Special Tests: AF

Supple flat feet

-Arch is present while NWBing -Arch is absent while WBing Supple flat feet are correctable with longitudinal arch supports

What is a positive anterior draw test? Negative?

-Movement of the calcaneus and talus anteriorly is positive -No movement is a negative

Thompson test: Patient position

-Prone -Kneeling on the table, chair or stool with their foot hanging over the edge

Calcaneal inversion/gapping test

-Stress test for ATF and calcaneofibular ligaments -If both ligaments are torn it will result in gross lateral ankle instability -Invert the calcaneus, if the talus gaps and rocks in the ankle mortise, then the ATF and calcaneofibular ligaments are damaged with resultant lateral ankle instability

Calcaneal eversion/gapping test

-Stress test for the deltoid ligament (medial side) -Stabilize the patients leg around the tibia and calcaneus and evert the foot. If the deltoid ligament is torn, you make feel a gross gapping at the ankle mortise.

Homan's sign

-Testing for deep vein thrombosis -DF the patient's ankle while their leg is extended and palpate their calf -Pain is a positive sign

Tibial torsion test

-Testing for excessive internal rotation of the tibia -The line between the tibial tuberosity and the midline of the malleoli will normally externally rotate 15 degrees -If there is internal tibial torsion, the malleolar line will face directly anteriorly

Why are inversion injuries more common than eversion injuries of the ankle?

-The lateral malleolus is long than the medial malleolus, and the talus can thus be forced to invert farther than it can evert -The ligaments on the lateral side of the ankle aren't as strong as the ligaments on the medial side (deltoid ligament)

Rigid flat feet

-The medial longitudinal arch is absent while WBing and NWBing Rigid flat feet can not be correct with an arch support

Test for rigid or supple flat feet

-observe patient's feet as they stand and while seated -If the medial longitudinal arch is absent in all positions, the patient has rigid flat feet -If the arch is present while the patient is sitting, and absent while standing, then they have supple flat feet

ATF inversion stress test tells you what about the ligament? Anterior draw?

ATF stress test tells you about the condition of the ligament. Anterior draw tells you about anterior instability between the tibia and talus.

Which ligament is most often involved in ankle sprains?

Anterior talofibular ligament

Ankle dorsiflexion test

First flex the knee joint. If you are able to achieve ankle DF when the knee is flexed, the gastrocnemius muscle is the cause of the limitation

Anterior draw sign for anterior talofibular ligament stability

Have the patient sit on the edge of the table with their legs dangling and the feet in a few degrees of PF. PLace one hand on the anterior aspect of the lower tibia and grip the calcaneus with the other hand. Draw the calcaneus anteriorly while pushing posteriorly on the tibia.

What type of motion do you perform when testing the integrity of the ATF ligament?

PF and inversion

What is a positive ATF ligament inversion stress test?

Pain when the patients foot is passively inverted and PF (no pain is negative)

Thompson test: Procedure

Squeeze the patients calf to determine if there is any resultant plantar flexion of the foot. Normally there is such a motion. However if the Achilles tendon is ruptured, the motion is decreased or absent.

After you complete a test on the involved foot...

Test the normal one as a means of comparison to determine the extent of abnormal gapping

What is the Thompson Test for?

Testing the continuity of the gastrocnemius and soleus muscles in the event of an Achilles tendon rupture

Toeing in may be caused by...

excessive internal rotation of the tibia