OnExam

Inspection

  • Inspect patient without shoes in standing and sitting, anteriorly, posteriorly, and laterally
    • Gait
    • Stance indicating pronation or supination
    • Arches: transverse and longitudinal
    • Muscle atrophy, hypertrophy, spasm or increased tone
    • Hallux valgus
    • Corns
    • Inspect shoes for wear pattern

Palpation

  • Note areas of pain, swelling, spasm, atrophy, deformity or crepitus in the following structures:
    • Calcaneus (bone spurs)
    • Navicular
    • Metatarsophalangeal joints and each metatarsal head in the forefoot
    • Metatarsals
    • Plantar fascia
    • Arches: transverse and longitudinal
    • Calcaneal bursa

Range of Motion

  • Dorsiflexion (normal = 15°), “Pull toes upwards”
  • Plantar flexion (normal = 55°), “Point toes downwards”
  • Inversion of heel at subtalar joint while examiner stabilizes ankle (up to 20°), “Turn foot inwards” Note:ensure motion is foot and not leg
  • Eversion of heel at subtalar joint while examiner stabilizes ankle (up to 10°), “Turn foot outwards” Note:ensure motion is foot and not leg
  • Flexion of great toe (normal = 40°), “Bend big toe downwards”
  • Extension of great toe (normal = 65°), “Pull big toe upwards"

References

  1. Baxter S, ed., McScheffrey G, ed. Toronto Notes: Comprehensive Medical Reference & Review for MCCQE 1 & USMLE 2. 26th ed. Toronto: Toronto Notes for Medical Students Inc; 2010.
  2. Bickley L. Bate’s Guide to Physical Examination and History Taking. 10th ed. New York: Lippincott Williams & Wilkins; 2009.
  3. Filate W, Leung R, Ng D, Sinyor M, eds. Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto, 2005.