Video


Exam Summary


1. Introduction

  • Introduce yourself and the exam
  • Ask them to expose their foot
  • Ask if the patient has any pain
  • Hand hygiene

2. General Inspection
Ask the patient to lie on the bed. Look for:
  • Wearing on the souls of the shoes - uneven wear could suggest a gait abnormality
  • Rashes
  • Pallor
  • Ulcers
  • Nail abnormalities
  • Tendons and tendon swelling
  • Joint swelling
  • Deformities
    • Bunions
    • Toe clawing
    • Calluses
Bunion.jpg
Bunion

Diabetic_Wound_121.jpg
Diabetic Ulcer
Venous Ulcer.jpg
Venous Ulcer

Arterial Ulcer.jpg
Arterial Ulcer

3. Gait

Ask the patient to walk away from you, turn around and walk back to you. Assess:
  • Fluidity of movement
  • Symmetry
  • Foot drop
  • Integrity of foot arches

Flatfoot.jpg
Flat Foot
Pes cavus.jpg
Pes Cavus (High arched foot)



4. Palpation
Foot Nerves.png
Cutaneous Nerves of the Foot

Start at the ankles and move more distally
  • Temperature
  • Swelling
  • Deformity
  • Tenderness
  • Crepitus
  • Stability
  • Nerves
    • Superficial Fibular
    • Deep Fibular
    • Saphenous
    • Sural
    • Tibial
    • Medial Plantar
    • Lateral Plantar

5. Movement

  • Ankle Dorsiflexion and Plantarflexion - normal range of motion 20º dorsiflexion and 50º plantarflexion
  • Subtalar Eversion and Inversion
  • Midtarsal Eversion and Inversion
  • Metatarsal-phalangeal Flexion and Extension
  • Interphalangeal Flexion and Extension

6. Simmond's Test

  • Ask the patient to kneel on the edge of the bed with their feet hanging over the edge.
  • Squeeze the calf on each leg
  • If plantar flexion does not occur then this suggests an Achilles' Tendon injury.

7. Conclude

Thank the patient and offer assistance

See Also

Diabetic Complications Examination
Talley and O'Connor Clinical Examination - 9th edition pp323-325

References

Flat foot image: "Flatfoot" by Benojeda at English Wikipedia - Own workOriginally from en.wikipedia; description page is/was here.. Licensed under Public Domain via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Flatfoot.jpg#/media/File:Flatfoot.jpg
Bunion image: "Hallux Valgus-Aspect pré op décharge" by The original uploader was Cyberprout at French Wikipedia - Transferred from fr.wikipedia to Commons.. Licensed under CC BY-SA 1.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Hallux_Valgus-Aspect_pr%C3%A9_op_d%C3%A9charge.JPG#/media/File:Hallux_Valgus-Aspect_pr%C3%A9_op_d%C3%A9charge.JPG
Pes Cavus image: "Charcot-marie-tooth foot" by Benefros at English Wikipedia - Own work, originally from en.wikipedia; description page is/was here.. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Charcot-marie-tooth_foot.jpg#/media/File:Charcot-marie-tooth_foot.jpg
Venous Ulcer image:
"Úlceras antes da cirurgia" by Nini00 - Own work --> http://www.varizinforma.com/Photo.htm (.jpg). Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:%C3%9Alceras_antes_da_cirurgia.JPG#/media/File:%C3%9Alceras_antes_da_cirurgia.JPG
Arterial Ulcer image:
"Arterial ulcer peripheral vascular disease" by Jonathan Moore - Creating the Ideal Microcosm for Rapid Incorporation of Bioengineered Alternative Tissues Using An Advanced Hydrogel Impregnated Gauze Dressing: A Case Series. The Foot and Ankle Online Journal 1 (9): 2.. Licensed under CC BY 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Arterial_ulcer_peripheral_vascular_disease.jpg#/media/File:Arterial_ulcer_peripheral_vascular_disease.jpg
Diabetic Ulcer image:
By Intermedichbo at sr.wikipedia [CC BY-SA 3.0 rs (http://creativecommons.org/licenses/by-sa/3.0/rs/deed.en) or GFDL (http://www.gnu.org/copyleft/fdl.html)], from Wikimedia Commons
Cutaneous Nerves of the foot image: Modified from "Gray834" by Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 834This is a retouched picture, which means that it has been digitally altered from its original version. Modifications: vectorization (CorelDraw). The original can be viewed here: Gray834.png. Modifications made by Mysid.. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:Gray834.svg#/media/File:Gray834.svg and "Gray826and831" by Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 826. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:Gray826and831.PNG#/media/File:Gray826and831.PNG
Diabetic_Wound_121.jpg
Diabetic Ulcer
Venous Ulcer.jpg
Venous Ulcer

Arterial Ulcer.jpg
Arterial Ulcer

"Gray834" by Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 834This is a retouched picture, which means that it has been digitally altered from its original version. Modifications: vectorization (CorelDraw). The original can be viewed here: Gray834.png. Modifications made by Mysid.. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:Gray834.svg#/media/File:Gray834.svg