Lower limb examination

Question 1

What is involved in inspection during the LL exam?

Answer 1

Look for:

Wasting (due to LMN lesion, motor neurone disease, neuropathy)

Fasciculations

Deformity or abnormal posture

Involuntary or abnormal movements

Question 2

How do we assess gait in the LL exam?

Answer 2

Ask patient to walk normally

Ask patient to walk heel-toe followed by walking on their toes then their heels

Ask patient to squat and then stand up

Romberg’s test (feet together then eyes closed)

Question 3

How do we assess for tone in the UL exam?

Answer 3

Assess knee tone by rapid flexion

Assess ankle clonus by rapid dorsiflexion

Comment on tone (normal, hypotonic, hypertonic)

Question 4

How do we assess for power in the LL exam?

Answer 4

Hip flexion, extension, abduction, adduction

Knee flexion and extension

Ankle plantarflexion and dorsiflexion

Feet eversion and feet inversion

Comment on power (score 0-5, 0 = paralysis, 5= normal)

Question 5

What reflexes are assessed in the LL exam?

Answer 5

Knee reflex

Ankle reflex

Babinski reflex

Question 6

How do we assess for coordination and RAM in the LL exam?

Answer 6

Ask patient to move heel of foot to knee and down the shin, can add toe to finger movement as well

Ask patient to rapidly tap soles of foot on hand, alternating between each foot

Question 7

How do we test sensation in the LL exam?

Answer 7

Light touch using cotton ball

Pain using blunt/sharp tip

Joint position using tuning fork on MTP of big toe

Ensure you cover the correct dermatomes

L2: pocket area
L3: front of knee
L4: medial thigh/medial malleolus
L5: lateral thigh/3rd MTP joint/dorsum of foot
S1: heel and sole.
S2: popliteal fossa