OnExam

Review the General Musculoskeletal Physical Examination

Inspection

  • Inspect patient without shoes in standing and sitting position. Inspect anteriorly, posteriorly and laterally
  • Note general ankle and foot contours. Note erythema, swelling or any noteable bony deformity
    • Gait
    • Inspect shoes for wear pattern
    • Stance
      • Pronation or supination
      • Metatarsus valgus or varus
    • Arches
      • Transverse and longitudinal
    • Muscle atrophy, hypertrophy, spasm or increased tone
    • Medial and lateral malleolus
    • Distal tibia, fibula and calcaneus
    • Integrity of achilles tendon
    • Inspect specifically for:
      • Hallux valgus
      • Corns
      • Ulcers
      • Calluses
      • Nodules
      • Lesions
      • Toenail Quality

Palpation

  • Note areas of pain, swelling, spasm, muscular atrophy, ligamenous laxity, deformity, boggines or crepitus in the following stuctures:
    • Medial malleolus (Tibia)
    • Lateral malleolus (fibula)
    • Medial and lateral ligaments
    • Achilles tendon
    • Tibiotalar joint line
    • Talus
    • Calcaneus (note bone spurs)
    • Calcaneal bursa
    • Plantar fascia
    • Arches
      • Transverse and longitudinal
    • Tarsal bones
      • Navicular
      • Cuboid
      • Cuneiform bones
    • Metatarsalphalangeal joints
      • Dorsal and ventral aspects
      • Compress the forefoot for bogginess and pain recreation
    • Metatarsal heads and interspaces
    • Proximal and distal phalanges

Range of Motion

  • Tibiotalar joint:
    • Dorsiflexion (normal = 15°) "try to touch the top part of your foot to your shin"
    • Plantar flexion (normal = 55°) "point your toes like standing on your toes"
  • Subtalar (talcalcaneal) joint (foot movement):
    • Inversion (normal = 20°) "bend your heel inward"
    • Eversion (normal = 15°) "bend your heel outward"
  • Transverse tarsal joint (forefoot movement)
  • Metatarsalphalangeal joints "point toes up and down"
    • Flexion of great toe (normal = 40°)
    • Extension of great toe (normal = 65°)

Special Tests

Ligamentous Stability Tests

Ottawa Ankle Rule

References

  1. Baxter, S. & McScheffrey G. (2010). Toronto Notes: Comprehensive Medical Reference & Review for MCCQE 1 & UMSLE 2. 26th ed. Toronto: Toronto Notes for Medical Students; 2010.
  2. Bickley, L. (2013). Bates Guide to Physical Examination and History Taking. 11th ed. New York: Lippincott Williams & Wilkins; 2013.
  3. Filate W., Leung, G., Ng, D. & Sinyor, M. (2005). Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto; 2005.