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Foot & Ankle examination

Follow the scheme below:

  • Inspection
  • Palpation  
  • Movement

Before starting

  • Introduce yourself
  • Ask permission to perform examination
  • Explain what the examination entails
  • Expose the patient appropriately - remove their shoes and socks and roll up trousers to the knees
  • Ask the patient to let you know if anything you do is uncomfortable
  • Remember - always watch the patients face 

Inspection

  • General observation
    • Does the patient look well?
    • Is there a walking stick? Frame?
    • Hands (Rheumatoid arthritis?)
    • Shoes - assymetrical wear? shoe raise? insoles?

Patient Standing

Remember to inspect from all sides (front, laterally and from behind):

  • Skin
    • Scars (previous injuries or surgical scars)
    • Sinuses
    • Colour - discolouration, bruising
    • Calluses
    • Ulcers
    • Hairlessness
  • Deformity of the toes
    • Hallux valgus
    • Claw toes
    • Hammer toes
    • Mallet toe
  • Toe nails
    • Ingrowing toe nails
    • Atrophic toe nails
  • Muscle wasting
  • Foot shape and position (see below)
  • Medial arch (obliterated in pes planus, exaggerated in pes cavus)
  • Hindfoot (observe from behind)
    • Varus (pes cavus)
    • Valgus (pes planus)

Patient Walking

  • Observe the patient walking. 
    • Gait pattern. There are different types of gait:
      • High stepping gait (foot drop)
      • Antalgic (ankle, hindfoot,or midfoot pain)
      • Short propulsive phase (forefoot pain)
    • Test ability to stand on tip toes and then on heels 

Foot shape

  • Normal
  • Flat foot - valgus heel, low arch, forefoot abducted and supinated.
  • High arched foot - plantar flexed first ray, high arch and forefoot pronation. In many cases the hindfoot is in varus
  • Skew foot - hindfoot valgus and forefoot adduction 
  • Metatarsus adductus - neutral hindfoot and adduction of forefoot

Patient Lying down - supine with one pillow under the head

Detailed check

  • Skin
    • Scars
    • Calluses
    • Bunions
    • Ulcers
    • Deformity - fixed flexion (gap between bed and knee)
  • Deformities

Palpation



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