Musculoskeletal (Ankle/foot)

Question 1

What do you look for on inspection of the ankle and foot?

Answer 1

Inspect patients shoes for uneven wear and presence of orthoses (splints)
Inspect patient whilst standing from front, side and back
Look for valgus/varus deformity of the ankle (by inspecting direction of toes)
Inspect the arches of the feet for pes cavus/planus
Check for swelling , scars, calluses, bunions (1st MTP)
Ask patient to stand on their toes
Ask patient to walk and observe gait
(with patient supine) Inspect nails, skin, between toes, sole, heel – calluses, clawing, joint swelling?

Question 2

What do you look for on palpation?

Answer 2

With patient standing – palpate Achilles tendon for thickening
Whilst supine – inspect the temperature of the foot and ankles, palpate the tibia and fibula including the malleoli for tenderness, palpate the bones of the foot and ligaments/tendons that cross the ankle joint
Perform a lateral squeeze test on the MTP joints

Question 3

How do you assess the ROM?

Answer 3

Assess active dorsi/plantarfexion, inversion and eversion of the foot and plantar/dorsiflex. Of the big toe
Assess passive ROM by supporting patients lower leg against the couch with one hand whilst manipulating the ankle joint though dorsi/plantarflex, inversion and eversion
Fix the position of the ankle with one hand and assess passive inversion and eversion of the subtalar joint by moving the heel side to side
Test passive plantar/dorsiflex of the great toe

Question 4

How do you complete the examination?

Answer 4

Examine the ipsilateral knee

Assess neurovascular status of limb