MSK Ankle & Foot

Question 1

Introduction

Answer 1

• Clean your hands and don appropriate PPE
• Full name & status and ask patient name & DOB, check wrist bands and charts
• Explain what you would like to examine, the area you would like to expose and wait for verbal consent
• Ask if they are experiencing any pain in the area you are to examine
• Ask the patient to remove necessary clothing

Question 2

LOOK

Initially with patient supine and feet hanging over end of bed

Answer 2

• Nail changes, skin rashes, scars, wounds and calluses
• Swelling or muscle wasting of calf muscles
• Toes for clawing or hammer toes
• Joint swelling or hallux valgus
• Look at sole for callus formation over metatarsal heads
• Check shoes for wear

Question 3

LOOK

Later standing

Answer 3

• Toe alignment
• Foot arch position and check for dropped arch or high arch
• Alignment of hind foot
• Check for varus or valgus deformity
• If arch is flattened, ask patient to stand on tip toes - the mobile arch will resolve
• Look for Achilles tendon swelling or thickening

Question 4

FEEL

Answer 4

• Feel for temperature of forefoot, mid-foot and ankle
• Palpate for tenderness with knowledge of the clinical anatomy while watching the patients face
• Palpate lateral and medial malleolus, fibula head and all bones in the foot
• Perform a lateral squeeze test to the metatarsophalangeal (MTP) joint by gently squeezing across the MTP joints to detect for Morton’s neuroma
• Palpate subtalar, midfoot, tarsal and ankle joints for tenderness
• Assess pulse - usually dorsalis pedis and posterior tibial and capillary refill

Question 5

MOVE

Assess active then passive movement

Answer 5

• Active - Dorsiflexion and plantar flexion at ankle joint and flexion and extension at big toe
• Assess dorsiflexion and plantar flexion at ankle joint
• Assess inversion and eversion at the subtalar joint with ankle at neutral
• Assess mid tarsal and subtalar movements by holding the heel with one hand and passively moving (twisting) the forefoot
• Assess flexion and extension of the big toe
• Check joint above and below - only knee in this case

Question 6

FUNCTION

Answer 6

• Assess gait
• Look for the normal cycle of heel strike and toe off
• Check for increased height of step, as in foot drop

Question 7

CLOSURE

Answer 7

• Thank the patient
• Help them redress if required and make them comfortable
• Doff PPE and dispose of safely
• Perform hand hygiene