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Examination of the foot and ankle video

Look

With the patient on a couch and their feet overhanging the end of it, look at the feet, comparing for symmetry. In the forefoot look for nail changes and skin rashes. Look for the alignment of the toes and any evidence of hallux valgus of the big toe. Look for clawing of the toes, joint swelling and callus formation. Look at the underside or plantar surface for callus formation. Look at the patient’s shoes for asymmetrical wearing of the sole, the presence of insoles or other signs of poor fit.

Feel

Assess the temperature of the ankle and forefoot and check for the presence of a peripheral pulse. Gently squeeze across the metatarsophalangeal joints while watching the patient’s face. The tarsal joints, ankle joint line and subtalar joints should all be palpated for tenderness.

Move

Range of movement in the foot and ankle includes inversion and eversion at the subtalar joint, dorsiflexion and plantar flexion at the big toe, and dorsiflexion and plantar flexion at the ankle joint. These should all be done both actively and passively. Mid-tarsal and subtalar movements can also be assessed passively.

With the patient weight-bearing, toe alignment and the foot arch should be checked. A dropped arch in a normal subject resolves when standing on tip-toes. The hindfoot should also be observed. Achilles tendon thickening or swelling may be seen. There should be normal alignment of the hindfoot, and disease of the ankle or subtalar joint may lead to a varus or a valgus deformity.

Function

Gait should be assessed looking for the normal cycle of heel-strike and toe-off.

Student handbook

Download 'Clinical assessment of the musculoskeletal system: a guide for medical students and healthcare professionals'
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