Ankle and Foot Examination
Foreword
Ankle and feet complaints are common presentations in Accident and Emergency, general practice, and orthopaedic clinics. The most common presentation is pain, such as acute fractures, plantar fasciitis and tendonitis.
The ankle and foot examination, along with all other joint examinations, is commonly tested on in OSCEs. You should ensure you are able to perform this confidently.
The examination of all joints follows the general pattern of “look, feel, move” as well as an assessment of function, in this case gait.
Procedure Steps
Step 01
Wash your hands and introduce yourself to the patient.
Clarify the patient’s identity and explain what you would like to examine and gain their consent.
Ensure that both ankles and feet are appropriately exposed.
Step 02
Begin with inspecting the joint whilst the patient is standing
- Watch the patient walk, observing for a normal heel strike, toe-off gait.
- Look at the alignment of the toes for any valgus or varus deformities.
- Examine the foot arches, checking for pes cavus (high arches) or pes planus (flat feet).
- Feel the Achilles tendon for any thickening or swelling.
- Inspect the patient’s shoes and note any uneven wear on either sole and the presence of any insoles.
Step 03
Ask the patient to lie on the bed, and perform a further general inspection.
Check the following:
- Symmetry
- Nails
- Skin
- Toe alignment.
- Toe clawing.
- Joint swelling.
- Plantar and dorsal calluses.
Step 04
Feel the temperature of each foot, comparing it to the temperature of the rest of the leg.
Step 05
Palpate the joint, start by squeezing over the metatarsophalangeal joints whilst observing the patient’s face.
Palpate over the midfoot, ankle and subtalar joint lines for any tenderness.
Palpate the foot pulses.
Step 06
Assess all active movements of the foot which are:
- Inversion
- Eversion
- Dorsiflexion
- Plantarflexion (of the great toe as well as of the ankle).
Movements should then be tested passively.
Step 07
Finally examine the midtarsal joints by fixing the ankle with one foot and inverting and everting the forefoot with the other.
Step 08
Allow the patient to dress and thank them. Wash your hands and report your findings to the examiner.
