Ankle & foot examination

Question 1

In the ankle & foot examination, what do we look for on GENERAL INSPECTION?

Answer 1

Surrounding area:
Walking aids
Specialist shoes

Patient:
Signs of pain
Body habitus

Question 2

In the ankle & foot examination, what do we look for in GAIT, FUNCTION and on INSPECTION of foot?

Answer 2

Gait:
Ask patient to walk
Normal or abnormal?
Antalgic? (limp) - shortened stance phase, reduced knee flexion
Stiff ankle? - limited plantar flexion/dorsiflexion
Foot drop? - damage to common peroneal nerve

Function:
Ask patient to stand on tip toes, facing wall with their hands on it for balance. Observe ankle from behind.
Patients with arthritis or lower limb muscle weakness will struggle with this.

Inspection (while standing):
Overall alignment and willingness to weight bear
Symmetry of feet and ankle
Deformity - hallux valgus/varus? claw toe? hammer toe? pes plenus? pes cavus? subluxation of toe? ankle valgus/varus?
Scars
Wasting - calf muscles?
Swelling - effusion? cyst? inflammation?
Skin changes - thickening? callus formation? bunions? ulcers (between toes)?
Nail changes - thickening? psoriatic nails?

Question 3

In the ankle & foot examination, what do we FEEL for?

Answer 3

Temperature:
Check forefoot, midfoot and ankle

Structures of foot & ankle:
MTP joint squeeze
Palpate the tarsal bones
Mid-tarsal joint squeeze
Subtalar joint squeeze
Achilles tendon
Medial and lateral malleoli
Anterior joint line
Bimanual palpation of toes if indicated

Question 4

In the ankle & foot examination, what MOVEMENTS do we assess?

Answer 4

Toe:
Flexion and extension

Ankle:
Plantarflexion and dorsiflexion

Subtarsal:
Passive inversion and eversion

Midfoot:
Passive rotation of forefoot in both directions

Question 5

In the ankle & foot examination, what SPECIAL TEST do we perform?

Answer 5

Simmon’s test - for ruptured achilles tendon

Question 6

In the ankle & foot examination, what JOINT ABOVE do we assess?

Answer 6

Knee joint - flexion and extension

Question 7

In the ankle & foot examination, what NEUROVASCULAR test do we perform?

Answer 7

Power:
Toe extension - common peroneal nerve
Plantarflexion - tibial nerve

Sensation:
Dorsum of foot - common peroneal nerve
Sole of foot - tibial nerve

Vascular:
Posterior tibial and dorsalis pedis