Foot and ankle

Question 1

Gait

Answer 1

Normal heel strike / toe off gait? 
Each step height normal?
Smooth and symmetrical?
Examine the patient's shoes
Walk on tip toes, then on heels

Question 2

Inspection

Answer 2

Front: symmetry of feet and ankles, toe alignment, bunions, deformities of toes, scars, calluses, swelling or erythema of foot and ankle

Side: pes planus or pes cavus? ask pt to stand on tip toes - supple flat feet will correct, fixed flexion deformity will not

Back: heel alignment: varus / valgus deformity? deformity or swelling of achilles tendon

Question 3

Feel

Answer 3

Temperature
Pulses
Achilles tendon - swelling or gaps?
Toe joints
MTP squeeze
Tarsal joint
Ankle joint
Subtalar joint
Calcaneum 
Medial / lateral malleoli 
Distal fibula

Question 4

Move

Answer 4

Active and passive:
Foot plantarflexion and dorsiflexion
Toe flexion and extension
Ankle inversion / eversion

Passive only:
Ankle joint
Subtalar joint
Midtarsal joint 
Metatarsal-phalangeal joint and interphalangeal joints

Question 5

Special Tests

Answer 5

Simmond’s test - ask patient to kneel on chair / lie on bed with feet hanging off - squeeze each calf in turn - normally the foot should plantarflex - if the achilles tendon is ruptured there will be no movement of the foot