Question 1

What ligaments support the ankle joint?

Accepted Answer

The ankle is supported by the deltoid ligament on the medial side, which connects the medial malleolus to the talus and calcaneus. Three lateral ligaments provide additional support: the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). These ligaments attach the fibula to foot bones and are commonly injured during ankle trauma.

Question 2

How do you assess ankle range of motion during a physical exam?

Accepted Answer

Test ankle motion actively first, comparing both sides for limitations or pain. Dorsiflexion (toes up) normally reaches 20 degrees, while plantar flexion (toes down) reaches about 50 degrees. Inversion (foot rolls inward) is typically 30 degrees, and eversion (foot rolls outward) is about 10 degrees. Passive testing follows if abnormalities are detected.

Question 3

What muscles are tested during ankle strength assessment?

Accepted Answer

Resisted dorsiflexion tests the tibialis anterior muscle. Resisted plantar flexion assesses the gastrocnemius, peroneal longus, and posterior tibialis muscles and tendons. Resisted inversion tests peroneal longus and brevis muscles, while resisted eversion evaluates tibialis anterior and posterior muscles. Always compare strength between both ankles.

Question 4

What does the anterior drawer test reveal about ankle ligaments?

Accepted Answer

During the anterior drawer test, the examiner stabilizes the lower leg and pulls forward on the calcaneus-talus complex. Laxity during this maneuver suggests lateral ligament rupture or significant ligamentous injury. The test is performed with the ankle in the same position as the talar tilt test for comprehensive ligament assessment.

Question 5

How is the Thompson test used to evaluate the Achilles tendon?

Accepted Answer

The Thompson test requires the patient to lie prone on the exam table. The examiner squeezes the base of the calf muscle and observes for ankle plantar flexion, which is the normal response. A lack of plantar flexion suggests a complete Achilles tendon rupture, indicating severe tendon damage requiring immediate clinical attention.

Question 6

What palpation findings indicate a syndesmosis sprain?

Accepted Answer

To assess for syndesmosis sprain, squeeze the proximal tibia and fibula together and ask if the patient feels pain distally at the ankle. Pain suggests tibiofibular ligament injury. External ankle rotation typically aggravates this pain, confirming the diagnosis of a syndesmosis sprain affecting the ligament between the two leg bones.

Question 7

Why are functional tests important at the end of an ankle exam?

Accepted Answer

Functional tests assess the patient's ability to return to normal activities. Ask the patient to walk, walk on toes and heels, squat, and jog. Toe walking tests plantar flexor strength, while heel walking evaluates dorsiflexor strength. These tests help guide return-to-activity decisions and reveal functional limitations not apparent during standard strength testing.

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