Patients Name

DOB
MRN
Date of Visit

Foot Pain H & P

HPI

KEY: Y = Yes(positive)

N = No(negative)

NE= Not Examined

History elements to ask:

- Mechanism of injury
- Acute traumatic, overuse, or spontaneous onset
- Pop or tear with injury

- Location of pain
- Swelling
- Provoking/alleviating factor

PMH/PSH
Prior foot injury or surgery
Other orthopedic history (surgeries, arthritis, trauma, injuries, flat feet, orthotic use, etc)
--------------------------------------------------------------------------------------------------------------------------------------------------Physical
exam

Inspection
Limping gait
Weight bearing
Swelling
Erythema
Ecchymosis
Atrophy
ROM
2-5th Toe Flexion
2nd-5th Toe Extension
1st MTP extension
Strength
Great toe flexion
Great toe extension
Resisted inversion
Resisted eversion
Special Tests
Effusion
Mulders test (foot squeeze)
Tuning Fork Test (to bone)

Y
Y
Y
Y
Y
Y

N
N
N
N
N
N

Full
Full
Full
Full
Full
Full
Full
Y
Y
Y

NE
NE
NE
NE
NE
NE
Limited
Limited
Limited

Weak
Weak
Weak
Weak

Painful
Painful
Painful
Painful

N
N
N

NE
NE
NE

Palpation
Heal (plantar fascia)
Plantar arch
Base of 1st metatarsal
Base of 2nd metatarsal
Medial Cuneiform
Base of 5th metatarsal
1st MTP joint
2nd and 3rd intermetarsal space
Neurologic exam
Monofilament test
Vibration (tuning fork)
Proprioception
Vascular exam
Dorsalis pedis pulse
Posterior tibial pulse
Capillary refill

Y
Y
Y
Y
Y
Y
Y
Y

N
N
N
N
N
N
N
N

NE
NE
NE
NE
NE
NE
NE
NE

Y
Y
Y

N
N
N

NE
NE
NE

Y
Y
Y

N
N
N

NE
NE
NE

--------------------------------------------------------------------------------------------------------------------------------------------------Asssessment
(circle suspected diagnosis - all that apply)
Plantar fasciitis
Pes planus (flat foot)
Osteoarthritis
Bunion deformity (Hallux valgus)
Hallux rigidus (1st MTP arthritis)
Turf Toe (1st MTP Strain)
Gout
Metatarsalgia
Mortons neuroma

Fat pad Contusion

Tibialis posterior tendinopathy
Tibialis anterior tendinopathy
Peroneal tendinopathy
Cuboid Syndrome
Sessamoiditis
Retrocalcaneal bursitis
Lisfranc Fracture
Jones Fracture

Joplins neuritis
Freibergs osteochondrosis
Severs apophysitis (pediatric)
Kohlers osteochondrosis (pediatric)
Haglunds deformity
Tarsal coalition
Referred lumbosacral radiculopathy
Stress Fracture:___________________
Other: _________________________

Plan:
1) Treatment (Circle all employed)
RICE (Rest, Ice, Compression, Elevation)
Foot Orthotic
Exercises: (specify)___________________________
Foot padding
Crutches/reduced weight bearing
Casting
Aspiration/Injection
2) Medications
NSAIDs
Y
N
Specify:________________________
Other:______________________________
3) Imaging
X-rays
Y
N
MRI
Y
N
If yes, specify test ordered:_____________________
4) Referral
Sports Med
Y
N
Orthopedics
Y
N
Podiatry
Y
N
Physical Therapy
Y
N
5) Follow up: ______ wks
Ashwin Rao and Jonathan Drezner, 2007

Foot exam- Anatomy and Pathology

Figure 1- Bones of the foot, dorsal and plantar views

Figure 2 Pes planus. Also known as flat foot. The

examiner should be aware of arch type when
evaluating an individual with foot pain, as pes planus
can the athelete to a painful foot

Figure 5- Jones Fracture of the

5th metatarsal base/ diaphysis.
These fractures require orthopeid
referral and often require internal
fixation.

Figure 3- Bunion deformity. The foot on the left shows a marked

bunion (hallux valgus), involving the 1st MTP. Compare this to the
foot morphology on the right, demonstrating normal anatomic
alignment.

Figure 6- Lisfranc fracture. Caused by

appliance of axial load to the plantar-flexed
foot, this injury may cause disruption of
TMT ligaments, fx at the base of the 1st &
2nd metatarsal, & cuboid fx. AP, lateral
weight bearing views of the foot should be
obtained. BEWARE, findings may be
SUBTLE!

Figure 4- Plantar fasciitis. The classic history of heal pain

with heal strike, worse with initial ambulation, is caused
by a strain or tear of the plantar fascia at its insertion onto
the calcaneus.

Figure 7- Stress fracture of the 3rd

metatarsal. This diagnosis should be
considered in individuals with mid
foot pain and recent activity
increase. Tuning fork test may be
positive.

Figure 8- Freibergs osteochondrosis,

typically seen in older adolescent females,
involves a painful collapse of the articular
surface of the 2nd or 3rd metatarsal head. It is
a relatively rare cause of forefoot pain.

Images obtained via Google Images; Source, Brukner & Khan, Clinical Sports Med, ed. 2