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Objective Assessment of the Ankle and Foot 1. Informal Observation: Physical behaviour Illness behaviour 2. Formal Observation: Foot index pattern i. Pronation/Supination ii. Inversion/Eversion iii. Thickness of Achilles iv. Ability to weight bear Symmetry i. Bony landmarks ii. Skin Creases iii. Lateral Shift Muscle Bulk i. Wasting, ii. Spasm Posture i. Lordosis ii. Kyphosis iii. Scoliosis Skin Colour i. Health ii. Scaring- healing or infection iii. bruising Functional Demonstration: Gait i. Stride length, ii. Willingness to weight bear iii. Muscle function Active Range of Motion (AROM)- Supine half lying Apply over pressure if no pain on active DorsiFlexion Plantarflexion Inversion Eversion PROM- Prone Passive physiological o IV o EV o PF o DF Passive accessory movements- only if limited active and passive range of motion- or if not highly irritable. o P-A Glide of the calcaneus (PF) P-A force is applied to the calcaneus whilst a A-P force is applied to the talus/tibia. o A-P Glide of the tibia (DF) A-P force is applies to the tibia whilst a P-A pressure stabilises the back of the patient’s leg. o Anterior Tibiofibular joint (lateral/medial malleolus AP-PA glide) A-P= heel of the left hand applies P-A force to tibia whilst right hand applies A-P force to fib. P-A= heel of right hand applies to A-P force to tibia whilst the left applies P-A force to fib o Medial/Lateral Rotation of the tib/fib- hands both around the subtalar joint. o ADD/ABD CALCANEOUS- One hand stabilises while the other and applies a pronation or supination of the foot in different areas. midfoot/distal/proximal o A-P-P-A Toes One hand stabilises the foot and each tarsal whilst the other applies an anterior or posterior glide of the toes. Muscle Length tests o Gastrocnemius Isometric Test i. DF ii. PF iii. IV iv. EV Palpation o Tib ant o Tarsal Tunnel (nerve runs through) o Gastroc belly o Plantar fascia insertion Special test o Thompsons test (rupture of the achillies) o Anterior draw (all the lateral ligaments of the ankle) o Talar tilt (rupture of the calcanofibular ligament)