Foot and ankle tests
Thompson's test
The Thompson test examines the integrity of the achilles tendon by squeezing the calf. It is performed as a clinical test to identify the presence of a complete Achilles Rupture.
Patient position:
The patient lies prone with his foot over the end of the table or he can also lie prone with his knee flexed to 90°.
Therapist position:
Standing next to the patient, near the leg to test.
Action of the test:
The examiner squeezes the calf muscles, more specific the gastrocnemius - soleus complex, with his hand. By squeezing the calf the achilles tendon should normally contract resulting in plantar flexion.
Positive result:
If the achilles tendon is completly ruptured, there won’t be any plantar flexion visible. But there is a hidden snag: the m. plantaris and deep toe flexors can also provide plantar flexion. To be sure that the patient has a complete achilles tendon rupture there a 4 clinical signs that indicate this clinical view:
1.on careful inspection with the patient prone and both ankles fully relaxed, the foot on the ruptured side hangs straight down due to the absence of the tendon tone.
2.there may be a palpable gap in the tendon, approximately 3-6cm proximal to the insertion into the calcaneus.
3.the strength of the plantar flexion is markedly reduced .
4.Simmond’s calf squeeze test is positive.
Tinnel's test
Tinel's sign is a way to detect irritated nerves
Patient position:
Lying in supine.
Therapist position:
Standing next to the patient, near his foot.
Action of the test:
It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve.
Positive result:
The test is positive when there is pressure neuropathy of the nerve in the foot or ankle. When the nerve is not trapt behind a structure there will be a negative test and the patient will feel no pain. On the opposite when the nerve is trapt the patient will feel tingling’s in the distal area.
Knock test
Patient position:
The patient lies supine, with his foot over the end of the table.
Therapist position:
Standing next to the patient, near the leg to test.
Action of the test:
The therapist puts the patient's ankle at maximum dorsiflexion in order to obtain as congruent as possible. Then he applies a strong knock over the heel of the patient.
Positive result:
If the patient feels pain in the heel, can be because of a calcaneous fracture.
Special considerations:
This test shouldn't be done if there are evident deformities.
Subastragalar inclination test (eversion)
This test is used to asses tibio-calcaneus ligaments.
Patient position:
Patient is supine with the ankle in neutral position.
Therapist position:
The therapist is placed close to patient´s foot being evaluated holding with one hand tibia and fibula bones and foot with the other hand.
Action test:
The therapist bends patient´s foot towars lateral body line performingn an eversion.
Resultado positivo:
Test is positive if excesive eversion is shown.
Subastragalar inclination test (inversion)
This test is used to assess heel bone-fibula ligaments.
Patient position:
Patient is supine with ankle in neutral position.
Therapist position:
The therapist is placed close to foot to be evaluated and holding tibia and fibula bones with one hand and foot with the other hand.
Action test:
The therapist bends patient´s foot towards medial body line performing an inversion.
Positive result:
Test is positive if excessive inversion is shown.