Ankle Exam

See Telemedicine
Patient should be wearing shorts (or similar) and barefoot for exam
Camera should be positioned to adequately visualize both lower legs with adequate detail
Perform general Ankle Exam with inspection, range of motion evaluation (see below)
Ankle strength may be tested against gravity or against resistance (e.g. towel, resistance bands)
Perform standing and gait exam (see below)
Patient should palpate and point to regions of ankle or foot with maximal pain
1. Include squeezing the ankle and calf (Squeeze Test, Thompson Test)
2. Include proximal tibia and fibula tenderness (e.g. Maisonneuve Fracture)
Neurovascular Exam
1. Capillary Refill may be assessed if adequate lighting and camera at close position
2. Dermatome distribution light Touch Sensation may be performed by patient
Consider Ankle XRay or other imaging indications
1. Ottawa Ankle Rule

Inspection (Compare both ankles without shoes or socks)
1. Erythema
2. Deformity
3. Swelling or joint effusion
4. Muscle Atrophy
5. Ecchymosis (recent Trauma)
6. Overlying skin changes
7. Scars suggesting old Trauma
Ankle Range of Motion (normal values)
1. Ankle Dorsiflexion 20 degrees
2. Ankle Plantar Flexion 45 degrees
3. Ankle Inversion 30 degrees
4. Ankle Eversion 20 degrees
Ankle stability
1. Talar Tilt
2. Ankle Anterior Drawer Test
Lateral Ankle
1. Palpate the distal fibula
2. Palpate the lateral ankle ligaments (torn in Lateral Ankle Sprain)
  1. Anterior talofibular ligament (ATFL)
  2. Posterior talofibular ligament (PTFL)
  3. Calcaneal fibular ligament (CFL)
Medial Ankle
1. Palpate the distal tibia and medial malleolus (Ottawa Ankle Rule)
2. Palpate the medial deltoid ligament complex

Standing Exam
1. Observe foot from patient's back with feet Shoulder width apart
  1. Toes seen lateral to foot >2.5 suggests out toeing or hyperpronation
2. Observe foot from side
  1. Pes cavus
  2. Pes Planus
3. Observe gait
  1. Hindfoot and knee alignment
  2. Knee Valgus Deformity
  3. Knee Varus Deformity
Foot vascular exam
1. Posterior tibial pulse
2. Dorsalis pedis pulse
3. Distal foot Capillary Refill
Foot and ankle Neurologic Exam
1. Active ankle plantar flexion, ankle dorsiflexion and great toe dorsiflexion
2. Toe movement
Foot
1. Palpate the Tarsal Navicular Bone for Fracture
2. Palpate the proximal fifth Metatarsal Bone (site of avulsion from peroneus brevis tendon)
3. Palpate the midfoot dorsum (lisfranc joint injury)
Leg
1. Palpate the proximal fibula (for Maisonneuve Fracture)
2. Thompson Test (evaluate for Achilles Tendon Rupture)
3. Syndesmotic Sprain testing