Foot and ankle history and clinical examination: A guide to everyday practice

Table 7 Examination techniques of performing the foot and ankle special tests[2,3,9,10]

Name of the test	Purpose of the test	Maneuver
Anterior drawer test	Lateral ligament complex	The leg hangs loosely off the table The examiner hold the patient’s leg just above the ankle joint with one hand The examiner uses the other hand to hold the ankle in plantar flexion and try to gently to pull the ankle forward - anterior translation (Figure 6) Look at the skin over the anterolateral dome of the talus to watch for anterior motion of the talus with this maneuver - sulcus sign
Inversion stress test	Stability of the lateral ankle ligaments (ATFL)	The knee is flexed 90 degree With one hand perform inversion stress by pushing the calcaneus and talus into inversion while holding the leg form the medial side with the other hand (Figure 7) The test is positive when there is excessive inversion and/or pain
Calf compression or “squeeze” test	Syndesmotic injury	The leg hangs loosely off the table - knee flexed The examiner uses both hand to squeeze at midpoint of the tibia and fibula Pain caused by this maneuver indicates Syndesmotic injury
External rotation stress	Syndesmotic injury	The leg hangs loosely off the table - knee flexed and foot fully dorsiflexed The examiner uses one hand to stabilize the lower leg With the other hand they externally rotate the foot Pain caused by this maneuver indicates Syndesmotic injury
Coleman block test	To assess the flexibility of the hindfoot, i.e., whether the cavus foot is caused by the forefoot or the hindfoot	A block is placed under the lateral border of the patients foot The medial forefoot is allowed to hang over the side The first metatarsal will be able to drop below the level of the block, i.e., eliminate the contribution by the first ray (Figure 8) With a flexible hindfoot, the heel will fall into valgus or neutral termed forefoot-driven hindfoot varus In case of rigid hindfoot or hindfoot-driven hindfoot varus the heel will remain in varus, and no correction will be happen
Semmes-weinstein monofilament test	To assess the degree of sensory deficit	Pressure testing using a 10 g Semmes-Weinstein mono- filament. Especially useful in diabetic charcot feet (Figure 9)