Foot and ankle history and clinical examination: A guide to everyday practice
This review summarises the keys points in taking a full history and performing a systematic clinical examination for patients with foot and ankle problem.
The common problems presented at the foot and ankle clinic are: pain, swelling, deformity, stiffness, instability and/or abnormal gait.
The chronicity and the severity of patient’s pain can help to establish whether there is an element of central sensitization, that is, if the patient becomes more sensitive and experiences more pain with less provocation.
It is necessary to establish when the patient first noticed the deformity, the region involved, progression and other correlated symptoms.
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It is important to establish whether the swelling is localised to one area or the whole leg or ankle. Also, whether it is uni- or bi-lateral, associated with activities, frequency and duration.
Clinicians should also enquire about the first episode of instability or sprain – when it occurred, how often it happens and what aggravates it.
It is important to look out for red flags such as night sweating, temperature or weight loss, which may be related to an infection or neoplasm.
The clinical examination begins by observing patient’s gait and whether he/she uses any walking aids.
There must be an inspection of the patient’s footwear, insole and walking aides.
The patient needs to examined in both sitting and standing positions.
The examination of the foot and ankle is not complete until the following are performed – neurovascular examination, an examination of the spine (deformity like scoliosis, hair tuft on the lower back), leg length examination, hip joint examination and knee joint examination.
Finally, it is important to consider functional testing which is important and needs to be appropriate to the level and background of the patient.
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References:
- Alazzawi, S., Sukeik, M., King, D., Vemulapalli, K. (2017) Foot and Ankle History And Clinical examination: A Guide to Everyday Practice. World Journal of Orthopedics: January 2017, Vol. 8, No. 1, pp. 21-29.
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