CHAPTER 50

Foot and Ankle: General Considerations

Physical Examination

• The most helpful part of the physical examination is to have the patient identify their area of discomfort, and then to perform focused palpation with a single finger or thumb to identify the anatomic structure that is tender (point of maximal tenderness) (Figure 50-1).

• Tenderness along the anterior joint line of the ankle may indicate an intra-articular process.

• Swelling that is diffuse or circumferential around the ankle suggests an ankle joint effusion, a sign of intra-articular pathology. Ankle effusions are best appreciated when viewing the ankle from behind.

• Examine the foot with the patient standing, if possible, to assess foot alignment in a functional position.

Accessory Centers of Ossification

• Accessory ossification centers are common around the foot and ankle.

• They may eventually fuse with the parent bone.

• Some persist as separate ossicles attached to parent bone by cartilage or fibrous tissue.

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