“I’d like to examine your ankles and feet. This will involve having a look and feel of these joints, in addition to assessing the joints’ movement”
Gain consent – “Do you understand everything I’ve said?” “Are you happy to go ahead with the exam?”
Gain adequate exposure – both legs should be exposed from the knee down
Position patient – ask patient to stand up straight with their feet aligned facing forwards
Is the patient demonstrating a normal heel strike/toe off gait?
Is each step of normal height? – increased stepping height is noted in foot drop
Is the gait smooth and symmetrical?
Examine the patient’s shoes –evidence of asymmetrical wearing may indicate abnormal gait
Ask the patient to walk on their tip-toes, then on their heels –problems with this may point to multiple problems such as arthritis, muscle strength in the calf muscles which help in plantarflexion and anterior muscles of the lower leg which help in dorsiflexion
Inspect from the front
Symmetry of feet and ankles
Toe alignment –hallux valgus of the big toe may be noted
Bunions – locatedat the 1st metatarsal phalangeal joint (MTP) joint
Deformities of the toes (claw/mallet/hammer toes)
Scars – suggestive of previous injury / surgery
Calluses – may indicate foot/gait deformity or poorly fitting footwear
Swelling or erythema of the foot or ankle –may suggest injury / inflammatory arthritis / septic arthritis / cellulitis
Inspect from the side
Foot arches – observe for evidence of flat feet (pes planus) or high arched feet (pes cavus)
If patient has flat feet ask to stand on tiptoes – supple flat feet will correct / rigid flat feet will not
Inspect from the back
Foot/ankle symmetry – heel alignment – valgus or varus deformity?