ASSESSMENT

ASSESSMENT OF THE ANKLE

This article follows on from our two previous articles outlining an overview of assessment followed by specific assessment of the knee joint (1,2). This assessment focuses on the ankle joint alone however it shouldnít be forgotten that many ankle problems may involve injury or malfunctions both above the actual articulation (joint area) as well as below at any of the anatomical points of the foot.

By Joan Watt, MCSP, MSMA

SUBJECTIVE As discussed previously all assessments should involve both a subjective and an objective element (1,2).

Observation Firstly where possible try and ensure the patient is wearing shorts and preferably no shoes or socks. Watch them walk forwards, backwards and sideways and in standing.

Look specifically for: ■ Asymmetry in size between the injured and the uninjured limbs ■ Swelling – which is likely to be marked and visible with an external sprain but an internal sprain may only be visible behind the ankle joint on both side of the tendoachilles

BOX 1: MUSCLE STRENGTH TESTS - ANKLE

Tibialis anterior – the patient should be supine with the knee fully extended. Stabilise the distal leg and resist dorsi-flexion.

Gastrocnemius – the patient is supine with the knee fully extended, foot in full dorsiflexion, stabilise the lower leg and resist plantar flexion.

Soleus – the patient is seated with the knee bent to approximately 60O

. With the foot in

dosiflexion, resist plan- tarflexion.

Tibialis posterior – the patient should be seated with the foot in neutral. Resist inversion, then put foot in eversion and again resist inversion.

Peroneus longus and brevis – with the patient seated and the foot in neutral. Ask the patient to invert their foot and then resist the eversion movement.

■ Bruising/discoloration – an external sprain is likely to result in large bruising, whereas an internal sprain may display minimal bruising

■ Compare bony and tendon landmarks right to left ■ Check weight is being evenly distributed between both legs.

REMEMBER

■ Tibialis anterior and posterior assist in inversion ■ Peroneus longus and brevis assist plantar flexion ■ Peroneus tertius dorsiflexes and assists eversion ■ The common flexors plantarflex and assist in inversion and eversion

■ The common extensors dorsiflex the foot.

www.sportex.net

11