What are the key components to document during an ankle exam?

From the Guidelines

A comprehensive ankle examination should include inspection, palpation, range of motion assessment, special tests, neurovascular evaluation, and functional testing, as outlined in the most recent guidelines 1. When documenting an ankle exam, it is essential to include the following key components:

• Inspection for swelling, bruising, deformity, and skin changes, noting any asymmetry compared to the unaffected side
• Palpation of key anatomical structures, including the medial and lateral malleoli, anterior talofibular ligament, calcaneofibular ligament, deltoid ligament, Achilles tendon, and peroneal tendons to identify areas of tenderness or abnormality
• Assessment of active and passive range of motion in all planes (dorsiflexion, plantarflexion, inversion, and eversion), comparing to the contralateral side and noting any pain or limitations
• Special tests, such as the anterior drawer test and talar tilt test, to evaluate ligamentous stability
• Neurovascular assessment, including checking sensation in the foot's dermatomes, testing muscle strength in all ankle movements, and assessing distal pulses
• Functional testing, including observation of the patient's gait and ability to perform functional movements like heel walking, toe walking, and single-leg stance This systematic approach ensures thorough documentation of ankle pathology and helps differentiate between ligamentous injuries, fractures, tendinopathies, and other conditions affecting the ankle joint, as recommended by the most recent guidelines 1. The most recent study 1 provides the highest quality evidence for the key components of an ankle examination, and its recommendations should be prioritized in clinical practice. Key points to consider when documenting an ankle exam include:
• The importance of inspecting the ankle for signs of injury or abnormality
• The need to palpate key anatomical structures to identify areas of tenderness or abnormality
• The value of assessing range of motion and performing special tests to evaluate ligamentous stability
• The importance of including a neurovascular assessment and functional testing in the examination
• The need to prioritize the most recent and highest quality evidence when determining the key components of an ankle examination, as outlined in the study 1.

From the Research

Key Components of an Ankle Exam

The key components to document during an ankle exam include:

• Inspection: visual examination of the ankle to identify any swelling, bruising, or deformity 2, 3
• Palpation: feeling the ankle to identify any areas of tenderness or pain 2, 3
• Range of motion: assessing the movement of the ankle joint 2, 3
• Special tests: performing specific tests to assess the stability and function of the ankle joint, such as the anterior drawer test and the talar tilt test 2, 4
• Evaluation of the patient's gait: observing the patient's walking pattern to identify any abnormalities or limitations 5
• Assessment of the patient's symptoms: reproducing the patient's symptoms to make a correct diagnosis 5

Anatomical Considerations

It is important to have a thorough understanding of the bony, ligamentous, and musculotendinous anatomy of the ankle, as well as the biomechanics of the joint and the mechanisms of injury 6. This knowledge is essential for accurately assessing ankle injuries and developing an effective treatment plan.

Diagnostic Considerations

A broad differential diagnosis should be considered when evaluating ankle disorders, including disorders of bones, joints, muscles, neurovasculature, and surrounding soft tissue structures 3. The examination should be thorough and focused on identifying the underlying cause of the patient's symptoms.