Foot and ankle examination:
For foot and ankle examination observe the patient’s gait, both barefoot and with shoes. Assess the normal heel-to-toe pattern and stride length, rhythm, the posture of the longitudinal arch and weight-bearing on both feet. Note any pain, stiffness and weakness.
Pulses (leg circulation):
Palpate the posterior tibial and dorsalis pedis pulses to establish the state of the distal circulation. Circulation is often poor in patients suffering from peripheral vascular disease or diabetes. Compare both sides.
This is commonly situated on the lateral aspect of the foot beneath the lateral malleolus, following lateral ligament tears.
|foot joint examination|
General condition for Foot and ankle examination:
Note the skin texture, colour and nail condition, which identifies the state of the peripheral circulation.
A foot with impaired arterial circulation is colder than normal and may appear cyanosed (blue); conversely a warm foot may be indicative of an inflammatory response, for example following an injury or associated with conditions such as rheumatoid arthritis.
- Tenderness localised over and just proximal to the malleoli often occurs following a fracture.
- The anterior talofibular ligament is the most commonly injured as the ligament is most often torn in the combined position of inversion and plantar flexion. This is the loose packed position and one in which the anterior band of the lateral ligament is particularly placed on stretch.
- This may be accompanied by local thickening
- Tenderness at the articular surface of the talus is common in osteoarthritic conditions.
- Tenderness at the heel is found in conditions such as calcaneal exostosis (bony spurs), tendocalcaneal bursitis and plantar fasciitis.
- Pain is reproduced on squeezing the medial and lateral sides of the forefoot together.
- Diffuse tenderness and swelling on both the plantar and dorsal surfaces of the forefoot is a common finding in rheumatoid arthritis.
Excessive pronation may cause posteromedial shin splints, plantar fasciitis, hallux valgus or Achilles tendonitis.
Leg and hindfoot examination:
With the patient prone, the physiotherapist bisects the calcaneus by drawing a vertical line through the posterior aspect of the calcaneus, then bisects the lower leg by drawing a vertical line on the posterior aspect of the lower third, and places the subtalar joint in a neutral position. If the lines are parallel there is correct alignment of the leg and hindfoot. Rear foot varus is observed as the calcaneus appearing to invert relative to the leg; rear foot valgus is observed as the calcaneus appearing to evert relative to the leg.
Hindfoot and forefoot examination:
- As above, observe the position of the whole foot. Correct alignment is observed if the hindfoot and forefoot are in line and perpendicular to the floor varus is observed if the first toe is superior to the lateral toes.The toes Look for:
- clawing (hyperextension of the metatarsophalangeal joints and flexion of the other phalanges);
- mallet toe (flexion of the distal interphalangeal joints);
- hammer toe (hyperextension of the metatarsophalangeal and flexion of the proximal interphalangeal joints);
- hallux valgus (lateral deviation of the first interphalangeal joint);
- hallux rigidus (stiffness of the first interphalangeal joint).