Foot and Ankle Examination Flashcards
Introduction
WIPER QQ
-expose from knee down
-any problems with feet, ankle
-pain, stiffness
-restriction of daily activities
Step 1 General inspection (clinical signs)
What are you looking for
What does this indicate
ON STANDING
Habitus
- obesity => OA?
- muscle wasting => disuse atrophy, LMN injury?
Scars
-previous joint surgery
Step 1 General inspection (objects, equipment)
What are you looking for
What does this indicate
Walking aids => knee, hip, ankle pathology?
Prescriptions => pain meds, immunosuppresants?
Orthotics, footwear
Step 1 Anterior inspection
What are you looking for
What does this indicate
Forefoot
-toe deformities
-skin changes - bruising (trauma, hemarthrosis)
-nail changes
-swelling - effusion, inflammatory
-scars - past surgery, trauma
Step 1 Lateral inspection
What are you looking for
What does this indicate
Medial longitudinal arches
-pes planus => ask them to stand on their toes - supple lat feat will correct, rigid flat feet will not
-pes cavus
Step 1 Posterior inspection
What are you looking for
What does this indicate
Achilles tendon
-deformity, discontinuity, swelling, erythema (tendonitis?)
Forefoot adduction
5deg hindfoot valgus is normal
Slight varus is normal on tip toes
Step 2 Gait
What are you looking for
What does this indicate
Any abnormalities in gait cycle
Range of movement => reduced (chronic joint pathology (OA, inflammatory arthritis)
Limping => joint pain, weakness or joint instability
Leg length => might have tilted hips
Turning => slow turning due to instability, restricted movement
Height of steps => high steps (foot drop from fibular nerve problems)
Step 3 Palpation
What are you looking for
What does this indicate
Ask patient to sit
Close inspection of
-scars, swelling, skin changes, rashes, nail signs
-soles for calluses
-look between toes
Temperature
Pulses - post tibialis, dorsalis pedis
Step 3 Palpation of foot and ankle
What are you looking for
What does this indicate
Calcaneus
Medial malleolus + deltoid ligament
Anterior joint line - tibiotalar
Lateral malleolus + lateral ligaments (ATFL, CFL, PTFL) + distal fibula
Sinus tarsi
Peroneal tendon + tubercle (under lateral malleolus)
Tarsals + metatarsals
MTP squeeze
Step 3 Palpation of Achilles tendon and sole + special tests
What are you looking for
What does this indicate
Patient kneeling on chair
Palpate gastrocnemius and achilles
-focal tenderness/swelling - achilles tendonitis
-gaps in tendon - rupture?
Simmonds test
Squeeze widest part of calf => plantar flexion :)
No response => achilles tendon rupture?
Palpate sole of forefoot
-pain, calluses, swellings
Morton’s neuroma - thickening of tissue around digital nerves supplying toes
-feels like you’re standing on a pebble, or fold in sock
- Squeeze along metatarsal heads
- Palpate plantar webspace for click
Step 4 Active and passive movements
What are you looking for
What does this indicate
Active movements
-ankle flexion, extension, inversion, eversion
-toe flexion, extension
Passive movements - crepitus, limited movements
-the above +
-subtalar inversion, eversion - stabilise talus and calcaneus
-midtarsal inversion, eversion, flexion, extension - isolate medial and lateral midtarsal bone
Step 4 Resisted movements
What are you looking for
What does this indicate
Dorsiplantar flexion of foot
Inversion, eversion of foot
Step 5 special tests - instability
What are you looking for
What does this indicate
Anterior drawer test - for anterior talofibular ligament
-hold heel in dom hand, hold lower leg in other hand => pull dom hand towards you
MTP joint instability test
-hold metatarsal head in non dom hand, feel for instability as you push and pull digit
Step 5 special tests - Coleman lateral block test for hindfoot varus
What are you looking for
What does this indicate
ONLY RELEVANT FOR PEOPLE WITH HINDFOOT VARUS
-valgus is normal
Ask patient to stand with heel on book so big toe touches floor
-if foot does not swing into valgus => fixed deformity
Step 7 Further assessments, investigations
Neurovascular exam of both lower limbs
Examination of knee
Further imaging if needed
-Xray to image bones
-USS, MRI to image soft tissues and joints
