{"id":11388,"date":"2022-08-11T10:30:22","date_gmt":"2022-08-11T08:30:22","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=physiotherapy&#038;p=11388"},"modified":"2025-01-30T11:07:21","modified_gmt":"2025-01-30T10:07:21","slug":"ankle-foot","status":"publish","type":"physiotherapy","link":"https:\/\/www.physiotutors.com\/physiotherapy\/ankle-foot\/","title":{"rendered":"Ankle\/Foot Assessment"},"featured_media":11117,"template":"","class_list":["post-11388","physiotherapy","type-physiotherapy","status-publish","has-post-thumbnail","hentry"],"acf":{"sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":11117,"background_image_alt_text":"Ankle\/Foot Assessment"},"heading":"Ankle\/Foot Assessment","subheading":"The Ankle & Foot Joints","content_editor":"","button_type":"url","button_label":"","button_style":"button-two","button_internal_link":"","button_anchor":"","button_url":"https:\/\/study.physiotutors.com\/course\/orthopedic-physical-assessment\/","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Learn","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Extremity Online Course","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Reviews","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":22104,"button_anchor":"","button_url":"","button_file":""},"button_description":""},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h4>Learn<\/h4>"},"column_right":{"content_editor":"<h3><strong>Introduction &amp; Epidemiology<img class=\"wp-image-11609 alignright\" src=\"https:\/\/physiotutors.com\/wp-content\/uploads\/study\/2018\/09\/8-768x766.jpg\" alt=\"\" width=\"437\" height=\"436\" \/><\/strong><\/h3>\r\nFirst and foremost let's talk a little bit about anatomy. The ankle joint consists of two different joints:\r\n<ol>\r\n \t<li>The\u00a0<strong>talocrural joint, <\/strong>which\u00a0is a hinge joint\u00a0allowing the two primary movements in the sagittal plane: <strong>plantar flexion<\/strong> and <strong>dorsiflexion<\/strong><\/li>\r\n \t<li>The <strong>subtalar joint<\/strong> is considered a hinge joint as well but its rotational axis runs obliquely. The possible movements at this joint are: <strong>inversion<\/strong> (a combination of plantar flexion, adduction and supination) and <strong>eversion<\/strong> (a combination of dorsiflexion, abduction and pronation).<\/li>\r\n<\/ol>\r\nNote: In the US nomenclature inversion is referred to as supination and eversion as pronation.\r\n\r\nThe one-year prevalence for ankle- and foot injuries seen in general practice is estimated at 9.2% and 9.4% respectively (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12620608\" target=\"_blank\" rel=\"noopener noreferrer\">Picavet et al. 2003<\/a>).\r\n\r\nThese can be traumatic and atraumatic in nature.\r\nCommon conditions for both categories are:\r\n\r\nTraumatic:\r\n<ul>\r\n \t<li>Ankle sprain with or without syndesmosis lesion<\/li>\r\n \t<li>Ankle fracture<\/li>\r\n \t<li>Achilles tendon rupture<\/li>\r\n<\/ul>\r\nAtraumatic:\r\n<ul>\r\n \t<li>Tendinopathies\/ Plantar fasciitis<\/li>\r\n \t<li>Hallux valgus\/rigidus<\/li>\r\n \t<li>Osteoarthritis of the ankle<\/li>\r\n<\/ul>\r\n<h3><\/h3>\r\n&nbsp;\r\n<h3><strong>Course<\/strong><\/h3>\r\nNot much can be said about the general course of ankle and foot pain and detailed prognostics are discussed in the individual chapters. Furthermore, it\u2019s unclear which specific prognostic factors influence the course of ankle and foot injuries.\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n<h3><strong>\u00a0Prognostic factors (<\/strong><strong><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28096253\" target=\"_blank\" rel=\"noopener noreferrer\">Artus et al. 2017<\/a><\/strong><strong>)<\/strong><\/h3>\r\nThe following factors are related, but not limited to, the course of ankle and foot pain:\r\n<ul>\r\n \t<li>widespread pain<\/li>\r\n \t<li>high functional disability<\/li>\r\n \t<li>somatization<\/li>\r\n \t<li>high pain intensity<\/li>\r\n \t<li>presence of previous pain episodes<\/li>\r\n<\/ul>\r\nWhere available, specific prognostic factors, as well as risk factors, are discussed in the individual units.\r\n\r\n<strong>\u00a0<\/strong>\r\n\r\n&nbsp;\r\n<h3><strong>Red flags<\/strong><\/h3>\r\nThere are several specific pathologies that count as red flags. These are:\r\n\r\n<strong>Fractures<\/strong>\r\n\r\nThe Ottawa Ankle Rules are a great tool to assess for fractures. We discuss them more in detail in the ankle sprain unit.\r\n\r\nSigns and symptoms include:\r\n<ul>\r\n \t<li>\r\n<div>Immediate and severe pain<\/div><\/li>\r\n \t<li>\r\n<div>Swelling<\/div><\/li>\r\n \t<li>\r\n<div>Bruising<\/div><\/li>\r\n \t<li>\r\n<div>Localized tenderness upon palpation<\/div><\/li>\r\n \t<li>\r\n<div>Inability to bear weight<\/div><\/li>\r\n \t<li>\r\n<div>Deformity, especially in case of a dislocation<\/div><\/li>\r\n<\/ul>\r\n&nbsp;\r\n\r\n<strong>Osteochondral lesions, osteophytes<\/strong>\r\n\r\nSigns and symptoms include:\r\n<ul>\r\n \t<li>Persisting synovitis<\/li>\r\n \t<li>Stiffness<\/li>\r\n \t<li>Ventral impingement causes limitation in dorsi- and plantarflexion<\/li>\r\n<\/ul>\r\n&nbsp;\r\n\r\n<strong>Osteochondritis dissecans<\/strong>\r\n\r\nMore often seen in young individuals. Can be post-traumatic.\r\n\r\nSigns and symptoms are:\r\n<ul>\r\n \t<li>Intermittent pain<\/li>\r\n \t<li>Swelling<\/li>\r\n \t<li>Clicking in the joint<\/li>\r\n \t<li>Moderate synovitis<\/li>\r\n<\/ul>\r\n&nbsp;\r\n\r\n<strong>Sinus Tarsi Syndrome<\/strong>\r\n\r\nSigns and symptoms include:\r\n<ul>\r\n \t<li>\u201cGiving-way\u201d feeling<\/li>\r\n \t<li>Tenderness 2cm anteriorly and distally from the tip of the lateral malleolus<\/li>\r\n<\/ul>\r\n&nbsp;\r\n\r\n<strong>Muscle- or tendon tears<\/strong>\r\n\r\nThe patient is unable to contract the muscles around the ankle\r\n\r\n&nbsp;\r\n\r\n[cta]\r\n\r\n&nbsp;\r\n<h3><strong>Basic Assessment<\/strong><\/h3>\r\nDepending on the outcome, your basic assessment can give you the following info:\r\n1) \u00a0Limitations in range of motion and their end-feel can guide structural assessment (e.g. bone to bone=osteoarthritis, empty=tendinopathy due to pain)\r\n\r\nIt's best to start with Active Range of Motion Assessment:\r\n\r\n<iframe src=\"https:\/\/www.youtube.com\/embed\/2pERJnhsCmw\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>\r\n\r\nStandard values for the range of motion in different directions are as follows:<strong>\u00a0<\/strong>\r\n\r\n<img class=\"aligncenter size-full wp-image-6671\" src=\"https:\/\/physiotutors.com\/wp-content\/uploads\/study\/2017\/01\/Bildschirmfoto-2017-07-06-um-11.34.16.png\" alt=\"\" width=\"643\" height=\"550\" \/>\r\n\r\n&nbsp;\r\n\r\nAROM assessment is then typically followed by Passive Range of Motion Assessment (PROM)\u00a0 which you can watch by a click on the following video:\r\n\r\n<iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/clByPFmROAs\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>\r\n\r\nDuring PROM assessment, it's important to compare the range of motion as well as the end-feel of the affected ankle with the unaffected side.\r\n\r\nDon\u2019t forget that inspection and palpation can also give you clues. Think swelling, hematoma, warmth, pain or tenderness. These can guide you in identifying which structures may be affected.\r\n<h3><\/h3>\r\n<h3><strong>Specific Pathologies in the Ankle &amp; Foot<\/strong><\/h3>\r\nThere are several pathologies that are commonly seen in the ankle &amp; foot area. For more information, click on the respective pathology (content will be added in the near future):\r\n<ul>\r\n \t<li>Syndesmosis Injury<\/li>\r\n \t<li>Ankle Impingement<\/li>\r\n \t<li>Tarsal Tunnel Syndrome<\/li>\r\n \t<li>Inversion Trauma and Lateral Ankle Sprain<\/li>\r\n \t<li>Achilles Tendon Rupture<\/li>\r\n \t<li>Achilles Tendinopathy<\/li>\r\n \t<li>Plantar Fasciitis<\/li>\r\n<\/ul>\r\n&nbsp;\r\n<h3><strong>References<\/strong><\/h3>\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28096253\" target=\"_blank\" rel=\"noopener noreferrer\">Artus, Majid et al. \u201cGeneric Prognostic Factors for Musculoskeletal Pain in Primary Care: A Systematic Review.\u201d\u00a0<em>BMJ Open<\/em>\u00a07.1 (2017): e012901.\u00a0<em>PMC<\/em>. Web. 6 Sept. 2018.<\/a>\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12620608\" target=\"_blank\" rel=\"noopener noreferrer\">Picavet, H. S. J., and J. S. A. G. Schouten. \"Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC3-study.\"\u00a0<em>Pain<\/em>\u00a0102.1-2 (2003): 167-178.<\/a>"}},{"acf_fc_layout":"cta-image-v2","layout":"vertical","background":"transparent","heading":"","content_editor":"<p class=\"heading-two\">Accredited online <strong>physiotherapy courses<\/strong><\/p>\r\n\r\n<ul>\r\n \t<li>Built by the experts at Physiotutors<\/li>\r\n \t<li>Best price per CEUs\/CPD Points<\/li>\r\n \t<li>Accredited in the Netherlands, Belgium, Germany, USA, UK, &amp; Australia<\/li>\r\n \t<li>Learn anywhere, any time, and at your own pace!<\/li>\r\n<\/ul>","button_type":"internal_link","button_label":"See all 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