Physical Examination Series for Semester 7 Orthopaedic Posting Students

Examination of the ankle and foot

History

The history depends on the age of the patient. Always ask about the developmental milestones.

Congenital deformities include birth defects such as meningomyelocele, congenital talipes equinovarus
(CTEV), coxa vara.

Childhood: cerebral palsy, polio, osteomalacia, genu valgum and genu varum

Adolescence: trauma; ankle and foot especially in those who play sports; there is a large number of
adolescent who play newer varieties of sports (not so well described in the textbooks) for instance futsal,
break dancing and roller blading. We are slowly getting to understand that the injuries associated with
these games do involve the ankle and foot.

Young adults: trauma usually motor vehicle accidents (MVAs). Two problems in MVAs: motorcyclist have
direct injuries to their ankle and feet due to the lack of protective foot wear and drivers usually have
injuries when their ankle and feet get caught in the pedals of the cars. Sports injuries occur in the same
sports as in adolescents and also the conventional sports like football, racket games and jumping games
like basketball.

Adults: Apart from those mentioned above (associated with MVA and sports), the other problems seen in
adults are associated with ischaemia, varicose veins, osteoarthritis and diabetes. In these mentioned
conditions, please look for ulcers and note the characteristic changes and/or deformities.

Physical examination

Tenderness (know your anatomy); also look at the gait as a painful ankle and/or foot will manifest in
changes in the gait.

Swellings including ganglions and deformities that appear as swellings.

Corns, callosities and bunions also high arches and flat feet

Paraesthesia (know your dermatomes and peripheral nerve sensory distribution) include such things as
tarsal syndrome.

Degenerative changes giving rise to symptoms as in osteoarthritis of the ankle and the other joints and
tendons e.g. subluxating peroneal tendons. Things like Achilles tendon rupture and anterior drawer sign
are better appreciated with the patient lying prone/supine on the couch with the feet hanging off the foot
end of the couch.

Examination of a child is better done with the child sitting in the mother’s lap.

Always remember that the feet carry the weight of the body and there is a stance, follow through and
toe off in the gait.

Lastly take a look at the patient’s foot wear to look at wear and tear at the sole.
Prepared by Dr Surinder

Edited by Dr Jon Chua

August 2016