Learning outcome
- Hallux valgus
- Calcaneovalgus
- Ankle joint effusion
- Ankle ligament injury
- Ankle fracture
- Syndesmosis injury
- Achilles rupture
- Morton's metatarsalgia
- Plantar fasciitis
- Heel spur
- Sever's disease (calcaneal apophysitis)
- Haglund's deformity and retrocalcaneal bursitis
- Tennis leg
- Traction periostitis
- Chronic compartment syndrome
- Common fibular nerve compression
Standard tests and special tests
Standard tests
- Inspection
- Active movement
- Passive movement
- Isometric movement
- Palpation
Special tests
- Drawer test for anterior talofibular ligament
- Talar tilt test for calcaneofibular ligament
- Ottawa Rules suspected ankle fracture
- Squeeze test for syndesmosis injury
- Test for anterior syndesmosis, anterior tibiofibular ligament
- Thompson test and palpation for Achilles rupture
- Squeeze test forefoot for Morton's metatarsalgia
- Test for common fibular nerve compression
Case 9
You are working as a 5th-year student at a general practitioner's office. The next patient is a 50-year-old man. He presents because of pain in the calf muscles down towards the heel. During a jog yesterday, he experienced acute onset pain and difficulty walking.
Leg/ankle/foot examination
- Perform standard leg/ankle/foot examination
- Inspection
- Active movement
- Passive movement
- Isometric movement
- Palpation
Inspection leg/ankle/foot
Active movements leg/ankle/foot
Passive movements leg/ankle/foot
Isometric movements leg/ankle/foot
Palpation leg/ankle/foot
Clinical findings
- You easily find bruising medially posteriorly in the middle of the calf. Pain upon palpation and you feel a small depression in the muscle. You register pain and are unsure whether there is reduced strength when walking on toes.
- Pain with passive dorsiflexion in the ankle joint.
What is wrong with the patient?
Tennis leg.
Case 10
You are working as a 5th-year student at a general practitioner's office. The next patient is a 50-year-old man. He presents because of pain in the calf muscles down towards the heel. During a jog yesterday, he experienced acute onset pain and difficulty walking.
- In the standard examination you found
- Pain on palpation medially in the middle of the lower leg.
- Slight bruising in the area where there is pain and a small indentation in the muscle.
- Pain when walking on toes but unsure about muscle weakness.
- Explain how you would conduct a leg/ankle/foot examination to determine if there is a tendon rupture.
Leg/ankle/foot examination
- Exclude ligament injury
- Show examination in case of suspected Achilles rupture
Ligament injury
Syndesmosis
Ottawa rules
Thompson test
Morton's metatarsalgia
Plantar fasciitis
Clinical findings
- You find missing strength in plantar flexion
- Positive Thompson test
- Pain on palpation of the muscle/tendon junction
What is wrong with the patient?
The patient has an Achilles rupture.