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Ankle & Foot Examination

Ankle and feet complaints are common presentations to A&E, general practice as well as orthopaedic clinics. The most common presentation is pain e.g. 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.

Subject steps
1. Wash your hands and introduce yourself to the patient.

Clarify the patients 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

2. This examination starts 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. Finally should you inspect the patients shoes, note any uneven wear on either sole and the presence of any insoles.

Observe the patient's gait

Feel the Achilles tendon for any thickening or swelling

3. Ask the patient to lie on the bed, and perform a further general inspection. Check the symmetry, nails, skin, toe alignment, toe clawing, joint swelling and plantar and dorsal calluses.

Perform a general inspection

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

Check the ankle temperature

5. Next palpate the joint, start by squeezing over the metatarsophalangeal joints whilst observing the patients face. Also palpate over the midfoot, ankle and subtalar joint lines for any tenderness. You should also palpate the foot pulses.

Squeeze the metatarsophalangeal joints

Palpate the mid-foot

Palpate the ankle

6. Assess all active movements of the foot. These movements are:

inversion, eversion, dorsiflexion and plantarflexion, of the great toe as well as of the ankle.

Movements should then be tested passively.

Foot inversion movement

Foot eversion movement

Dorsiflexion movement

Plantarflexion movement

Toe dorsiflexion passively

Toe plantarflexion passively

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

Passive inversion

Passive eversion

8. Allow the patient to dress and thank them. Wash your hands and report your findings to the examiner. - See more at: http://www.osceskills.com/e-learning/subjects/ankle-footexamination/#sthash.1Btq6g19.dpuf