Examination of the Foot & Ankle
Look
- General
- RA, diabetes
- No evidence of systemic disease
- walking / mobility aids
- external appliances
- Shoes
- Wear pattern: toes & heel
- Off the self commercial shoes with no modifications & orthotic
Undress from waist down
From Front
stand patient facing you
Decribe proximal to distal
Deformity
- knee alignment
- physiological valgus
- patella alignment
- valgus with pes planus
- foot rotation
- symmetrical ER
- forefoot
- splaying
- hallux
- valgus / varus
- pronation
- lPJ
- lesser toes
- if abnormal, general comment
- overriding
- hammer
- claw
- callosities over IPJ
- if abnormal, general comment
Skin
- scars
- trophic changes
- circulatory disturbance
- hair loss
- hyperpigmentation
- varicosities
- ulcers
- disuse / denervation
- dry skin
- dekeratinisation
- Nails
- Paronychia
- Infection of the lateral nail folds
- Eponychia
- Infection of the proximal nail fold
- Onychomycosis
- Fungal infection of the nail
Contour
- Swelling
- anterolateral ankle
- navicular
- bunion
- bunionette
- Muscle Wasting
- Calf
- EDB
From Medial Side
- turn affected side away
Deformity
- medial arch is preserved
- pes planus
- pes cavus
Skin
- scars
Contour
- Swelling
- tibialis posterior
From Lateral Side
Deformity
- knee
- flexion attitude
- ankle
- equinus
Skin
- scars
Contour
- Swelling
- peroneal tendons
From Behind
Deformity
- Back
- Sagitall spinal deformity
- Cutaneous manifestastions of spinal dysraphism
- hindfoot
- physiological valgus
- varus
- then ask for Coleman Block
- Valgus
- Single heel raise
- forefoot
- too many toes
- Skin
- scars
Contour
- Swelling
- calf
- Duchenne
- Tendo Achilles
- heel
- Haglund’s
- Wasting
- calf
Gait
ask patient to walk
- walk away
- walk towards
- Features
- Stiff ankle
- Foot drop
- Fixed equines
- Antalgic
- Rocker
Walk to wall & face it
Wall
face wall
Double heel raise
- Ability
- neurological
- likely central cause
- cerebral palsy, spina bifida, cord injury
- muscular
- muscular dystrophy
- disuse
- Heel movement
- symmetrical heel swing into varus
- heel remains in valgus
- Medial arch
- restoration
- Single heel raise
- on normal foot
- on abnormal foot
- neurological
- central – stroke, polio, radiculopathy
- peripheral - nerve injury
- tendinous
- tibialis posterior dysfunction
Sole
sit patient on side of bed with you seated
look at sole
Skin
- scars
- footprint
- normal
- well-distributed weight-bearing
- heel, lateral border, metatarsal heads
- abnormal
- altered weight distribution
- callosities
- MT heads (II, III), midfoot
- normal
- lesions
- warts
- ulcers
- soft corns
- pedal sepsis
Contour
- Swelling
- plantar fibromatosis