ANKLE AND FOOT EXAMINATION
Introduction
Wash hands
Introduce yourself – state your name and role
Confirm patient details – name and DOB
Explain examination:
“I’d like to examine your ankles and feet. This will
involve having a look and feel of these joints, in
addition to assessing the joints’ movement”
Gain adequate exposure – both legs should be
exposed from the knee down
Position patient – ask patient to stand up straight
with their feet aligned facing forwards
Look
Gait
Is the patient demonstrating a normal heel
strike/toe off gait?
Is each step of normal height? – increased
stepping height is noted in foot drop
Is the gait smooth and symmetrical?
Examine the patient’s shoes – evidence of
asymmetrical wearing may indicate abnormal gait
Ask the patient to walk on their tip-toes, then on
their heels – problems with this may point to
multiple problems such as arthritis, muscle strength
in the calf muscles which help in plantarflexion and
anterior muscles of the lower leg which help in
dorsiflexion
Inspect from the front
Symmetry of feet and ankles
Toe alignment – hallux valgus of the big toe may be
noted
Bunions – located at the 1st metatarsal phalangeal
joint (MTP) joint
Deformities of the toes (claw/mallet/hammer toes)
Scars – suggestive of previous injury / surgery
Calluses – may indicate foot/gait deformity or
poorly fitting footwear
Swelling or erythema of the foot or ankle – may
suggest injury / inflammatory arthritis / septic
arthritis / cellulitis
Inspect from the side
Foot arches – observe for evidence of flat feet (pes
planus) or high arched feet (pes cavus)
If patient has flat feet ask to stand on
tiptoes – supple flat feet will correct / rigid flat
feet will not
Inspect from the back
Foot/ankle symmetry – heel alignment – valgus or
varus deformity?
Achilles tendon – deformity / discontinuity /
swelling (may suggest Achilles tendonitis) /
erythema
Feel
Ask the patient to lay on a bed
Assess temperature and compare between legs
– ↑ temperature may indicate inflammatory
pathology / septic arthritis / cellulitis
Assess pulses in both feet – posterior tibial and
dorsalis pedis
Palpate the achilles tendon:
 Position the patient kneeling on a chair
 Palpate the gastrocnemius muscle and
achilles tendon
 Note any focal tenderness or swelling
– achilles tendonitis
 Note any apparent gaps in the tendon
– suggestive of rupture
Palpate the joints and bones
Work distal to proximal – assess for tenderness /
swelling / irregularity
 Squeeze MTP joints
 Metatarsal and Tarsal bones
 Tarsal joint
 Ankle joint
  Subtalar joint To complete the examination

 Calcaneum Thank patient

 Medial/lateral malleoli Wash hands

 Distal fibula Suggest further assessments and investigations

Move  Examine the knee and hip joint

Active and passive assessment  Full neurovascular examination of

the lower limbs
Assess each of the following movements actively
and passively, feeling for crepitus (excluding toe  Further imaging of the relevant joints if
flexion/extension) indicated (Xray / CT / MRI)

Foot plantarflexion – “push your feet downwards,

like pushing a car pedal” – 0-50º

Foot dorsiflexion – “point your feet towards your

head” – 0-20º

Toe flexion – “curl up your toes”

Toe extension – “point your toes towards your

head”

Ankle/foot inversion – 0-35º

Ankle/foot eversion – 0-15º

Passive assessment only

Assess the passive movement of:

 Ankle joint

 Subtalar Joint

 Mid-tarsal joint

 Metatarsal-phalangeal and Interphalangeal

joints (proximal and distal)

Special tests

Simmonds’ test

Simmonds’ test is used to assess for rupture of

the achilles tendon

1. Ask patient to kneel on a chair with their

feet hanging off the edge

2. Squeeze each calf in turn

3. Normally the foot should plantarflex

4. If the achilles tendon is ruptured there will

be no movement of the foot