Lecture Notes: Assessing Range of Motion and Special Tests for the Ankle

Importance of Ankle Range of Motion

• Ankle measurements are crucial, especially post-sprain, in contrast to rarer clinical toe measurements.

Range of Motion Measurements

Dorsiflexion

• Definition: Movement of toes towards the shin.
• Goniometer Setup:
  • Fulcrum on the lateral side.
  • Metal on the lateral malleolus.
  • Movement arm aligns with the fifth metatarsal.
• Normative Values: 15-20 degrees.
  • Lack indicates increased risk of ankle sprains.

Plantar Flexion

• Setup: Similar to dorsiflexion.
• Movement: Toes pointed downward.
• Normal Range: 40-50 degrees; 70-80 degrees for dancers, etc.

Inversion and Eversion

• Inversion: More range due to fibula positioning.
  • Normal: 15-20 degrees.
• Eversion: Less range due to fibula blocking.
  • Normal: 5-10 degrees.

Ligamentous Testing

Anterior Talofibular Ligament

• Test: Anterior Drawer Test.
  • Position: Seated, knee extended.
  • Positive: Laxity or joint looseness.

Calcaneal Fibular Ligament

• Test: Inversion Taylor Tilt Test.
  • Movement: Inversion of the calcaneus.
  • Positive: Increased inversion range.

Posterior Talofibular Ligament

• Test: Posterior Drawer Test (rarely positive).
  • Movement: Posterior glide of the calcaneus.

Deltoid Ligament

• Tests:
  • Eversion Taylor Tilt Test (tests middle bundle).
  • Kleiger's Test (tests anterior bundle).
  • Eversion Taylor Tilt Positive: More movement into eversion.

Syndesmotic (High Ankle) Sprains

Cotton's Test

• Setup: Patient side-lying.
• Movement: Glide calcaneus laterally.

Squeeze Test

• Movement: Squeeze tibia and fibula together.
• Positive: Pain or increased movement.

Dorsiflexion Eversion Test

• Movement: Maximal dorsiflexion and eversion.
• Positive: Pain at the syndesmosis.

Fracture Tests

Squeeze Test

• Method: Squeeze above and below the fracture site.

Hop Test

• Performance: Patient hops five times.
• Positive: Inability to complete due to pain.

Miscellaneous Pathologies

Oz Trigonum Injury

• Common in: Dancers, gymnasts.
• Test: Passive over plantar flexion.

Achilles Tendon Rupture

• Test: Thompson’s Test.
  • Positive: No plantar flexion on calf squeeze.

Homan’s Test (Blood Clot)

• Context: Post-surgery risk of embolus.
• Test: Dorsiflexion and pressure on gastroc heads.
  • Positive: Immediate pain; requires urgent referral.

These notes summarize the key procedures and special tests for assessing ankle injuries and range of motion, crucial for clinical diagnosis and treatment planning.