ANKLE AND FOOT EXAMINATION
Introduction Swelling or erythema of the foot or ankle – may
suggest injury / inflammatory arthritis / septic
Wash hands arthritis / cellulitis
Introduce yourself – state your name and role Inspect from the side
Confirm patient details – name and DOB Foot arches – observe for evidence of flat feet (pes
Explain examination: planus) or high arched feet (pes cavus)
“I’d like to examine your ankles and feet. This will If patient has flat feet ask to stand on
involve having a look and feel of these joints, in tiptoes – supple flat feet will correct / rigid flat
addition to assessing the joints’ movement” feet will not
Gain adequate exposure – both legs should be Inspect from the back
exposed from the knee down Foot/ankle symmetry – heel alignment – valgus or
Position patient – ask patient to stand up straight varus deformity?
with their feet aligned facing forwards Achilles tendon – deformity / discontinuity /
Look swelling (may suggest Achilles tendonitis) /
erythema
Gait
Feel
Is the patient demonstrating a normal heel
strike/toe off gait? Ask the patient to lay on a bed
Is each step of normal height? – increased Assess temperature and compare between legs
stepping height is noted in foot drop – ↑ temperature may indicate inflammatory
pathology / septic arthritis / cellulitis
Is the gait smooth and symmetrical?
Assess pulses in both feet – posterior tibial and
Examine the patient’s shoes – evidence of dorsalis pedis
asymmetrical wearing may indicate abnormal gait
Palpate the achilles tendon:
Ask the patient to walk on their tip-toes, then on
their heels – problems with this may point to Position the patient kneeling on a chair
multiple problems such as arthritis, muscle strength Palpate the gastrocnemius muscle and
in the calf muscles which help in plantarflexion and achilles tendon
anterior muscles of the lower leg which help in
dorsiflexion Note any focal tenderness or swelling
– achilles tendonitis
Inspect from the front
Note any apparent gaps in the tendon
Symmetry of feet and ankles – suggestive of rupture
Toe alignment – hallux valgus of the big toe may be Palpate the joints and bones
noted
Work distal to proximal – assess for tenderness /
Bunions – located at the 1st metatarsal phalangeal swelling / irregularity
joint (MTP) joint
Squeeze MTP joints
Deformities of the toes (claw/mallet/hammer toes)
Metatarsal and Tarsal bones
Scars – suggestive of previous injury / surgery
Tarsal joint
Calluses – may indicate foot/gait deformity or
poorly fitting footwear Ankle joint
Subtalar joint To complete the examination
Calcaneum Thank patient
Medial/lateral malleoli Wash hands
Distal fibula Suggest further assessments and investigations
Move Examine the knee and hip joint
Active and passive assessment Full neurovascular examination of
the lower limbs
Assess each of the following movements actively
and passively, feeling for crepitus (excluding toe Further imaging of the relevant joints if
flexion/extension) indicated (Xray / CT / MRI)
Foot plantarflexion – “push your feet downwards,
like pushing a car pedal” – 0-50º
Foot dorsiflexion – “point your feet towards your
head” – 0-20º
Toe flexion – “curl up your toes”
Toe extension – “point your toes towards your
head”
Ankle/foot inversion – 0-35º
Ankle/foot eversion – 0-15º
Passive assessment only
Assess the passive movement of:
Ankle joint
Subtalar Joint
Mid-tarsal joint
Metatarsal-phalangeal and Interphalangeal
joints (proximal and distal)
Special tests
Simmonds’ test
Simmonds’ test is used to assess for rupture of
the achilles tendon
1. Ask patient to kneel on a chair with their
feet hanging off the edge
2. Squeeze each calf in turn
3. Normally the foot should plantarflex
4. If the achilles tendon is ruptured there will
be no movement of the foot
