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DOC Right Ankle/Foot Exam
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Inspection (swelling, erythema, ecchymosis, warmth, wounds, deformity)
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Inspection Abnormal?
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Inspection ALL NORMAL?
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Swelling?
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Ecchymosis?
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Erythema?
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Increased Warmth?
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Masses?
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Open Wounds?
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Deformity?
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Inspection Comments
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Tenderness (lat/med mal,ant/post tib, achilles, hindfoot, hind/dor/plant, metatarsals)
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Tenderness Abnormal?
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Tenderness ALL NORMAL?
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Lateral malleolus
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Medial malleolus
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Anterior tibialis
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Posterior tibialis
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Achilles insertion
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Anterior talofibular ligament
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Calcaneofibular ligament
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Posterior talofibular ligament
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Syndesmotic ligament
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Deltoid ligament
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Peroneal tendons
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Posterior tibial tendon
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Hindfoot
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Dorsal midfoot
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Plantar foot
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1st metatarsal
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2nd metatarsal
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3rd metatarsal
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4th metatarsal
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5th metatarsal
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Proximal 5th metatarsal
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Calcaneal tuberosity
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Tenderness Comments
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ROM (ltd dorsi/plant flex, ltd add/abd)
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ROM Abnormal?
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ROM ALL NORMAL?
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Limited dorsiflexion?
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Limited plantar flexion?
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Limited adduction
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Limited abduction
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ROM Comments
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Stability
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Anterior Drawer Test Positive?
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Inversion Stress Test Positive?
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Stability Comments
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Strength (EHL, FFL, Tib Ant, Gastroc/Soleus, Inv/Eve)
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Strength Abnormal?
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Strength ALL NORMAL?
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Extensor Hallucis Longus
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Flexor Hallucis Longus
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Tibialis anterior
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Gastroc/soleus
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Inversion
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Eversion
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Strength Comments
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Sensation (dor med/lat foot, plan med/lat foot)
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Sensation Abnormal?
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Sensation ALL NORMAL?
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Intact dorsal medial foot?
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Intact medial lateral foot?
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Plantar dorsal medial foot?
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Intact plantar lateral foot?
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Sensation Comments
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Vascular
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Palpable dorsalis pedis pulse
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Palpable post tib pulse
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Vascular Comments
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Gait (antalgic gate, reciprocal heel/toe w/o asst device)
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Gait Abnormal?
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Gait ALL Normal?
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Antalgic gate?
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Asst devices needed for Reciprocal Heel Toe Gait?
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Assistive Devices?
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Assistive devices
• • •
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Assistive devices
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Gait Comments
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Tests
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Thompson test positive?
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Comments
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Pain w/syndesmosis squeeze test positive?
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Comments
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Palpable Achilles tendon gap?
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Comments
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Molder’s squeeze test positive?
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Comments
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Imaging and Labs
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Ankle X-Ray?
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Ankle X-Ray Views
• • •
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Comparison
• • •
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Comparison Date and Comments
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Normal Findings
• • •
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Normal Comments
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Abnormal Findings
• • •
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Abnormal Comments
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Impression:
• • •
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Comments:
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Foot X-Ray?
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Foot X-Ray Views
• • •
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Comparison
• • •
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Comparison Date and Comments
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Normal Findings
• • •
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Normal Comments
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Abnormal Findings
• • •
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Abnormal Comments
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Impression:
• • •
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Comments:
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Toe(s) X-Ray?
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Toe(s) X-Ray Views
• • •
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Toe(s) Comparison
• • •
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Comparison Date and Comments
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Normal Toe(s) Findings
• • •
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Normal Comments
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Abnormal Toe(s) Findings
• • •
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Abnormal Comments
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Impression
• • •
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Comments:
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Calcaneous X-Ray?
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Calcaneous X-Ray Views
• • •
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Comparison
• • •
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Comparison Date and Comments
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Normal Findings
• • •
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Normal Comments
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Abnormal Findings
• • •
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Abnormal Comments
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Impression:
• • •
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Comments:
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Ultrasound Utilized?
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Ultrasound Comments:
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