Chapter 1

Foot and Ankle Examination

Foot and ankle examination means rule of three!

Precise clinical examination of foot and ankle is the first step toward successful treatment of foot and ankle ailments. Three important rules to be followed by the examiner are listed in Box 1.1.

Similarly, there are three important rules to be followed by the patient for proper evaluation, which would allow the examiner to interpret the condition of the disease correctly. Three important rules meant for the patient are listed in Box 1.2.

Gait Examination

Examination should be performed in three positions. Box 1.3 illustrates the three rules for patient’s positions during examination. Examination of the foot is divided into three parts (Box 1.4) and is performed in three basic steps, which are listed in Flowchart 1.1.

Flowchart 1.1 Steps of examination.

Inspection

Palpation is done by using the index finger, either self or that of the patient (Fig. 1.1), beginning sequentially from the medial aspect to the plantar, to the lateral, followed by the anterior, and finally ending at the posterior aspect.

Fig. 1.1 Patient pointing at the painful area with his index finger.

The three important parts of palpation are mentioned in Box 1.5.

For the right foot, start clockwise, and for the left foot start anticlockwise (Figs. 1.2 and 1.3).

Fig. 1.2 Palpation of the right foot.

Fig. 1.3 Palpation of the left foot.

Topographical Palpation

Structures to be palpated in sequence are as follows:

♦ Skin

♦ Bone and joints

♦ Ligaments

♦ Muscles and tendons

♦ Arches

Topographical palpation areas of (1) ankle are depicted in Figs. 1.4 to 1.8 and are described in Table 1.1; (2) midfoot are depicted in Figs. 1.9 and 1.10 and are described in Table 1.2; (3) forefoot are depicted in Figs. 1.11 and 1.12 and are described in Table 1.3.

Fig. 1.4 Medial aspect of the foot and ankle. A, Achilles rupture/noninsertional tendonitis; B, insertional Achilles tendonitis; C, calcaneal apophysitis/pump bump; D, retrocalcaneal bursitis; E, tarsal tunnel syndrome/ tibial posterior tendon; F, medial/deltoid ankle sprain; G, entrapment of first branch of lateral plantar nerve; H, accessory navicular/master knot of Henry/medial plantar nerve entrapment.

Fig. 1.5 Plantar aspect of the foot. A, plantar fasciitis; B, fat pad atrophy.

Fig. 1.6 Lateral aspect of the foot and ankle. A, Jones fracture; B, avulsion fracture of the fifth metatarsal; C, anterior ankle impingement; D, anterior talofibular ligament; E, sinus tarsi syndrome; F, calcaneofibular ligament; G, retrocalcaneal bursitis; H, Achilles tendonitis; I, calcaneal apophysitis/Sever’s disease/pump bump.

Fig. 1.7 Anterior (dorsal) aspect of the foot and ankle. A, anterior ankle impingement; B, osteochondral defect of talar dome medial or lateral; C, the n spot: navicular stress fracture.

Fig. 1.8 Posterior aspect of the foot and ankle. A, tendo Achilles; B, insertion of tendo Achilles.

Table 1.1 Areas for topographical palpation of ankle

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