ankle and foot examination

Question 1

start

Answer 1

WIPER

3Ps

inspection, palpation, movement, neuro. end.

Question 2

inspection

Answer 2

With the patient standing:

• Appearance of the foot – is there any obvious deformity such as hindfoot
pronation/calluses/hallux vulgaris/hammer toe/pes planus
• Get patient to stand on tiptoe – painful and difficult in Achilles tendinitis, almost impossible if
Achilles tendon ruptured
• Look at patient walking to assess gait
With the patient supine:
• Look for scars, swelling, deformity, colour change, callosities

Question 3

palpation

Answer 3

Feel for any swelling and decide if it is synovial, bone or oedema.

Feel Temp

Cap refill

Question 4

movement

Answer 4

Active then passive.
• Ankle dorsiflexion and plantarflexion: move foot upwards and downwards.
• Subtalar inversion and eversion: stabilise calf with one hand, invert and evert foot with other.
• Midtarsal movements: stabilise the ankle with one hand then plantarflex and dorsiflex the foot
with the other.
• Movements of the MTP and IP joints

Question 5

neurological

Answer 5

Feel for the posterior tibial and dorsalis pedis pulses

Motor weakness resulting from lesions of nerves of lower limb:

Femoral – knee extensors
Obturator – hip adductors
Sciatic – knee flexors/hamstrings
Posterior tibial – ankle and toe plantarflexors
Deep peroneal – ankle and toe dorsiflexors
Superficial peroneal – ankle evertors (foot drop)