Examination Of The Ankle And Foot

Question 1

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Answer 1

Intro

Question 2

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Answer 2

Inspection
-look at the patient’s shoes for uneven wear and the presence of orthoses
-inspect the patient’s feet and ankles whilst they are standing. Inspect front the front, side and behind. Valgus or varus deformities of the ankle can be detected by looking at the alignment of the toes relative to those of the contralateral foot.
- Inspect the arches of the feet for pes cavus (high-arched feet) or pes planus (flat feet)
-Swelling of the ankle joint can be mostly seen around the malleoli. Check for scars, bunions (first MTP joint) and calluses

Question 3

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Answer 3

-Whilst the patient is standing, ask the patient to stand on their toes

Question 4

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Answer 4

Ask the patient to walk and observe for a normal heel strike and toe-off gait.

Question 5

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Answer 5

-Whilst the patient is standing, palpate the Achilles’ tendon for thickening

Question 6

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Answer 6

-Ask the patient to lie on the couch and inspect the nails and skin. Remember to inspect between the toes, the sole of the foot and lift the foot to look at the heel. Check the alignment of the toes and note the presence of calluses, clawing and joint swelling.
-Using the dorsum of your hands, compare the temperature of both ankles and feet, moving from proximal to distal

Question 7

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Answer 7

Palpate the shafts of the tibia and fibula for tenderness, including the medial and lateral malleoli.
To palpate the talus, palpate anterior to the malleoli whilst everting and inverting the foot.
Palpate the ligamentous attachments of the ankle joint and the muscle tendons that cross the ankle joint.
Perform a lateral squeeze test on the metatarsophalangeal joint

Question 8

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Answer 8

-Assess the active range of motion (ROM) of dorsiflexion, plantar flexion, inversion, and eversion of the foot. Test active dorsiflexion and plantarflexion of the great toe.
-Assess the passive ROM with the patient’s lower leg supported on the examination couch and their foot unsupported. Stabilize the lower leg against the couch with one hand and use your other hand to assess joint mobility. The normal ranges are passive dorsiflexion 10-15°, plantar flexion 50-70°, inversion 40° and eversion 10°.
-Fix the position of the ankle joint with one hand and using your other hand, assess passive inversion and eversion at sub talar joint.
-Test passive dorsiflexion and plantarflexion of the great toe

Question 9

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Answer 9

-Examine the ipsilateral knee
-Assess the neurological and vascular status of the limb (In the OSCE, unless you are given specific instructions to perform this assessment, you should simply state to the
examiner that you would do so).