Orthopaedic examination of any bone or joint follow the same basic structure:

LOOK - gait (if lower limb), erythema, swelling, scars, deformity, muscle wasting

FEEL - warmth, tenderness, swelling, crepitus

MOVE - range of motion, power

SPECIAL TESTS - joint stability, isolated muscle power, provocative tests

JOINT ABOVE & BELOW - ensure pain not radiating from elsewhere

NEUROVASCULAR - examine neurological and vascular supply to limb

This is followed by INVESTIGATIONS - blood tests, X-rays, further imaging

Each section describes a basic technique to examine the joints regularly seen in the exams and clinics. By following the routine described above, most joints can be examined thoroughly. The text does not provide an exhaustive description of every test available but outlines the commonly used basic examinations.

Foot & ankle examination

LOOK 

Shoes - always examine a patient’s shoes for signs of asymmetrical wear

Gait - antalgic (short stance phase due to pain)

Scars - medial and lateral longitudinal (fixation of fractures), anterior longitudinal (fracture fixation, ankle joint replacement), posterior (Achilles tendon rupture repair)

Ulceration - throughout the ankle, foot and between toes for evidence of vascular insufficiency and diabetes

Deformity - VaLgus (ankle/foot deviates Laterally), Varus (ankle/foot deviates medially), fixed plantar flexion

Hallux valgus and inflamed bunion

High arch of foot or flat foot

Clawing of toes

                        

FEEL

Tenderness - feel for tenderness along lateral malleolus (fibular fracture), medial malleolus (fracture, deltoid ligament injury), anterior joint line (anterior talofibular ligament (ATFL) injury, ankle osteoarthritis), Achilles tendon (Achilles tendonitis)

Palpate midfoot for tenderness

Squeeze metatarsophalangeal joints looking for pain

Temperature - feel for warmth over ankle, mid foot and toes

MOVE           

Foot and ankle have complex linked ranges of motion                 

Range 

1.             ankle plantar flexion 0-50°

2.             ankle dorsiflexion 0-20° 

3.             ankle inversion 0-35°

4.             ankle eversion 0-15°

                        

SPECIAL

Ankle drawer test - grasp tibia with one hand and heel with the other. Attempt to sublux ankle joint anteriorly, identifying ATFL laxity

Syndesomosis compression test - squeeze distal fibular at level of syndesmosis onto tibia. Pain implies syndesmosis injury