How to assess ankle strength
Previous TopicAssess function at the ankle
- Ask the person to stand up on their toes ten times (they can hold on to something for support if needed)
- Can the person put their toes up onto a small step?
If the person is unable to independently perform each movement with full strength, assess all individual foot and ankle movements on both sides using the MRC muscle power test.
Assess function at the ankle by asking the person to stand on their toes ten times
Assess function at the ankle by asking person to touch toes onto small step
Read on to learn how to assess strength of individual movements at the ankle.
How to assess ankle dorsiflexion strength
Positioning of person:
- For grade 0-2 (gravity eliminated): person in side-lying with side being tested on top, knee extended, ankle in neutral position
- For grade 3-5: person in seated position, with ankle hanging off the ground
Clinician positioning and handling:
- For grade 0-2: support the ankle above the other ankle or bed. To test the opposite side, move to the other side of the bed
- For grade 3-5: clinician kneeling on the test side. Support the ankle. Apply resistance downwards to top of foot
Instructions for person:
- ‘Please bend your foot towards the front of your leg’
Watch these videos to learn how to assess ankle dorsiflexion strength:
Assess ankle dorsiflexion strength grade 0-2
Assess ankle dorsiflexion strength grade 3-5
How to assess ankle plantarflexion strength
Positioning of person
-
For grade 0-2 (gravity eliminated): person in side-lying with side being tested on top, knee extended and ankle in neutral position -
For grade 3-5: person in standing position, holding on to stable object for support
Clinician positioning and handling:
-
For grade 0-2: support the ankle and foot. To test the opposite side, move to the other side of the bed -
For grade 3-5: clinician observing from lateral test side
NOTE: Testing for grade 3-5 ankle plantarflexion is different than most other movements. The person is asked to perform a single leg heel raise. Strength can be graded as follows:
Grade 3: Active movement for 1 repetition
Grade 4: active movement for 2-3 repetitions
Grade 5: active movement for at least 4-5 repetitions
Instructions for person:
- For grade 0-2: ‘Point your toes away from your head’
- For grade 3-5: ‘On one leg only, lift your heel off the ground and stand up on your toes five times, or as many times as you can’
Watch these videos to learn how to assess ankle plantarflexion strength:
Assess ankle plantarflexion strength grade 0-2
Assess ankle plantarflexion strength grade 3
Assess ankle plantarflexion strength grade 4-5
Activity
Practice performing each of the muscle strength assessments with a colleague for:
- Ankle dorsiflexion
- Ankle plantarflexion
Practice assessing in gravity eliminated and against gravity positions.
Time: 10 minutes
Post any questions on the discussion forum.
Congratulations, you have now learnt how to assess muscle strength for the foot and ankle.
Learning how to properly assess muscle strength for each movement will take time so we encourage you to practice assessing each movement in your own time as well as in this module.
Summary
- It is important to be aware of the contraindications and precautions to assessing muscle strength
- The subjective assessment can help indicate the movements that need to be assessed
- Observing the person can give you information about the movements and activities a person has difficulty with
- Where possible, the person’s ability to perform functional movements should be assessed
- There are different functional movements that can be assessed for each area of the body
- If a person cannot perform a functional movement independently with full strength, the strength of individual movements should be assessed
- Individual movements should be assessed using the MRC Muscle Power Test
- The positioning of the person and the clinician will depend on the movement and grade being assessed
You have completed lesson 2!
If you have any questions or comments, post them on the discussion forum.
Lesson 2 quiz
Please complete the following quiz before moving on to the next lesson:
Quiz
1. If someone is unable to perform 5 ‘sit to stands’, what should you do?
- a. Move on to assessing knee function
- b. Assess individual movements of the hip and also assess transfers and mobility
- c. Stop assessment as the person is not suitable for muscle strength assessment
- d. Ask the person to perform the sit to stands again until they can perform 5
If you selected b, you are correct.
If a person is unable to do 5 sit to stands you should assess the individual movements at their hip, and you should also assess their transfers and mobility.
2. You assess a person’s knee extension strength as being 3/5, what position would you have assessed that person in?
- a. Side-lying
- b. Lying on back
- c. Sitting
- d. Lying on stomach
If you selected c, you are correct.
As the person has been assessed as having 3/5 knee extension strength, this means they can move the knee against gravity, so the person must have been sitting when assessed.
3. How do you know whether you should assess a person’s individual shoulder movements?
- a. If they cannot grip an object with full strength
- b. If they cannot move from a lying position to a seated position
- c. If they cannot bend their elbow
- d. If they cannot put their hand behind their head
If you selected d, you are correct.
Reaching a hand behind the head is a functional assessment for shoulder strength. If a person cannot perform this movement, you should assess the strength of individual shoulder movements.
4. If, on assessment, a person can perform ankle dorsiflexion against gravity, you should then apply resistance to the movement and assess strength?
- a. True
- b. False
If you selected a, you are correct.
If a person can perform ankle dorsiflexion against gravity, you should then assess against resistance.
5. Should the person ‘push through’ pain when you are assessing muscle strength?
- a. Yes
- b. No
If you selected b, you are correct.
A person should not be experiencing any pain during muscle strength assessment. You should advise the person before they begin assessment that they should stop the movement if they experience pain.
