Ankle & Foot Examination

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1. This examination starts with observing the joint. Watch the patient walk, observing for a normal heel strike, toe-off gait. Also look at the alignment of the toes for any valgus or varus deformities. You should also check the foot arches checking for pes cavus (high arches) or pes planus (flat feet). Whilst the patient is stood, feel the Achilles tendon for any thickening or swelling. Finally you should look at the patient’s shoes, note any uneven wear on either sole and the presence of any insoles.

   1. 

      Observe the joint

2. With the patient lying on the bed, you should make a general inspection. Check the symmetry, nails, skin, toe alignment, look for toe clawing, joint swelling and plantar and dorsal calluses.

   1. 

      General inspection

3. Feel each foot for temperature, comparing it to the temperature of the rest of the leg. Feel for distal pulses, squeeze over the metatarsophalangeal joints observing the patient’s face for any pain and also palpate over the midfoot, ankle and subtalar joint lines for any tenderness.

   1. 

      Check for temperature ankle
   2. 

      Check for temperature mid-foot
   3. 

      Squeeze over the metatarsophalangeal joints
   4. 

      Palpate over the mid-foot
   5. 

      Palpate over the ankle

4. You should assess all active movements of the foot. These movements are inversion, eversion, dorsiflexion and plantarflexion of the great toe as well as of the ankle.

   1. 

      Inversion movement 1
   2. 

      Inversion movement 2
   3. 

      Eversion movement back
   4. 

      Eversion movement forward
   5. 

      Toe dorsiflexion
   6. 

      Toe plantarflexion

5. These movements should be tested passively. Also test the midtarsal joints, which are tested by fixing the ankle with one foot and inverting and everting the forefoot with the other.

   1. 

      Passive inversion
   2. 

      Passive eversion