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Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.00,0:00:02.06,Default,,0000,0000,0000,,English captions by Jade Cheng from the University of Michigan
Dialogue: 0,0:00:02.06,0:00:07.11,Default,,0000,0000,0000,,To ensure a thorough assessment, it is best\Nto perform the musculoskeletal exam of the
Dialogue: 0,0:00:07.11,0:00:09.05,Default,,0000,0000,0000,,ankle and foot in a systematic way.
Dialogue: 0,0:00:09.05,0:00:13.08,Default,,0000,0000,0000,,The following is a suggested order of examination\Nthat incorporates the common techniques for
Dialogue: 0,0:00:13.08,0:00:17.01,Default,,0000,0000,0000,,diagnosing ankle and foot injuries.
Dialogue: 0,0:00:17.01,0:00:19.08,Default,,0000,0000,0000,,Begin with the standing evaluation of the\Nfoot anatomy.
Dialogue: 0,0:00:19.08,0:00:25.01,Default,,0000,0000,0000,,Look for muscular atrophy, skin changes, or\Nanatomic variance, such as pes planus, pes cavus,
Dialogue: 0,0:00:25.01,0:00:32.08,Default,,0000,0000,0000,,or bunion formation.
Dialogue: 0,0:00:32.08,0:00:37.33,Default,,0000,0000,0000,,From a posterior view, observe for more than\Ntwo toes laterally, also called the 'too-many-toes'
Dialogue: 0,0:00:37.33,0:00:41.05,Default,,0000,0000,0000,,sign, which can indicate overpronation or\Nan abducted foot.
Dialogue: 0,0:00:41.05,0:00:44.65,Default,,0000,0000,0000,,Have a patient perform a toe raise and evaluate\Nfor heel positioning.
Dialogue: 0,0:00:44.65,0:00:50.47,Default,,0000,0000,0000,,Normally the heel should change from a neutral\Nto a varus position.
Dialogue: 0,0:00:50.47,0:00:54.05,Default,,0000,0000,0000,,Observe gait as the patient walks away from\Nand towards the examiner.
Dialogue: 0,0:00:54.05,0:01:04.03,Default,,0000,0000,0000,,Look for an antalgic gait or excessive pronation\Nor supination.
Dialogue: 0,0:01:04.03,0:01:06.47,Default,,0000,0000,0000,,Next evaluate active range of motion.
Dialogue: 0,0:01:06.47,0:01:14.00,Default,,0000,0000,0000,,If pain or limitation exists, repeat passive\Nrange of motion.
Dialogue: 0,0:01:14.00,0:01:23.60,Default,,0000,0000,0000,,First check dorsiflexion, plantarflexion,\Ninversion, eversion, great toe dorsiflexion,
Dialogue: 0,0:01:23.60,0:01:26.75,Default,,0000,0000,0000,,and great toe plantarflexion.
Dialogue: 0,0:01:26.75,0:01:39.01,Default,,0000,0000,0000,,Now check resisted strength with dorsiflexion,\Nplantarflexion, inversion, eversion, great
Dialogue: 0,0:01:39.01,0:01:45.78,Default,,0000,0000,0000,,toe dorsiflexion, and great toe plantarflexion.
Dialogue: 0,0:01:45.78,0:01:58.65,Default,,0000,0000,0000,,Palpate anatomic landmarks for tenderness:\Nthe calf belly; the Achilles tendon for Haglund's
Dialogue: 0,0:01:58.65,0:02:15.06,Default,,0000,0000,0000,,deformity; along the tibia, checking for any\Nareas of tenderness; the medial malleolus;
Dialogue: 0,0:02:15.06,0:02:30.06,Default,,0000,0000,0000,,the deltoid ligament; the tarsal tunnel; the\Nposterior tibial muscle and tendon; the navicular
Dialogue: 0,0:02:30.06,0:02:47.38,Default,,0000,0000,0000,,bone and tubercle; the fibula, including the\Nfibular head; the lateral malleolus; the anterior
Dialogue: 0,0:02:47.38,0:02:56.97,Default,,0000,0000,0000,,talofibular ligament; calcaneofibular ligament\Nand posterior talofibular ligament; the peroneal
Dialogue: 0,0:02:56.97,0:03:15.16,Default,,0000,0000,0000,,tendon; the talar dome; the calcaneus and\Ncalcaneal fat pad; the plantar fascia; the
Dialogue: 0,0:03:15.16,0:03:36.00,Default,,0000,0000,0000,,metatarsal heads; the base of the fifth metatarsal;\Nthe sesamoid bones; and the phalanges, or
Dialogue: 0,0:03:36.00,0:03:37.96,Default,,0000,0000,0000,,toes.
Dialogue: 0,0:03:37.96,0:03:42.07,Default,,0000,0000,0000,,Specific testing for the ankle and foot to\Nevaluate for injuries may include, but is
Dialogue: 0,0:03:42.07,0:03:45.09,Default,,0000,0000,0000,,not limited to, the following tests.
Dialogue: 0,0:03:45.09,0:03:51.11,Default,,0000,0000,0000,,The squeeze test evaluates for a syndesmotic\Nankle injury. With the foot dorsiflexed, the
Dialogue: 0,0:03:51.11,0:03:53.05,Default,,0000,0000,0000,,tibia and the fibula are squeezed together.
Dialogue: 0,0:03:53.05,0:03:54.09,Default,,0000,0000,0000,,Pain is a positive test.
Dialogue: 0,0:03:54.09,0:04:00.09,Default,,0000,0000,0000,,Kleiger's test also evaluates for a syndesmotic\Ninjury. With the knee fixed, the foot is dorsiflexed
Dialogue: 0,0:04:00.09,0:04:02.01,Default,,0000,0000,0000,,and externally rotated.
Dialogue: 0,0:04:02.01,0:04:07.08,Default,,0000,0000,0000,,Pain is a positive test.
Dialogue: 0,0:04:07.08,0:04:12.27,Default,,0000,0000,0000,,The anterior drawer test is for anterior talofibular\Nligament stability. With the foot slightly
Dialogue: 0,0:04:12.27,0:04:15.04,Default,,0000,0000,0000,,plantarflexed, brace the shin and pull the\Nheel anteriorly.
Dialogue: 0,0:04:15.04,0:04:21.95,Default,,0000,0000,0000,,Laxity or poor endpoint is a positive test\Nand indicative of anterior talofibular injury.
Dialogue: 0,0:04:21.95,0:04:27.00,Default,,0000,0000,0000,,The talar tilt test assesses for both anterior\Ntalofibular ligament and calcaneofibular ligament
Dialogue: 0,0:04:27.00,0:04:28.01,Default,,0000,0000,0000,,stability.
Dialogue: 0,0:04:28.01,0:04:32.00,Default,,0000,0000,0000,,With the foot slightly plantarflexed, brace\Nthe heel and invert the foot.
Dialogue: 0,0:04:32.00,0:04:35.00,Default,,0000,0000,0000,,Repeat on the opposite side and compare degrees\Nof inversion.
Dialogue: 0,0:04:35.00,0:04:39.02,Default,,0000,0000,0000,,Inversion of more than twenty three degrees,\Nor more than five degree difference, is a
Dialogue: 0,0:04:39.02,0:04:45.82,Default,,0000,0000,0000,,positive test and indicative of anterior talofibular\Nand calcaneofibular ligament injury.
Dialogue: 0,0:04:45.82,0:04:50.04,Default,,0000,0000,0000,,The calcaneal squeeze test evaluates for calcaneal\Ninjury, such as a stress fracture.
Dialogue: 0,0:04:50.04,0:04:52.09,Default,,0000,0000,0000,,Apply a compressive force on the calcaneus.
Dialogue: 0,0:04:52.09,0:04:55.04,Default,,0000,0000,0000,,Pain is a positive test.
Dialogue: 0,0:04:55.04,0:05:00.01,Default,,0000,0000,0000,,The midfoot torsion test assesses for midfoot\Ninjuries, such as Lisfranc sprain.
Dialogue: 0,0:05:00.01,0:05:02.92,Default,,0000,0000,0000,,Stabilize the hind foot and rotate the midfoot.
Dialogue: 0,0:05:02.92,0:05:05.03,Default,,0000,0000,0000,,Pain is a positive test.
Dialogue: 0,0:05:05.03,0:05:08.10,Default,,0000,0000,0000,,Mulder's test evaluates for Morton neuroma.
Dialogue: 0,0:05:08.10,0:05:12.06,Default,,0000,0000,0000,,The first and fifth metatarsal heads are grasped\Nand squeezed together.
Dialogue: 0,0:05:12.06,0:05:14.07,Default,,0000,0000,0000,,Pain or paresthesia is a positive test.
Dialogue: 0,0:05:14.07,0:05:19.01,Default,,0000,0000,0000,,If an audible click is heard, it's called\Na Mulder's sign and indicative of a fibrotic
Dialogue: 0,0:05:19.01,0:05:21.04,Default,,0000,0000,0000,,neuroma.
Dialogue: 0,0:05:21.04,0:05:25.08,Default,,0000,0000,0000,,Perform a Tinel's over the tarsal tunnel,\Nattempting to reproduce pain, numbness, or
Dialogue: 0,0:05:25.08,0:05:31.29,Default,,0000,0000,0000,,tingling caused by tarsal tunnel syndrome.
Dialogue: 0,0:05:31.29,0:05:36.00,Default,,0000,0000,0000,,In a prone position, Achilles tendon stability\Ncan be assessed using Thompson's test.
Dialogue: 0,0:05:36.00,0:05:40.45,Default,,0000,0000,0000,,Flex the knee to ninety degrees, squeeze the\Ncalf, and observe for plantarflexion of the
Dialogue: 0,0:05:40.45,0:05:41.00,Default,,0000,0000,0000,,foot.
Dialogue: 0,0:05:41.00,0:05:45.01,Default,,0000,0000,0000,,Absence of plantarflexion indicates Achilles\Ntendon rupture.
Dialogue: 0,0:05:45.01,0:05:49.04,Default,,0000,0000,0000,,In concluding the ankle and foot exam, it's\Nimportant to document neurovascular.
Dialogue: 0,0:05:49.04,0:05:55.80,Default,,0000,0000,0000,,Here we demonstrate dorsalis pedis pulse,\Nposterior tibial artery pulse, and capillary refill.
Dialogue: 0,0:05:55.80,0:05:59.01,Default,,0000,0000,0000,,Further neurovascular exam may be indicated\Nby history.
Dialogue: 0,0:05:59.01,0:06:00.33,Default,,0000,0000,0000,,Acknowledgement: The Japanese translation of this video was made as part of Shizuoka-University of Michigan Advanced Residency Training, Education and Research in Family Medicine (SMARTER FM) Project supported by Shizuoka Prefecture and funded by the Community Healthcare Revival Fund.