Exam - Ankles and feet

From CambridgeNotes

Look

  • Shoes – wear of the heel
  • Standing – weight bearing?
  • Skin (bruising), swelling, scars, oedema, wasting
  • Ankle deformities
  • Foot deformities:
    • Pes cavus is very arched foot while pes planus is a flat arch
    • Talipes is a club foot - equinovarus is on tip toes with foot turned in, calcaneovalgus is on heels with foot turned out
    • Claw toes suggest rheumatoid arthritis

Feel

  • Tenderness: diffuse or local over bone?
  • Bony prominences: malleoli, base of 5th metatarsal
  • Joint warmth, swelling
  • Tendons – medial, lateral, Achilles
  • Ligaments – medial, lateral

Move

  • Ankle – dorsiflexion (15 degrees), plantarflexion (55 degrees)
  • Subtalar joint – inversion and eversion of heel
  • Midtarsal joint – pronation and supination of foot
  • Check toe movements

Others

  • Check foot pulses, sensory neuropathy
  • Ankle radiograph if tenderness in malleolar zone and:
    • Posterior edge of medial or lateral malleolus
    • Totally unable to bear weight or 4 steps
  • Foot radiograph if pain in midfoot and:
    • Bony tenderness base of 5th metatarsal or navicular
    • Unable to bear weight

References

  1. [Ottawa ankle rules for injury radiography (1994)]
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