REMS Foot and Ankle

Question 1

What do you look for in inspection?

Answer 1

• Symmetry and skin/nail changes (psoriasis)
• Callus formation on the dorsum of the foot, toe alignment, toe clawing, hallux valgus (subluxation of MTP joints)
• Callus formation on sole of foot
• Check for abnormal/asymmetrical wear or poor fitting or insoles

Question 2

What do you inspect when pt is standing?

Answer 2

• Foot/toe alignment
• Mid-foot for foot arch position; standing on tip toe should resolve dropped arch
• Look from back for Achilles tendon thickening/swelling
• Examine alignment of hind-foot for varus/valgus ankle deformity

Question 3

What do you feel for?

Answer 3

• Assess heat with back of hand
• Assess tenderness and from which anatomical structure is arises
• Assess any intra/extra articular swellings
• Check for peripheral pulses
• Squeeze MTP joints and watch face for pain
• Palpate mid-foot ankle and sub-talar joints for tenderness

Question 4

What do you move in the foot?

Answer 4

• Check active and passive inversion and eversion at sub-talar joint
• Active and passive dorsi and plantar flexion of big toe and ankle
• Hold heel in one hand and passively invert and evert the forefoot

Question 5

What are the function and special tests?

Answer 5

• Ask patient to change position to stand and walk across room
• Asses gait, watching for heel strike, stance and toe of phase of normal gait cycle