Ankle Exam
Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA
The ankle and foot provide the foundation for the body and the stability needed for upright posture and ambulation. Because of its weight-bearing function, the ankle joint is a common site of injury among athletes and in the general population. Ankle injuries occur as a result of both acute trauma and repetitive overuse (such as running). The ankle is a fairly simple joint, consisting of the articulation between the distal tibia and talus of the foot, along with the fibula on the lateral side. The ankle is supported by numerous ligaments, most notably the deltoid ligament on the medial side, and laterally by three lateral ligaments: the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL).
Physical examination of the ankle and the patient history (including the mechanism of the injury and the location of pain) provide diagnostic information that helps the physician to pinpoint specific structures involved in an injury, and are essential for determining the severity of the injury and the subsequent diagnostic steps. When examining the ankle, it is important to closely compare the injured ankle to the uninvolved side. Essential components of the ankle exam include inspection, palpation, range of motion (ROM), and strength. In addition, special tests can assess the integrity of ligaments.
1. Inspection
- Inspect and compare both fully exposed ankles from the front, the side, and from behind looking for any asymmetry, as well as for swelling, ecchymosis, or arch deformities.
- Inspect the patients' shoes for abnormal wear patterns, which can be seen in patients with flat feet or muscle and ligament injuries.
2. Palpation
Palpate for tenderness, swelling, or deformity in the lower leg, ankle, and foot using the tips of the in
Examination of the ankle is best done following a stepwise approach with the patient in a sitting position. It is important to have the patient remove enough clothing so that all surface anatomy can be seen and compared to the uninvolved side. The exam should begin with inspection, looking for asymmetry between the involved and uninvolved ankle. Palpation of key structures is done next, looking for tenderness, swelling, or deformity. This is followed by assessing ROM, first actively and then against resistance to assess
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