Foot & Ankle Exam

Look

 

Aids

Shoes - raises / wear patterns

Stigmata generalised disease

Hands - RA, CMT

 

Front

 

Knee alignment

Forefoot - Hallux & Lesser toes 

Scars

Circulatory changes

 

Medial Side

 

Turn affected side away & ask to step foot forward

Flexed attitude of knee

Medial arch - planus / cavus

 

Behind

 

Spine - scoliosis / spinal dysraphism

Hindfoot varus / valgus

Forefoot (Too many toes)

Scars

 

Calf wasting

 

Double heel raise 

- Heel swings into varus or remains in valgus

- ? mobile subtalar joint

- ? Medial arch restoration

 

Single heel raise

- Must put patient close to blank wall half a foot length from the wall

- otherwise will cheat by pushing up or leaning forward against wall 

 

Lateral side

 

Haglund's

Peroneal tendons

 

Gait

 

Ankle

- Stiff / Fixed equinus 

- Weak / Foot drop

- Painful / Antalgic

 

Foot Progression angle

Tip toe - strong S1

Heel walk - strong L4

 

Sit

 

On edge of bed with legs hanging

- examiner sits on chair

 

Screen active ROM AKJ and STJ bilaterally

 

Look at sole

- normal distribution weight pattern

- callosities

- lumps / plantar fibromatosis

 

Feel

" Where is it painful?"

 

Lateral aspect

- lateral malleolus

- lateral ligament complex

- Peroneal tendons

- sinus tarsi

- base of 5th 

 

Posterior aspect

- tendo-achilles

- insertional / non insertional

 

Medially

- deltoid ligament

- tibialis posterior

- MT joints

- sustenaculum tali

 

Anterior

- ankle joint tenderness / effusion

- AITLF

 

Sole

- fat pad

- insertion of plantar fascia

 

Midfoot

 

Forefoot

- hallux rigidus

- sesamoids

- metatarsalgia

- Mulder test / interdigital tenderness

 

Move

 

DF - active and passive range 20o

 

PF - active and passive range 50o

 

Subtalar joint motion 

- ankle in 90° DF

- thumb on talar neck to detect talar movement 

- opposite hand cups heel and inverts & everts 

- Inversion 10-15o

- Eversion 0-5o

 

Midtarsal joint

- Foot at 90 to lock ankle mortise

- Adduct foot 20o

- abduct foot 10o

- dorsiflex

- plantarflex

 

T Ach

- Tenderness along tendon /Insertion, ? lump

- test power / pain

 

Foot Exam Tibialis AnteriorFoot Exam Tibialis PosteriorFoot Exam Peroneals

 

Tibialis posterior

- Prominent with plantarflexion and inversion

- Thickening

- Tenderness

- Check power if abnormal

 

Peroneus brevis & longus

- thickening

- Tenderness

- Dislocation (resisted eversion)

- active eversion

 

Tibialis anterior

- Prominent with dorsiflexion and inversion

- Insertion

 

EHL & EDL - Dorsiflex toes

 

Special tests

 

Instability

 

Anterior drawer

- Due to complete tear of ATFL

- Grasp lower tibia and cup calcaneum

- "clunk" or draw

- compare with other side > 3 mm

 

Lateral instability

- Inversion stress

- Gaping of soft tissues

- Talar tilt (may occur in normal & must compare with other side)

- Needs to be confirmed on stress views

- > 20o

 

Medial instability

- Eversion stress

- Gaping / widening

- Needs to be confirmed on stress views

 

Gastrocnemius /soleus contracture

 

Test if limited dorsiflexion

 

Silverskiold Test

- Extend knee - dorsiflexion limited by both soleus & gastrocnemius contracture

- Flex knee - gastrocnemius relaxed (crosses knee joint)

- If dorsiflexion still limited it is due to soleus contracture

- If limited in extension & not in flexion then due to gastrocnemius contraction

 

Pes cavus

 

Claw toes - flexible / fixed

 

Individual power compared with other side

- Tibialis anterior (inversion in DF)

- Tibialis posterior (inversion in PF)

- Peronei

 

Coleman block test

- Dynamic visualisation of hindfoot correction

- Stand on 2cm block

 

Passive correction of plantar-flexed 1st MT

 

Spine / Neuro Exam

 

Hallux valgus

 

MTPJ Painful / limited range

- flexion 45o

- extension 70-90o

- redo range with correction

 

IPJ

- hallux interphalangeus

- extension / flexion

 

Lesser toes

- fixed / mobile

- dislocated

 

Concealed

 

Spine

Neuro exam

Vascular exam

Ligamentous laxity