Ankle and Foot Examination Flashcards
What can calluses indicate?
Calluses: thickened, hardened skin that develops as a result of repetitive friction which may be caused by poorly fitting footwear or a gait abnormality
Give some examples of toe abnormalities
Fixed flexion deformity of the toes: subtypes include hammer-toe and mallet-toe.
Big toe misalignment: note any evidence of lateral (hallux valgus/bunion) or medial (hallux varus) big toe angulation.
Explain the difference between pes planu and pes cavus
Foot arch: inspect for evidence of flat feet (pes planus) or an abnormally raised foot arch (pes cavus)
What can cause heel misalignment?
Heel misalignment: may be caused by a valgus or varus deformity of the ankle joint.
When palpating the achilles tendon what can focal tenderness or swelling suggest?
What can discontinuity in the tendon suggest?
Achilles tendon palpation
Palpate the gastrocnemius muscle and the Achilles tendon:
Note any focal tenderness or swelling suggestive of tendonitis.
Note any discontinuity in the tendon suggestive of rupture.
Describe simmonds test?
Simmonds’ test
Simmonds’ test is used to assess for clinical evidence of Achilles tendon rupture:
- Ask the patient to kneel on a chair with their feet hanging over the edge.
- Squeeze each of the patient’s calves in turn.
Interpretation
In healthy individuals, the foot should plantarflex when you squeeze the calf due to the contraction of the gastrocnemius muscle and the subsequent pulling force transmitted via the Achilles tendon.
There will be no movement of the foot if the Achilles tendon is ruptured due to loss of continuity between the gastrocnemius and the foot.
What further investigations/ examinations will you do?
Further assessments and investigations
Neurovascular examination of both lower limbs.
Examination of the knee and hip joint.
Further imaging if indicated (e.g. X-ray and MRI).
