Foot examination Component What to do Mobility aid Signs of systemic disease Inspect the ankles, feet and then toes and look for: Scars Ulcers Rashes Swelling Deformities Muscle wasting. Alignment and symmetry. Blisters. Hallux valgus Hammer toe. Deformities to look for: Clawing -> in fixed flexion deformity. Crowding of the toes -> RA Sausage toes -> psoriatic arthropathy. Look for features of: OA Asymmetrical Joint enlargement Tenderness Crepitus NO SYSTEMIC FEATURES Normal walking Toe standing and walking. Gait Hell standing and walking. Is the gait smooth and symmetrical? Assess for temperature Check for capillary refill time. Begin with the ankle. Feel for: Synovitis Stress fractures Plantar fasciitis -> medical calcaneal tubercle tenderness Effusion. Palpation Examine the subtalar and midtarsal joints: Fix the os calcaneus and ankle joint with the left hand while inverting and everting the midfoot to the right. Tenderness on movement is more important than range of movements. The midfoot/midtarsal joint -> rotation of the forefoot on a fixed hinge joint. Squeeze the MPT joints for tenderness. Palpate the calcaneus Feel the Achilles tendon for modules and palpate the inferior aspect of the hell for tenderness -> plantar fasciitis. Palpate the medial and lateral malleolus. Passive movements of the talar joints: Inversion Eversion Foot plantar flexion Push your feet downwards as you would push car pedals. Foot dorsiflexion Point your feet towards your head. Midtarsal joints Hold ankle with one head while moving the tarsus up/down and then side to side. Movement THIS IS ONLY A PASSIVE TEST. Toe flexion Ask the patient to curl up their toes. Toe extension Point your toes towards your head. Toe adduction Hold this paper between your toes and don’t let me pull it away. Toe abduction Spread out your toes as far as you can. Sensations Test for them as you would in a neurology exam -> but only the foot.