EXAMINATION OF

THE FOOT AND

ANKLE
Dr. Mohammed Zaheer Dalati
Senior Registrar
Department of Orthopaedics
College of Medicine
King Khalid University Hospital
 Objectives
• Review anatomy of Foot and Ankle.
• Discuss key history
• Hands on exam
• Discuss cases concerning common injuries
of the Foot and Ankle
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
 History
• Onset
• Duration
• Mechanism
• Swelling / Ecchymosis
• Ambulation
• Hx of previous injury
2 PARTS:

1- ERECT POSITION.

2-SUPINE POSITION.
Inspection.
Palpation.
Movements.
Special tests.
 INSPECTION OF THE PATIENT’S GAIT:

Evaluation of the
walking cycle

GAIT ANALYSIS
• STANCE PHASE 65%
– Contact Period - heel strike to forefoot loading
– Midstance Period - forefoot loading to heel
raise
– Propulsive Period - heel raise to toe off

• SWING PHASE 35%

 Stance phase

GAIT ANALYSIS
Trendelenburg gait
Tip-toe walking
Foot drop walking
Spastic gait
Intoeing/Out toeng gait
Antalgic gait
Inspection in standing position
INSPECTION:

POSTERIOR HEEL STANDING

FOOT SHAPE
ALL THE TOES SHOULD BE IN GROUND
CONTACT IN W.B.(stability of the foot on the
ground)
INSPECTION: of the L.L

Any asymmetry of
length, rotational
problem, or mal
alignment of the
lower limbs.
INSPECTION:

- Deformity, swelling, skin changes, muscle

wasting, asymmetry of length, abnormal
position….

INSPECT ALL ARROUND

INSPECTION:

PLANTAR SKIN
callosity
Palpation:
Bone and joints

Soft tissues
Anatomical landmarks:
-Medial malleolus, lateral malleolus,
Achilles tendon, calcaneal tuberosity,
peroneal tendon, tibialis posterior tendon,
tibialis anterior tendon, plantar fascia, base of
5th metatarsal, 1st MP joint, metatarsal
heads……..etc
PALPATION:
Tenderness, swelling, deformity….

Knowing the anatomy:

MOVEMENTS:

Ankle: -dorsiflection -plantar flection.

Subtalar: -inversion -eversion.
Midtarsal: -pronation -supination
Tarso-metatarsals: move the
metatarsals one by one.
Toes:
Ankle movements:
MOVEMENT: SUBTALAR:

MOVE THE HEEL:

Inversion---eversion
 Midtarsal supination

Move the metatarsals one by one

 MOVEMENTS:

IMPORTANCE OF THE BIG TOE

(running, jumping)

Problem of hallux rigidus

EXAMINATION OF THE
SHOES
Special tests
Ankle sprain:
Lateral ligament.
Stress view. Dynamic X-Ray

Anterior drawer.
Varus stress test.
SPECIAL PATHOLOGIES:

Ligaments injuries:

-Lateral collateral ligament of

the ankle: varus stress view AP.
-Subtalar ligaments: increased
valgus by standing on one leg.
 ACHILLES TENDON:

-RUPTURE:(signs in prone position)

~depression.
~absence of rest plantar flexion.
~no plantar flection by
squeezing the calf muscles.
SPECIAL PATHOLOGIES

Pes planus: common 20%

-GAIT: UGLY.

-INSPECTION STANDING: HEEL, ARCH, FOREFOOT.

-LIGAMENT LAXITY

-MOVE THE HEEL AND THE 1ST METATARSAL.

-EXAMIN THE TENDO ACHILLES

-May be asymptomatic
Pes cavus
High arch
Varus
Special pathologies:

TARSAL COALSION:

Painful stiff flat foot

Usually bilateral, can be unilateral
-Stiff subtalar.
MORE COMMON:calcaneo-
navicular and subtalar.
-Request CT scan
SPECIAL PATHOLOGIES:

INTOING GAIT:

-Internal femoral torsion: exaggerated anteversion.

-Internal tibial torsion.

-Forefoot adduction.
SPECIAL PATHOLOGIES:

-PLANTAR FASCIITIS:

~Any tightness of Achilles tendon.

~Any mechanical foot disorder.

~Any use of bad shoes.

Metatarsalgia
Hallux
valgus
Hallux rigidus:
O.A 1st MPJ
THANK YOU