Ankle Exam
 

Assessing Movement

 
 
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Active Movement

    • How to Assess

    • Ask the patient to move the joint themselves. Assess the neutral position and the range of motion, and ask whether range of motion is limited by pain, weakness or stiffness.
    • Significance

    • Active movement is an indicator of the patient's ability to move the joint. It may be limited due to weakness, pain, mechanical stiffness or poor compliance.
    • Causes of Limited Active Movement

    • Joint pain / stiffness - see below
    • Upper motor neuron lesion - stroke, tumour, trauma, hypoxia, demyelination, deposition, inflammation
    • Lower motor neuron lesion - trauma, compression, demyelination, neuromuscular disorders, diabetes
    • Poor compliance

Passive Movement

    • How to Assess

    • Move the patient's joint. Note the range of motion and whether it is limited by pain, swelling or stiffness. Note any crepitus.
    • Significance

    • Passive movement is a measure of the objective range of motion of the joint. It may be limited by stiffness of the joint, or active resistance on the patient's part.
    • Causes of Limited Range of Motion

    • Trauma - dislocation, fracture
    • Arthritis - osteoarthritis, rheumatoid arthritis, septic arthritis, gout, pseudogout, reactive arthritis, psoriatic arthritis, Reiter’s syndrome
    • Intra-articular haemorrhage
    • Tendinitis
    • Bursitis
    • Intra-articular bleed
    • Tear - meniscus, ligament
    • Loose intra-articular body
    • Fibrous adhesions - surgery, trauma, overuse, inflammation
    • Muscle tightness
    • Prolonged joint immobilisation
    • Compartment syndrome

Overview

    • Causes of Limited Ankle Range of Motion

    • Achilles tendinitis
    • Arthritis - gout, septic arthritis, osteoarthritis, rheumatoid arthritis
    • Causes of Limited Foot Range of Motion

    • Fracture
    • Plantar fasciitis
    • Calcaneal bursitis
    • Arthritis - gout, septic arthritis, osteoarthritis, rheumatoid arthritis
 
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 Allen RH, Gross MT. Toe Flexors Strength and Passive Extension Range of Motion of the First Metatarsophalangeal Joint in Individuals with Plantar Fasciitis. Journal of Orthopaedic & Sports Physical Therapy. 2003; 33: 468-478. Davis H, Blundell C. Clinical examination of the foot and ankle. Orthopaedics and Trauma. 2011; 25(4): 287-292.
Dix-Peek SI. An approach to the assessment of cavus deformity. SA Orthopaedic Journal. 2008 Sep;7(3):54-8.
 Douglas J, Kelly M, Blachut P. Clarification of the Simmonds-Thompson Test for Rupture of the Achilles Tendon. Canadian Journal of Surgery. 2009 Jun; 52(3): 40-41. Douglas J, Kelly M, Blachut P. Clarification of the Simmonds-Thompson test for rupture of the achilles tendon. J Can Chir. 2009; 52(2): E40-E41. Hecht PJ. Hallux Valgus. The Medical Clinics of North America. 2014 Mar; 98(2): 227-232. Heron JR. Neurological Syndromes Associated with Pes Cavus. Proceedings of the Royal Society of Medicine. 1969 Mar; 62: 270-271. Jacobs B. Toe walking, flat feet and bow legs, in-toeing and out-toeing. Paediatrics and Child Health. 2010 May; 20(5): 221-224. Jhadav V, Mahajan P, Mhaske C. Nail Pitting and Onycholysis. Indian Journal of Dermatology, Venereology and Leprology. 2009; 75(6): 631-633. Piazza S, Ricci G, Ienco EC, Carlesi C, Volpi L, Siciliano G, Mancuso M. Pes cavus and hereditary neuropathies: when a relationship should be suspected. Journal of Orthopaedics and Traumatology. 2010 Dec 1;11(4):195-201. Redmond AC, Crosbiec J, Ouvrier RA. Development and eValidation of a Novel Rating system for Scoring Standing Foot Posutre: the Foot Posture Index. Clinical Biomechanics. 21(1): 89-98. Roche A, Hunter L, Pocock N, Brown D. Physical examination of the foot and ankle by orthopaedic and accident and emergency clinicians. Injury, Int. J. Care Injured. 2009; 40: 136–138. Scher RK. Toenail Disorders. Clinics in Dermatology. 1983; 1(1): 114-124. Schwieterman B, Haas D, Columber K, Kunpp D, Cook C. Diagnostic accuracy of physical examination tests of the ankle / foot complex: a systematic review. Int J Sports Phys Ther. Aug 2013; 8(4): 416–426. Scott BW, Al Chalabi A. How the Simmonds-Thompson Test Works. J Bone Joint Surg Br. 1992 Mar; 74B(2): 314-315. Shirzad K. Lesser Toes Deformities. Journal of the American Academy of Orthopaedic Surgeons. 2011 Aug; 19(8): 505-514. Singh D, Bentley G, Trevino SG. Callosities, Corns and Calluses. British Medical Journal. 1996 Jun; 312(7043): 1403. Solis G, Hennessy MS, Saxby TS. Pes Cavus: a Review. Foot and Ankle Surgery. 2000; 6: 145-153. Talusan PG, Milewski MD, Reach JS. Fifth Toe Deformities: Overlapping and Underlapping Toe. Foot Ankle Spec. 2013 Apr; 6(2): 145-149. Torpy J, Burke A. Thrombophlebitis. JAMA. 2011 Apr; 305(13): 1372. Yeagerman SE, Cross MB, Positano R, Doyle S. Evaluation and Treatment of Symptomatic Pes Planus. Current Opinion in Paediatrics. 2011 Feb; 23(1): 60-67.
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