Clinical examination of the ankle joint

For the clinical examination of the ankle joint, both lower limbs exposed from below the knees and the patient should be observed from in front and behind, standing and walking. The gait is observed and the ability of the patient to stand and walk on tiptoe tested.

The patient is then laid down, or sat in front of the examiner placing his feet in the examiner's lap.

Look þ deformity of the foot: plantar flexion, talipes deformity, drop foot

• callosities, corns, bunions and discolouration
• foci of infection
• swelling and bruising - unilateral or bilateral

Feel þ palpate any swellings or lumps

• areas of tenderness should be localised by checking bony prominences and tendon insertions
• pulses and skin temperature

Move þ ankle, subtalar, mid-tarsal and toe joints should be assessed systematically

• muscle power and tendons may be checked by testing inversion, eversion, etc. against resistance
• lateral ligament stress test - involves grasping the heel and forcibly inverting the foot while feeling for opening up of the lateral side of the ankle between the tibia and talus
• inferior tibio-fibular ligament test - dorsiflexion of the foot induces pain when the tibia is displaced laterally
• range of movement: from a neutral point at right angles to the leg, the range of plantar and dorsiflexion should normally be 55 and 15 degrees

Shoes þ look at the heels to assess sites of wear