Foot & Ankle examination

Follow the scheme below:

• Inspection
• Palpation  
• Movement

Before starting

• Introduce yourself
• Ask permission to perform examination
• Explain what the examination entails
• Expose the patient appropriately - remove their shoes and socks and roll up trousers to the knees
• Ask the patient to let you know if anything you do is uncomfortable
• Remember - always watch the patients face 

Inspection

• General observation
  • Does the patient look well?
  • Is there a walking stick? Frame?
  • Hands (Rheumatoid arthritis?)
  • Shoes - assymetrical wear? shoe raise? insoles?

Patient Standing

Remember to inspect from all sides (front, laterally and from behind):

• Skin
  • Scars (previous injuries or surgical scars)
  • Sinuses
  • Colour - discolouration, bruising
  • Calluses
  • Ulcers
  • Hairlessness
• Deformity of the toes
  • Hallux valgus
  • Claw toes
  • Hammer toes
  • Mallet toe
• Toe nails
  • Ingrowing toe nails
  • Atrophic toe nails
• Muscle wasting
• Foot shape and position (see below)
• Medial arch (obliterated in pes planus, exaggerated in pes cavus)
• Hindfoot (observe from behind)
  • Varus (pes cavus)
  • Valgus (pes planus)

Patient Walking

• Observe the patient walking. 
  • Gait pattern. There are different types of gait:
    • High stepping gait (foot drop)
    • Antalgic (ankle, hindfoot,or midfoot pain)
    • Short propulsive phase (forefoot pain)
  • Test ability to stand on tip toes and then on heels 

Foot shape

• Normal
• Flat foot - valgus heel, low arch, forefoot abducted and supinated.
• High arched foot - plantar flexed first ray, high arch and forefoot pronation. In many cases the hindfoot is in varus
• Skew foot - hindfoot valgus and forefoot adduction 
• Metatarsus adductus - neutral hindfoot and adduction of forefoot

Patient Lying down - supine with one pillow under the head

Detailed check

• Skin
  • Scars
  • Calluses
  • Bunions
  • Ulcers
  • Deformity - fixed flexion (gap between bed and knee)
• Deformities

Palpation