Ankle & Foot Exam

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 movement in the ankle and foot	0	1
Washes hands	0	1
Exposes patient’s ankles and feet and the joints above (knees) and asks them to stand	0	1
General inspection around bed and patient (walking aids, obvious scars, wasting or deformities)	0	1
Asks patient to walk to the end of room and turn	0	1
Comments on patient’s speed, the phases of walking, stride length and arm swing	0	1	2
Inspects front for shoulder/hip alignment, limb-limb discrepancy, varus/valgus deformity, wasting of quadriceps	0	1
Inspects back for wasting of muscles (gluteal, calf), scoliosis, wear of shoes	0	1
Inspects sides for fixed flexion deformities and increased kyphosis or lordosis	0	1
Inspects foot closely for skin changes, arch abnormalities, scars, hindfoot deformities, corns, callosities, ulcers, infections, ingrown toenails	0	1
Palpates temperature of ankle and foot	0	1
Palpates joint margin, hindfoot, midfoot and forefoot for tenderness, effusions, oedema	0	1
Tests active dorsal and plantar flexion and flexes further passively if range of movement is restricted. Comments on maximum angle (normal: dorsiflexion - 10 degrees, plantar flexion 40 degrees)	0	1	2
Tests active inversion and eversion using the ankle as a pivot turning the sole towards the midline and away and extends passively if necessary (normal: 30 degrees for both)	0	1	2
Passively tests abduction/external rotation (normal: 40 degrees) and adduction/internal rotation (normal: 25 degrees)	0	1	2
Assesses midtarsal movement holding heel firmly and forefoot in other and moving forefoot up and down, side to side	0	1
Performs Simmond’s test for rupture of Achilles tendon (squeeze calves with patient lying prone and feet hanging off bed, looking for normal reflex plantar flexion)	0	1
Offers examination of hip and knee exam, neurovascular exam and history	0	1
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 indicated, MRI for soft tissue)	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses	0	1

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