MSK - Foot and Ankle

Question 1

What do you look for while the patient is lying supine/feet off bed? (5)

Answer 1

1) Swelling or muscle wasting of calf muscles.
2) Skin rashes, scars, wounds, calluses and nail changes.
3) Toes for clawing, joint swelling or hallux valgus.
4) Look at sole for callus formation over metatarsal heads.
5) Check shoes for wear.

Question 2

What do you look for while the patient is standing? (5)

Answer 2

1) Look for toe alignment.
2) Look for foot arch position and check for dropped arch or high arch.
3) Look for alignment of hind foot.
4) Check for varus or valgus deformity.
5) Look for Achilles tendon swelling or thickening.

N.B. If arch is flattened, ask patient to stand on tip-toes. The mobile arch will resolve.

Question 3

What do you feel for? (4)

Answer 3

1) Feel for temperature over forefoot, mid-foot and ankle.
2) Palpate the medial malleolus, the lateral malleolus, fibula head and all bones in the foot.
3) Palpate ankle, subtalar, midfoot (tarsal) and MTP joints for tenderness.
4) Assess pulse - usually dorsalis pedis and posterior tibial and capillary refill

N.B. You are palpating for tenderness with knowledge of the clinical anatomy while watching the patients face.

Question 4

What active movements do you assess?

Answer 4

1) Dorsiflexion and plantar flexion at ankle joint.
2) Flexion and extension at big toe.

Check joint above and below. Knee only in this case.

Question 5

What passive movements do you assess?

Answer 5

1) Assess dorsiflexion and plantar flexion at ankle joint.
2) Assess flexion and extension of the big toe.
3) Assess mid tarsal and subtalar movements by holding the heel with one hand and passively moving (twisting) the forefoot.
4) Assess inversion and eversion at the subtalar joint with ankle at neutral.

Check joint above and below. Knee only in this case.

Question 6

What function do you assess?

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.