Foot and Ankle Examination

Question 1

How do you position the patient?

Answer 1

Either standing or supine, with feet hanging over the end of the bed

Question 2

What do you look fo

Answer 2

Supine

• Nail changes, rashes, scars, wounds, calluses
• Swelling or muscle wasting ofd calf muscles
• Toes for clawing, joint swelling, hallux valgus
• Sole - callus formation over metatarsal heads

Check shoe for wear

Later Standing

• Toe allignment
• Foot arch position, dropped arch or high arch? If arch is flattened ask patients to stand on tip-toes. The mobile arch will resolve.
• Allignment of hindfoot
• Varus or valgus deformity
• Look for achilles tendon swelling or thickening

Question 3

What do you feel?

Answer 3

Temperature over forefoot, mid-foot and ankle.

Palpate for tenderness

Squeeze MTP joints

Palpate subtalar, midfoot, tarsal and ankle joints for tenderness

Pulse - dorsalis pedis and posterior tibial

Question 4

What do you move for the feet?

Answer 4

Active - dorsiflexion and plantar flexion at the ankle joint and big toe

Passive - Dorsiflexion and plantarflexion at the joint. Inversion and eversion at subtalar joint and mid-tarsal joint. Assess dorsiflexion and plantar flexion of the big toe

Question 5

How do you assess function?

Answer 5

Gait

Look for normal cycle of heel strike and toe off

Check for increased height of step, as in foot drop