Physical exam is critical for diagnosing ankle and foot injuries. It’s easy to order the x-ray and rely on a radiologist to make the diagnosis for you, but there are a few ‘can’t miss’ things to evaluate for on the physical examination.
One such injury is an Achilles tendon rupture. Anyone who presents with ankle or foot pain should have the presence of an intact Achilles tendon documented in the chart. Patients may report hearing a popping sound when the rupture occurs, but that makes it too easy. Most of these will be found and diagnosed on the exam.
Achilles Tendon Palpation
To assess for Achilles tendinopathy, palpate the entire length of the tendon moving downwards. Identify any swelling, defects or tenderness. There will often be bruising or ecchymosis over the area of the tendon.
Squeeze Test or Thompson’s Test
To confirm a suspected rupture, have the patient lay prone and then squeeze the calf while observing the foot. If there is plantar flexion of the foot, this means that the tendon is intact. Otherwise, a reduced or absent plantar flexion, when compared with the other side, is indicative of a tendon rupture.
Once the diagnosis is made, splint the leg in an equine position with the toes pointed slightly downwards, make the patient non weight-bearing, and have them follow up with an orthopedic surgeon.
