FOOT & ANKLE

PANUM PROFESI FISIOTERAPI UNIVERSITAS MUHAMMADIYAH SURAKARTA

16 OCTOBER 2020

Taufik Eko Susilo

LEARNING OBJECTIVES
• Ankle structure & function
• Foot and ankle examination
• Foot-ankle contribution of gait
• Example ankle guideline
Kenapa orang yang menggunakan
high-heels sangat rentan cidera
ankle saat berjalan?
PERSPEKTIF ANATOMI
Foot motion
• Triplane motion act as
• Shock absorbers
• Assist in maintaining balance
• Improve the efficiency muscle contraction
• Assist in distribution of normal force through the lower kinetic chain
• Help establish a stable structure at push off
Foot and ankle
• The foot is the terminal joint in the lower kinetic chain that
opposes external resistance.
• Proper arthrokinematic movement within the foot and ankle
influences the ability of the lower limb
• to attenuate the forces of weightbearing. The maintenance of the
arch in the static foot is attributed to passive ligamentous and
osseous support.
• In the static stance position, the plantar aponeurosis takes up
approximately 60% of the stress of weightbearing and the beam
action of the metatarsals approximately 25%.
Foot and ankle
• The complex motions of the foot and ankle which promote the
interdependence of joint movement are called pronation and
supination
• Supination and pronation occur at certain points in the stance
phase to assist movement, stabilize joints, and reduce forces
within the foot and lower limb
• The triplane joints include the talocrual, the subtalar, the midtarsal,
the first ray (first metatarsal/cuneiform), and the fifth ray (fifth
metatarsal).
• The foot is pronating at heel strike and passes through neutral and
starts to supinate at midstance
midstance heel strike
(SUPINATED) (PRONATE)
CLINICAL INSIGHT (PES CAVUS)
Because the foot is more rigid (stiff) in its arched position, it is less able to “give” and adequately
absorb weight-bearing forces. Therefore, a person with pes cavus is typically more vulnerable to
stress-related injury, not only in the foot but throughout the entire lower extremity
CLINICAL INSIGHT (ANKLE PALPATION)
CLINICAL INSIGHT (ANKLE PALPATION)
Foot and Ankle Examination
• Subjective
• Patient intake
• Special question
• Investigations
• Red flags
• Clinical reasoning
• Objective
• General observation (in standing)
• Functional tests
• Inspection & Palpation
• Neurological Assessment
• Vascular Assessment
• Special tests
• Biomechanical evaluation
FOOT-ANKLE CONTRIBUTION

Approximately 7° of dorsiflexion occurs at the end of midstance, as the heel

begins to rise, and 25° of plantarflexion occurs at the end of stance
Foot and Ankle Examination
Subjective

• Pain, swelling, deformity, stiffness, instability and or abnormal gait

Patient intake

• Any trauma ? History of injury

Special question

• Any back or leg pain?

• Is there hip or knee pain?
• Type of shoes?
Foot and Ankle Examination
Additional information

•Past medical history, drug history, social history

Investigation

•Radiological considerations (x-ray or scan)

Red flags

•Numbness in the LL
•Bowel bladder problem
•Paresthesia groin region
•Loss of pulse in the LL
•Obvious deformity
•Babinski sign
Foot and Ankle Examination

Clinical reasoning

•Knowing history clues to structured affected

•How the mechanism of injury ? Force injury ?
Damage structure?
•Rule out the back (lumbal region)
•Immediate swelling ?  trauma (need x-ray)
•Test the hypothesis with testing and
measurement
Foot and Ankle Examination
Objective

General observation

• Posture – foot posture in standing, arch posture

• Red movement pattern
• Gait analysis

Functional test

• Small knee band

• Sit to stand
• Squad
• Double heel raise
• Jump
• Single knee bend
• Single heel raise
• Hop
• Running
• Star excursion balance test
Foot and Ankle Examination

Inspection & Palpation

• Inspection: deformity, effusion, muscle wasting

• Palpation: Joint lines, medial-lateral ligament, Achilles tendon, peronei,
intrinsic muscle

Neurological assessment (if suspect from lumbar spine)

• Reflexes (patella lig L3-L4, achiles tendon S1-S2)

• Dermatome (L1-S4)
• Myotomes (L2 hip flex, L3 knee ext, L4 dorsiflexion, L5 big toe extension,
L5/S1 knee flex, S1 plantar, S2 toe flex)
• Babinski / clonus
Foot and Ankle Examination
Vascular assessment

• Palpate pulses dorsalis pedis artery

Special tests

• Ottawa ankle rules

• Ankle ligament stress test (Talar tilt test ,Anterior draw ankle, Eversion stress
test)
• Muscle stress (instrinsic-extrinsic)
• Squeeze
• Windlass
• Impingement sign
• Navicular drop test
TERIMA KASIH
e-mail: taufikekosusilo@gmail.com