Physical Examination of Ankle

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

Physical Examination of the Ankle is inspected for deformities, swelling, skin discoloration, muscle atrophy, and asymmetry with the opposite side. The lower leg muscles are inspected for atrophy. Sensation to light touch is tested, at minimum, on the top of the first webbed space and the side of the foot. The dorsal pedal pulse is palpated over the anterior foot, and the posterior tibial pulse...

Key Takeaways

  • 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.
  • This article explains Strength in simple medical language.
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Definition

Physical Examination of the Ankle is inspected for deformities, , , muscle , and asymmetry with the opposite side. The lower leg muscles are inspected for atrophy. Sensation to light touch is tested, at minimum, on the top of the first webbed space and the side of the foot. The dorsal pedal pulse is palpated over the anterior foot, and the posterior tibial pulse is palpated behind the medial malleolus.

The physical exam is of crucial importance for the evaluation of painful conditions of the foot and ankle. These disorders are very common in the 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.

The ankle is gently felt for warmth and to detect subtle swelling. Comparison to the unaffected side is useful. Palpation for is done over the bones and then the major . Touching only the bone, and then only the , can help distinguish bony from ligamentous injury.

Laterally, palpation includes the tip of the lateral malleolus, the , and the three lateral ligaments: anterior talofibular, posterior talofibular, and fibulocalcaneal. Because an inversion injury of the ankle can the proximal fibula, the proximal fibula is palpated. The base of the 5th is also palpated.

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

Inspection

  • Skin
    • Color: , ecchymosis, white, black
    • Trophic changes (altered hair growth, sweat production)
    • Scars
    • Pressure sores, calluses, blisters
    • Bunions, hammertoes, claw toes, calluses
  • Toenails
  • Swelling or Joint effusion
  • Muscle tone: atrophy,
  • Deformity: asymmetry, rotation,
  • 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
    • 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
    • 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
    • Dorsalis Pedis Artery
    • Posterior Tibial Artery
    • refill on toes

Special Tests

  • General
    • Ottawa Ankle Rules
  • Peroneal 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
    • Squeeze Test
    • Anterior Drawer Test Ankle
    • Talar Tilt Test
    • Anterolateral Drawer Test Ankle
  • Medial Ankle Sprain
    • External Rotation
    • 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
    • Tinels Test
    • Dorsiflexion Eversion Test
    • Triple Compression Stress Test
  • Hindfoot Deformity
    • Coleman Block Test
    • Dynamic Coleman Block Test
  • Calf
    • Silfverskiold Test
  • Upper Motor Neuron Disease
    • Oppenheims Test
    • Babinskis Response
    • Windlass Test
  • Anterior Ankle Impingement Syndrome
    • Ankle Impingement Sign
  • Foot Pronation
    • Navicular Drop Test
  • Posterior Ankle Impingement Syndrome
    • Plantar Flexion Test

Different types of abnormal gaits

Type of the gait Physical findings and observations Possible cause
Antalgic gait The short stance phase of the affected side Decrease of the swing phase of the normal side on weight-bearing could be any reason from Back pathology to a toe problem, e.g., degenerative
Ataxic (stamping) gait Unsteady and uncoordinated walk with a wide base Cerebral cause Tabes dorsalis
Equinus (tiptoes) gait Walking on tiptoes Weak dorsiflexion and/or plantar contractures
Equinovarous gait Walking on the out border of the foot CETV
Hemiplegic (circumduction) gait Moving the whole leg in a half-circle path Spastic muscle
Rocking horse (gluteus maximum) gait The body shifts backward at heel strike then move forward Weak or hypotonic gluteus maximum
Quadriceps gait The body leans forward with hyperextension of the knee in the affected side or pathology
Scissoring gait One leg crosses over the other 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 both Leg length discrepancy
Steppage gait (high stepping – slapping – foot drop) No heel strike The foot lands on the floor with a sound like a slap Foot drop Polio Tibialis anterior dysfunction
Trendelenburg (lurching) gait Trunk deviation towards the normal side When the foot of the affected side leaves the floor, the pelvis on this side drops Weak gluteus medius
Waddling gait Lateral deviation of the trunk with an exaggerated elevation of the hip Muscular dystrophy

Examination techniques of muscles functions[]

Muscle Ankle position Manoeuvre of the test
Tibialis Anterior Maximum Dorsiflexion and inversion Try 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 posterior Plantar flexion and inversion The 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 brevis Plantar flexion and eversion The 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 longus Neutral The patient extends the great toe and the examiner try to plantarflex it
Extensor digitorum longus Neutral The patient extends the lesser toes toe and the examiner try to plantar flex it
Flexor hallucis longus and flexor digitorum longus Neutral The patient curls the toes downward and the examiner tries to dorsiflex them1
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Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider
Tests to discuss with doctor
  • Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
  • Relevant blood, urine, imaging, or specialist tests only after clinical assessment
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Physical Examination of Ankle

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.