Approach to the Exam of the Ankle and Foot

The painful conditions of the ankle and foot are very common presentations and most commonly caused by trauma or injury related to sport activities. It is important to be familiar with some basic physical exam maneuvers necessary to confirm the presence of a lesion and to assess its severity.

Foot and Ankle Exam

The physical exam is of crucial importance for the clinical evaluation of painful conditions of the foot and ankle. These disorders are very common in the outpatient setting, both among professional athletes and recreational exercisers. It is important to be familiar with some basic maneuvers and physical signs necessary to assess the presence and the severity of lesions in the osteo-ligamentous structures of the foot.

Foot and Ankle Anatomy

Important anatomical structures that one must be familiar with while examining the painful ankle and foot, are the following:

1. Lateral ligaments of the ankle:
   1. Anterior Talo-Fibular Ligament (ATFL): running anteriorly from the lateral malleolus to the talusPosterior Talo
   2. Fibular Ligament (PTFL): running posteriorly from the lateral malleolus to the posterior aspect of the talus
   3. Calcaneo-Fibular ligament (CFL): running from the lateral malleolus to the lateral aspect of the calcaneous, in the middle between the ATFL and the PTFL

   

   Anatomy of the ankle. Image credit

   Lateral Ankle Sprain

   Foot and Ankle Exam

   One of the most common causes of foot pain is a lateral ankle sprain. In the mildest presentations, the only structures to be injured are the lateral ankle ligaments, usually in the number or one or two. However, if the damage is more severe, we can observe lesions of all the lateral ligaments plus other structures like the talar dome, the base of 5 th metatarsal and the tibio-fibular syndesmosis.

   The approach is to check for the integrity of the lateral ligaments first and if all the three ligaments are injured, then we will check the other structures.

   Inspection and Palpation

   First, have the patient lying down supine with the knee bent on the affected side.

   Then, observe the lateral aspect of the foot and ankle for hematomas or bruises.

   Then, locate the three lateral ligaments and palpate along their course for crepitus and tenderness.