Physical Examination of Ankle

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 6 min read
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Article Summary

The physical exam is of crucial importance for the clinical evaluation of painful conditions of the foot and ankle. These disorders are very common in the outpatient setting, both among professional athletes and recreational exercisers. It is important to be familiar with some basic maneuvers and physical signs necessary to assess the presence and the severity of lesions in the osteo-ligamentous structures of the foot....

Key Takeaways

  • This article explains Introduction in simple medical language.
  • This article explains Inspection in simple medical language.
  • This article explains Palpation in simple medical language.
  • This article explains Range of Motion in simple medical language.
Educational health guideWritten for patient understanding and clinical awareness.
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Use this article to understand possible causes, tests, treatment options, prevention, and questions to ask your clinician.

The physical exam is of crucial importance for the clinical evaluation of painful conditions of the foot and ankle. These disorders are very common in the outpatient setting, both among professional athletes and recreational exercisers. It is important to be familiar with some basic maneuvers and physical signs necessary to assess the presence and the severity of lesions in the osteo-ligamentous structures of the foot.

  • A physical exam should be performed with shoes and socks removed
  • Ideally, there is a weight-bearing component and a seated component

Introduction

  • Follows the IP-PASS examination methodology
    • Inspection
    • Palpation
    • Passive Range of Motion
    • Active Range of Motion
    • Strength & Neurovascular
    • Special Tests

Inspection

  • Skin
    • Color: allergy, infection, or inflammation. সহজ বাংলা: চামড়া লাল হয়ে যাওয়া।" data-rx-term="erythema" data-rx-definition="Erythema means skin redness, often from irritation, allergy, infection, or inflammation. সহজ বাংলা: চামড়া লাল হয়ে যাওয়া।">erythema, ecchymosis, white, black
    • Trophic changes (altered hair growth, sweat production)
    • Scars
    • Pressure sores, calluses, blisters
    • Bunions, hammer toes, claw toes, calluses
  • Toenails
  • Swelling or Joint effusion
  • Muscle tone: atrophy, hypertrophy
  • Deformity: asymmetry, rotation, amputation
  • Areas of emphasis for foot and ankle exam exam
    • Look at patients shoes (wear pattern, arch support, etc)
    • Gait examination and evaluation (consider normal, walking on insides and outsides of feet, heel and toe-walk, tandem, running)
    • Arch (Pes Cavus or Pes Planus)
    • Ankle alignment (posteriorly)
    • Knee alignment

Palpation

  • Palpate for
    • Effusion
    • Clicking
    • Snapping
    • Crepitus
    • pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।" data-rx-term="tenderness" data-rx-definition="Tenderness means pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।">Tenderness
    • Temperature
    • Masses
  • Ankle Areas of Emphasis
    • Posterior aspect of medial and lateral malleolus
    • Lateral Ankle Ligaments: ATFL, CFL, PTFL
    • Medial Ankle Ligaments: Deltoid Ligament
    • Achilles Tendon and insertion
  • Foot Areas of Emphasis
    • Navicular
    • Lisfranc Joint
    • Base of 5th metatarsal

Range of Motion

  • Ankle
    • Dorsiflexion: 20-30°
    • Plantarflexion: 40-50°
    • Pronation: 30°
    • Supination: 60°
  • Foot
    • Inversion: 35°
    • Eversion: 25°
  • Metatarsophalangeal joints
    • Flexion: 30°
    • Extension: 80°
  • Interphalangeal joints of toes
    • Flexion: 50°
    • Extension: 50°

Strength

  • Ankle
    • Plantarflexion: Gastrocnemius, Soleus, Plantaris, Tibialis Posterior, Fibularis Longus
    • Dorsiflexion: Tibialis Anterior, Extensor Hallucis Longus, Extensor Digitorum Longus
    • Eversion: Fibularis Longus, Fibularis Brevis
    • Inversion: Tibialis Posterior
  • Great Toe
    • Extension: Extensor Hallucis Brevis, Extensor Hallucis Longus
    • Flexion: Flexor Hallucis Longus, Abductor Hallucis, Flexor Hallucis Brevis
    • Abduction: Abductor Hallucis
    • Adduction: Adductor Hallucis
  • Toes 2-4
    • Extension: Extensor Digitorum Brevis, Extensor Digitorum Longus, Lumbricals
    • Flexion: Flexor Digitorum Longus, Flexor Digitorum Brevis, Abductor Digiti Minimi, Quadratus Plantae, Lumbricals, Flexor Digiti Minimi Brevis
    • Abduction: Abductor Digiti Minimi, Dorsal Interossei
    • Adduction: Plantar Interossei

Neurovascular

  • Sensory Nerves
    • L4: Lateral thigh, anterior knee, medial leg
    • L5: Lateral leg, dorsal foot
    • S1: Posterior Leg
    • S2: Plantar foot
  • Dermatome
    • Needs to be updated
  • Reflexes
    • Patellar (L3, L4)
    • Achilles (S1, S2)
  • Myotomes:
    • L4: Knee Extension, Dorsiflexion
    • L5: Hip Abduction, Hip Extension, Toe Dorsiflexion, Foot Inversion, Dorsiflexion
    • S1 Foot Version, Plantarflexion
    • S2: Toe Plantar Flexion
  • Vascular:
    • Popliteal Artery
    • Dorsalis Pedis Artery
    • Posterior Tibial Artery
    • Capillary refill on toes

Special Tests

  • General
    • Ottawa Ankle Rules
  • Peroneal Tendon Injuries
    • Peroneal Tunnel Compression Test
  • Achilles Tendon Rupture
    • Thompson Test
    • Matles Test
    • Hyper Dorsiflexion Sign
    • Copelands Test
    • Obriens Needle Test
    • Achilles Palpation Test
  • Posterior Tibial Tendon Dysfunction
    • Too Many Toes Sign
    • Single Limb Heel Rise
  • Lateral Ankle Sprain
    • Squeeze Test
    • Anterior Drawer Test Ankle
    • Talar Tilt Test
    • Anterolateral Drawer Test Ankle
  • Medial Ankle Sprain
    • External Rotation Stress Test
    • Abduction Stress Test
    • Eversion Test
    • Anterior Drawer Test Ankle
  • Syndesmotic Injury
    • Squeeze Test
    • External Rotation Stress Test
    • Cotton Test
    • Fibular Translation Test
    • Crossed Leg Test
    • Stabilization Test
    • Forced Dorsiflexion Test
    • Syndesmotic Palpation Test
  • Peroneal Nerve Injury
    • Tinels Test
  • Tarsal Tunnel Syndrome
    • Tinels Test
    • Dorsiflexion Eversion Test
    • Triple Compression Stress Test
  • Hindfoot Deformity
    • Coleman Block Test
    • Dynamic Coleman Block Test
  • Calf tendon. সহজ বাংলা: মাংসপেশি/টেনডনে টান।" data-rx-term="strain" data-rx-definition="A strain is injury to a muscle or tendon. সহজ বাংলা: মাংসপেশি/টেনডনে টান।">Strain
    • Silfverskiold Test
  • Upper Motor Neuron Disease
    • Oppenheims Test
    • Babinskis Response
  • Plantar Fasciitis
    • Windlass Test
  • Anterior Ankle Impingement Syndrome
    • Ankle Impingement Sign
  • Foot Pronation
    • Navicular Drop Test
  • Posterior Ankle Impingement Syndrome
    • Plantar Flexion Test

Examination techniques of muscles functions[]

MuscleAnkle positionManoeuvre of the test
Tibialis AnteriorMaximum Dorsiflexion and inversionTry to plantarflex the ankle with your hand and ask the patient to resist, use your second hand on the tendon to feel the contraction
Tibialis posteriorPlantar flexion and inversionThe patient inverts the foot in full plantar flexion whilst the examiner pushes laterally against the medial border of the patient’s foot (in an attempt to evert the foot). The examiner needs to use a second hand on the tendon to feel the contraction
Peroneal longus and peroneal brevisPlantar flexion and eversionThe patient everts the foot in full plantar flexion and the examiner pushes medially against the lateral border of the patient’s foot (in an attempt to invert the foot)
Extensor hallucis longusNeutralThe patient extends the great toe and the examiner tries to plantarflex it
Extensor digitorum longusNeutralThe patient extends the lesser toes toe and the examiner tries to plantarflex it
Flexor hallucis longus and flexor digitorum longusNeutralThe patient curls the toes downward and the examiner tries to dorsiflex them1

Different types of abnormal gaits

Type of the gaitPhysical findings and observationsPossible cause
Antalgic gaitThe short stance phase of the affected side Decrease of the swing phase of the normal sidePain on weight-bearing could be any reason from Back pathology to a toe problem, e.g., degenerative hip joint
Ataxic (stamping) gaitUnsteady and uncoordinated walk with a wide baseCerebral cause Tabes dorsalis
Equinus (tiptoes) gaitWalking on tiptoesWeak dorsiflexion and/or plantar contractures
Equinovarous gaitWalking on the out border of the footCETV
Hemiplegic (circumduction) gaitMoving the whole leg in a half-circle pathSpastic muscle
Rocking horse (gluteus maximum) gaitThe body shift backward at heel strike then move forwardWeak or hypotonic gluteus maximum
Quadriceps gaitThe body leans forward with hyperextension of the knee in the affected sidepain, numbness, tingling, or weakness. সহজ বাংলা: নার্ভ রুট চাপা/জ্বালায় ব্যথা বা অবশভাব।" data-rx-term="radiculopathy" data-rx-definition="Radiculopathy means nerve-root irritation or compression causing pain, numbness, tingling, or weakness. সহজ বাংলা: নার্ভ রুট চাপা/জ্বালায় ব্যথা বা অবশভাব।">Radiculopathy or spinal cord pathology
Scissoring gaitOne leg crosses over the otherBilateral spastic adductors
Short leg (Equinus) gait (more than 3 cm)Minimum: Dropping the pelvis on the affected side Moderate: Walks on forefoot of the short limb Severe: Combination of bothLeg length discrepancy
Steppage gait (high stepping – slapping – foot drop)No heel strike The foot lands on the floor with a sound like a slapFoot drop Polio Tibialis anterior dysfunction
Trendelenburg (lurching) gaitTrunk deviation towards the normal side When the foot of the affected side leaves the floor, the pelvis on this side dropsWeak gluteus medius
Waddling gaitLateral deviation of the trunk with an exaggerated elevation of the hipMuscular dystrophy

Correlations between the anatomical site of the pain and the possible underlying causes[]

Location of painCommon possible pathology
Anterior ankle painDegenerative diseaseImpingement
Ankle joint capsule injury ex. Sports injury with maximum ankle joint plantarflexion
Medial pain below the medial malleolusSinus tarsi syndrome Subtalar degenerative changes Tarsal coalition of mid facetSpring ligament or deltoid ligament pathology Tibialis posterior pathology or medial impingement
Postero-medial painTibialis posterior tendonitisFlexor hallucis longus Tarsal tunnel syndrome
Posterior painAchilles tendinopathy Posterior impingementOs trigonum pathology
Postero-lateral painPeroneal tendon
Lateral painStress fracture of distal fibula ATFL injury Lateral impingementSinus tarsi syndrome Subtalar pathology Calcaneal fracture malunion
Heel painPlantar fasciitis Calcaneal stress fracture Entrapment of the first branch of lateral plantar nerveFat pad atrophy/contusion Tarsal tunnel syndrome Foreign body reaction Plantar fascia rupture
Midfoot painDegenerative disease Post-traumatic arthritisTarsal bones stress fracture Ligament injury ex Lisfranc injury Insertional tendinopathy of peroneal brevis
Forefoot painMetatarsalgia Morton neuropathy Stress fracture Freiberg diseaseMetatarsophalangeal joint synovitis Nail pathology
Forefoot pain – big toeHallux valgus/rigidus Inflamed bunionSesamoiditis Sesamoid fracture
Forefoot pain – 2nd, 3rd, and 4th toeClaw toe HammertoeMallet toe
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