteriorly)
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44. Bony structures (Anteriorly)
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45. Palpate plantar surface
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46. Palpate plantar surface
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47. Palpate plantar surface
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48. Soft Tissue Palpation: Zone 1
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49. Soft Tissue Palpation: Zone 1
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50. Palpation
 Swelling:
• Extracapsular vs intraarticular swelling:
• Edema is pitting type or the non-pitting type
 Palpate for different bones
•Kohler’s disease  Osteochondritis of the
navicular bone
•Palpate for any Exostosis
•Morton’s neuroma  In between 3rd and 4th
metatarsal bones
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51. Palpate medial side:
 Apex of malleolus for any tenderness Deltoid
ligament sprain
 Move distally from the medial malleolus to
palpate for the parts of deltoid ligament
 Long toe flexors behind the medial malleolus
 Posterior tibial artery pulse behind the medial
malleolus ( it supplies 75% of the foot)
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52. Palpate anteriorly:
 Extensor tendons from medial to lateral
 Anterior tibial artery: in between tendons
of EHL and EDL
 Deep peroneal nerve:
 Extensor retinaculum for any tear
 Dorsalis pedis pulse
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53. Palpate Laterally:
 Peroneal muscle tendons
•If peroneal retinaculum is torn then peroneal
tendons slip out of their groove
 Lateral ligament
•ATFL
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