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.

Wash your hands
Wash your hands

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.
Observe the patient's gait
Observe the patient's gait
Feel the Achilles tendon for any thickening or swelling
Feel the Achilles tendon for any thickening or swelling

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.
Perform a general inspection
Perform a general inspection

Step 04

Feel the temperature of each foot, comparing it to the temperature of the rest of the leg.

Check the ankle temperature
Check the ankle temperature

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.

Squeeze the metatarsophalangeal joints
Squeeze the metatarsophalangeal joints
Palpate the mid-foot
Palpate the mid-foot
Palpate the ankle
Palpate the ankle

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.

Foot inversion movement
Foot inversion movement
Foot eversion movement
Foot eversion movement
Dorsiflexion movement
Dorsiflexion movement
Plantarflexion movement
Plantarflexion movement
Toe dorsiflexion passively
Toe dorsiflexion passively
Toe plantarflexion passively
Toe plantarflexion passively

Step 07

Finally examine the midtarsal joints by fixing the ankle with one foot and inverting and everting the forefoot with the other.

Passive inversion
Passive inversion
Passive eversion
Passive eversion

Step 08

Allow the patient to dress and thank them. Wash your hands and report your findings to the examiner.

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