|
|
Home Care Kit
|
|
(L) Foot/ Ankle
|
Date of Exam
|
|
Pain Diagram
|
(R) Foot/ Ankle
|
|
Observation
|
Observation WNL
|
|
Bruising
|
[+] Bruising Comments
• • •
|
|
Swelling
|
[+] Swelling Comments
• • •
|
|
Redness
|
[+] Redness Comments
• • •
|
|
ABN Foot Posture
• • •
|
Observation Comments
|
|
Ankle ROM Exam
|
ROM WNL
|
|
Plantar Flexion (40)
|
Plantar Flexion Symptoms
• • •
|
|
Dorsiflexion (20)
|
Dorsiflexion Symptoms
• • •
|
|
Inversion (20)
|
Inversion Symptoms
• • •
|
|
Eversion (10)
|
Eversion Symptoms
• • •
|
|
Motor Function
|
MMT WNL
|
|
Grade 5/5
• • •
|
Grade 4/5
• • •
|
|
Grade 3/5
• • •
|
Grade 2/5
• • •
|
|
Grade 1/5
• • •
|
Grade 0/5
• • •
|
|
Pain with MMT
• • •
|
|
|
Othopedic Tests
|
|
|
Anterior Drawer Neutral
|
[+] Anterior Drawer Neutral
• • •
|
|
Anterior Drawer Plantarflexed
|
[+] Anterior Drawer p/f
• • •
|
|
Posterior Drawer Neutral
|
[+] Posterior Drawer Neutral
• • •
|
|
Posterior Drawer Plantarflexed
|
[+] Posterior Drawer p/f
• • •
|
|
Inversion Talar Tilt Neutral
|
[+] Inversion Talar Tilt Neutral
• • •
|
|
Inversion Talar Tilt Plantarflexed
|
[+] Inversion Talar Tilt p/f
• • •
|
|
Eversion Talar Tilt
|
[+] Eversion Talar Tilt
• • •
|
|
Rotational Stress Test
|
[+] Rotational Stress Test
• • •
|
|
Achilles Squeeze Test
|
|
|
Thompson's Test
|
[+] Thompson's Test
• • •
|
|
Calaneal Squeeze Test
|
[+] Calcaneal Squeeze Test
• • •
|
|
Homan's Sign
|
[+] Homan's Sign
• • •
|
|
Morton's Squeeze Test
|
|
|
Tinel's Test at the Ankle
|
|
|
Hoffa's Test
|
|
|
Ankle Impingement Prediction Rules
• • •
|
|
|
DDX Impressions
|
|
