Ankle Pain: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
  • Inspection (viewing).
    • Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
    • Gait (fluid, limping).
    • Body or joint posture (upright, bent, gentle posture).
    • Malpositions (deformities, contractures, shortenings).
    • Muscle atrophies (side comparison!, if necessary circumference measurements).
    • Ankle joint [abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment].
  • Palpation (palpation) of prominent bone points, tendons, ligaments; musculature; [joint (joint effusion); soft tissue swelling; tenderness (localization!)]
  • Measurement of joint mobility and range of motion of the ankle joint(according to the neutral zero method: the range of motion is given as the maximum deflection of the joint from the neutral position in angular degrees, where the neutral position is designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first.)Comparison measurements with the contralateral joint (side-to-side comparison) can reveal even small lateral differences.
    • Upper ankle joint (OSG):
      • Dorsiflexion (flexion in the direction of the dorsum of the foot) of the foot up to 20°.
      • Plantar flexion (flexion in the direction of the sole of the foot) of the foot up to 30°.
    • Lower Ankle Joint (USG):
      • Supination (lifting the medial (toward the center) edge of the foot while lowering the lateral edge of the foot) up to 50°.
      • Pronation (lifting of the lateral (to the side) foot edge with simultaneous lowering of the medial foot edge) up to 30°.
      • Inversion (supination and plantar flexion and adduction (bringing a body part to the body or limb axis) together).
      • Eversion (pronation and dorsal extension and abduction (lateral displacement of a body part from the center of the body) together).
    • Assessment of blood flow, motor function and sensitivity:
      • Circulation (palpation of pulses).
      • Motor function: testing of gross strength in lateral comparison.
      • Sensibility (neurological examination)
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.