The document provides a comprehensive guide on assessing the ankle and foot, covering aspects such as patient history, observation, and palpation. It details various conditions, symptoms, and deformities while outlining assessment techniques, including ROM, muscle strength, and the impact of footwear and activity on foot health. Notably, it emphasizes distinguishing between different swelling types and evaluating weight-bearing positions for effective diagnosis.

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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