Ankle & Foot Exam

osce-stations.blogspot.com/2016/05/ankle-foot-exam.html

Introduces self 0 1

Confirms name & age of patient 0 1

Explains & gains consent 0 1

Asks if patient suffers from pain, stiffness or reduced range of 0 1

movement in the ankle and foot

Washes hands 0 1

Exposes patient’s ankles and feet and the joints above (knees) and 0 1
asks them to stand

General inspection around bed and patient (walking aids, obvious 0 1

scars, wasting or deformities)

Asks patient to walk to the end of room and turn 0 1

Comments on patient’s speed, the phases of walking, stride length 0 1 2

and arm swing

Inspects front for shoulder/hip alignment, limb-limb discrepancy, 0 1

varus/valgus deformity, wasting of quadriceps

Inspects back for wasting of muscles (gluteal, calf), scoliosis, wear of 0 1

shoes

Inspects sides for fixed flexion deformities and increased kyphosis or 0 1

lordosis

Inspects foot closely for skin changes, arch abnormalities, scars, 0 1

hindfoot deformities, corns, callosities, ulcers, infections, ingrown
toenails

Palpates temperature of ankle and foot 0 1

Palpates joint margin, hindfoot, midfoot and forefoot for tenderness, 0 1

effusions, oedema

1/2
Tests active dorsal and plantar flexion and flexes further passively if 0 1 2
range of movement is restricted. Comments on maximum angle
(normal: dorsiflexion - 10 degrees, plantar flexion 40 degrees)

Tests active inversion and eversion using the ankle as a pivot turning 0 1 2
the sole towards the midline and away and extends passively if
necessary (normal: 30 degrees for both)

Passively tests abduction/external rotation (normal: 40 degrees) and 0 1 2

adduction/internal rotation (normal: 25 degrees)

Assesses midtarsal movement holding heel firmly and forefoot in 0 1

other and moving forefoot up and down, side to side

Performs Simmond’s test for rupture of Achilles tendon (squeeze 0 1

calves with patient lying prone and feet hanging off bed, looking for
normal reflex plantar flexion)

Offers examination of hip and knee exam, neurovascular exam and 0 1

history

Thanks patient and offers help to redress 0 1

Washes hands 0 1

Offers next step (imaging: 2 plain x rays for bony pathology or CT if 0 1

indicated, MRI for soft tissue)

Summarises appropriately with only key findings 0 1

Offers appropriate differential diagnoses 0 1

2/2