OnExam
Inspection
- Non-weight bearing: use SEADSS (Swelling, Erythema, Atrophy, Deformity, Symmetry, Skin changes), nodules, calluses/corns
- In weight-bearing patients, have them remove their socks and shoes and inspect them both walking, sitting, and standing
- Foot position
- Arches
- Supination/pronation
Palpation
- Note areas of pain, swelling, deformity or crepitus in the following structures:
- Medial malleolus (tibia)
- Achilles Tendon
- Lateral malleolus (fibula)
- Tibiotalar joint line
- Talus
- Medial and Lateral ligaments
- Calcaneus (bone spurs)
- Navicular
- Metatarsophalangeal joitns and metatarsal heads
- Plantar fascia
Range of Motion
- Tibiotalar joint:
- Dorsiflexion (normal = 15°) “Point your toes up toward the ceiling”
- Plantar flexion (normal = 55°) “Point your toes down toward the floor”
- Subtalar/talocalcaneal and transverse tarsal joints:
- Inversion (normal = 20°) “Bend your heel inward”
- Eversion (normal = 15°) “Bend your heel outward”
- Ligament stability tests
References
- 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.
- Bickley L. Bate’s Guide to Physical Examination and History Taking. 10th ed. New York: Lippincott Williams & Wilkins; 2009.
- Filate W, Leung R, Ng D, Sinyor M, eds. Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto, 2005.