Foot & Ankle:

Inspection

• close inspection for any abnormalities, arches (flat foot =pes planus, high arch =pes cavus), muscle wasting, scars, check calf muscles, big toe bunion (hallux valgus), toe deformities (claw =toes curl under, hammer =middle of toe points upwards = inverse ‘V’ shape, & mallet =tip points downwards), calluses on soles show abnormal weight bearing
• remember foot has 3 parts: hindfoot (back), midfoot & forefoot (front e.g. toes)

Palpate

• ankle joint line, hindfoot (including achilles tendon insertion), mid foot, & compress forefoot (if elicit tenderness usually due to RA, OA, or morton’s neuroma = thickening of nerve)
• assess temp

Movement

• dorsiflex (upwards) & plantarflex the ankle
• support the heel, abduct & adduct then invert & evert to assess midfoot movements

Neuro/special tests

• simmon’s test: detects an achilles tendon rupture, get patient to kneel on a chair (or lay on front with foot hanging off bed), squeeze the calf muscle, if the foot moves down (plantarflexes) the achilles is intact
• N.B. the nerve supply to the foot & ankle is complex, it is unlikely you get asked them in the exam