Ankle and foot examination

Question 1

look, standing

Answer 1

Swelling, nail changes, bruising, deformity (hallux valgus, pes planus, pes cavus, heel varus, heel valgus)

Question 2

look, tip toes

Answer 2

inability to do so in a fracture, tendon rupture or tibialis posterior insufficiency
Stiffness in first MTPJ may be noticed in hallux rigidis

Question 3

look, sitting

Answer 3

view the sole for ulcers and callosities – thickened skin at the site of repeated pressure.

Question 4

look, gait

Answer 4

note inability to weight bear, pace, symmetry, gait abnormalities (antalgic gait, slapping foot), walking aids
Feel

Question 5

feel

Answer 5

Lateral malleolus and lateral ligament complex – anterior, posterior and distal to the lateral malleolus
Anterior joint line
Medial malleolus and deltoid ligament
Achilles tendon
Base of the fifth metatarsal
Metatarsal heads on plantar surface of foot

Question 6

move

Answer 6

Dorsiflexion (15o) and plantarflexion (45o)
Inversion (20o) and eversion (10o) Metatarsal phalangeal movement

Question 7

tests

Answer 7

Suspected metatarsophalangeal joint pathology (such as osteoarthritis) – grind test

Suspected ligament instability – anterior drawer test

Suspected Morton’s neuroma – Mulder’s click test

Suspected Achilles tendon rupture – Simmond’s test

Suspected trauma – apply Ottawa ankle rules