Calf, Ankle, And Foot Tests

Front 1

squeeze test (calf)

Back 1

This test is used to determine if a high ankle sprain (syndesmotic sprain) is present. The patient lies supine. The physician grasps the
patient’s leg and applies a medial pressure at mid-calf to the tibia and fibula between the palms of their hands. Localized pain is a positive finding (as long as fracture etc. has been ruled out). The test can also be performed over the malleoli.

Front 2

Homan's Sign

Back 2

This test is used to determine if a DVT is present in the calf. It is a
screening test, not a definitive test. While the patient is lying supine, and
the leg is extended, forcibly dorsiflexing the ankle will produce calf pain if
a DVT is present. Pain with squeezing the muscle belly of the involved
calf further supports the diagnosis.

Front 3

Thompson's (simmonds) test

Back 3

This test determines if there is a rupture of the Achilles tendon. It
is a screening test, not a definitive test. While the patient is lying prone, or
kneeling on a chair, gently squeeze the muscle belly of the involved calf.
A positive sign is a lack of plantar flexion at the ankle.

Front 4

Ankle Drawer Test

Back 4

This test determines if the anterior talo-fibular ligament is intact.
With the patient sitting on the edge of the exam table, place one hand on
the calcaneus and the other on the anterior aspect of the distal tibia. Your
thumb can rest on the dorsum of the foot. With the foot slightly plantar
flexed (200), apply an anterior directed force to the calcaneus and talus
with a simultaneous posterior directed force to the tibia. A positive test is
laxity or increased motion of the calcaneus and talus anteriorly.

Front 5

Talar Tilt

Back 5

This test is used to determine if the calcaneofibular ligament is
torn. The patient lies in the supine or side lying position with the foot
relaxed and the knee flexed. The foot is held in the normal anatomic
position and the talus is tilted from side to side into abduction and
adduction. Laxity with a valgus stress (abduction) indicates deltoid
ligament laxity. Laxity with a varus stress (adduction) indicates
calcaneofibular ligament laxity.

Front 6

Lateral Translation, Side-to-side, Cotton test

Back 6

This test determines if there was an injury to the distal
syndesmosis/interosseous membrane (IOM). While stabilizing the distal
tibia, and the ankle dorsiflexed, a side to side translation force is
introduced. Pain with this test indicates a high ankle sprain or
syndesmotic disruption.

Front 7

Kleiger, External Rotation Test

Back 7

This test determines if there was an injury to the distal
syndesmosis/interosseous membrane (IOM). The patient is seated with
the leg hanging over the examining table with the knee at 900. The
examiner faces the patient and holds the foot at 900 dorsiflexion. A
passive lateral rotation stress is applied to the foot and ankle. Pain over
the anterior or posterior talofibular ligaments with an external rotation
stress indicates a syndesmotic sprain.

Front 8

Metatarsal Compression Squeeze Test (morton's test)

Back 8

This test determines if an interdigital neuroma or stress fracture is
present. The patient’s foot is squeezed across the metatarsal heads, from
the lateral and medial sides. Reproduction of pain or paresthesias into the
toes is a positive test.

Front 9

Tinel's Sign

Back 9

This test indicates a compression neuropathy. The anterior tibial
branch of the deep peroneal nerve in front of the ankle or the tibial nerve
as it passes behind the medial malleolus may be tested. A tapping of the
nerve with the fingers or reflex hammer reproduces paresthesias or pain
in the nerves distribution.

Front 10

Too many toes sign

Back 10

This sign indicates that the patient has a severely weak or
ruptured tibialis posterior muscle. The physician crouches behind their
standing patient and observes the position of the patient’s feet. If the
tibialis posterior is weak, the hindfoot is in valgus, the tibia is laterally
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rotated, or the forefoot is abducted the involved foot will evert revealing
“too many toes” visible to the observer from behind when compared to the
other side.