EXAMINATION OF ANKLE AND FOOT

LOOK

clues

·      walking / mobility aids

·      external appliances

·      ask to comment

·      shoes

from front

·      stand patient facing you

Deformity

·      knee alignment

·      physiological valgus

·      foot rotation

·      symmetrical ER

·      forefoot

·      splaying

·      hallux

·      only if abnormal

·      valgus / varus

·      pronation

·      IP jt

·      lesser toes

·      if abnormal, general comment

Skin

·      scars

·      circulatory disturbance

·      hair loss

·      hyperpigmentation

·      varicosities

·      ulcers

·      disuse / denervation

·      dry skin

·      dekeratinisation

Contour

Swelling

·      anterolateral ankle

·      navicular

·      bunion

·      bunionette

Wasting

·      calf

·      EDB

from medial side

·      turn affected side away

Deformity

·      medial arch

·      preservation

·      loss / cavus

Skin

·      scars

Contour

Swelling

·      tib post

from behind
Deformity

·      hindfoot

·      physiological valgus

·      increased / decreased valgus

·      varus

·      forefoot

·      too many toes

Skin

·      scars

Contour

Swelling

·      calf

·      Duchenne

·      tendo Achilles

·      heel

·      Haglund’s

Wasting

·      calf

from lateral side
Deformity

·      knee

·      flexion attitude

·      ankle

·      equinus

Skin

·      scars

Contour

Swelling

·      peroneal tendons

gait

·      walk away

·      walk towards

Features

Stiff ankle

Foot drop

Fixed equinus

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 - polio, stroke, radiculopathy

·      peripheral - nerve injury

·      tendinous

·      tib post 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

·      lesions

·      warts

·      ulcers

·      creases

·      medial

·      between toes

·      soft corns

·      pedal sepsis

Contour

Swelling

·      plantar fibromatosis

Feel

·      ask patient “where is it painful ?”

sole

·      metatarsal heads

·      I - sesamoids

·      II-V - metatarsalgia

·      interdigital neuroma

·      interdigital tenderness

·      lateral compression - pain & click

·      heel

·      origin of plantar fascia

tendons

·      tendo Achilles

·      insertion

·      tenderness

·      along tendon

·      tenderness (diffuse or focal)

·      lump

·      tibialis posterior

·      thickening

·      tenderness

·      crepitus

·      check power if abnormal

·      navicular

·      peroneals

·      thickening

·      tenderness

·      dislocation (resisted eversion)

·      base of 5th MT

ankle joint

·      lateral ligaments

·      joint line

·      deltoid ligament

forefoot

·      bunion

·      bunionette

·      pulses

·      dorsalis pedis

·      posterior tibial

Move

active, passive, power

·      compare both feet

Dorsiflexion

·      “pull feet up”

·      equal / decreased

·      you push foot up

·      passive range equal / further x° achieved passively

·      breaking at midfoot

·      “hold foot up” and resist

·      power

Plantarflexion
Inversion
Eversion
ankle

·      thumb on talar neck

·      grasp heel with other hand

·      plantarflex and dorsiflex ankle

·      movement occurring at ankle joint

subtalar

·      foot relaxed with thumb on talar neck

·      grasp heel with other hand

·      invert and evert heel

Special tests

pes cavus
Modify

·      claw toes

·      individual power cf. other side

·      tib ant (inversion in DF)

·      tib post (inversion in PF)

·      peronei

Add

·      Coleman block test

·      dynamic visualisation of hindfoot correction

·      stand on 2 cm block

·      sensation

·      spine

·      hands

Hallux Valgus / rigidus
Add

·      MTP jt

·      dorsal osteophytes

·      passive ROM

·      attempt to correct deformity

·      grind test

·      hallux interphalangeus

·      lesser toes

lesser toes
Add

·      describe deformity

·      claw, hammer, mallet, overriding, curly

·      callosities

·      palpate joints

·      MTP, PIP, DIP

·      fixed or mobile

·      subluxed or dislocated

adult flatfoot
Modify

·      tibialis posterior function

·      Lisfranc joint

tarsal coalition
Modify

·      palpate

·      medially (sustentaculum tali)

·      dorsolaterally (through EDB)

lateral ligament instability
Add

·      anterior drawer

·      talar tilt

Other

·      ligamentous laxity

·      spine

·      sensation