With patient weight bearing;
- Observe the feet, comparing one with other, for symmetry.
- Look for nail changes or skin rashes such as psoriasis
- From behind, look at the hindfoot for Achilles tendon thickening or swelling
- Look for the alignment of the toes and any evidence of HALLUX VALGUS (bunion)– of the big toe – it deviates laterally.
- Look at the arches of the feet.
- Flat feet = Pes Planus- mostly asymptomatic.
- Pes Cavus= accentuated longitudinal arches that do not flatten with weight bearing. Can be idiopathic or from spina bifida, cerebral palsy. Claw toes may occur- causing pain. If foot used to be normal – refer to neurologist. Treatment = custom footwear
- Any swelling, clawing of toes or calluses.
- Look at the patient’s footwear. Check for abnormal or asymmetrical wearing of the sole or presence of special footwear.
With patient sitting on couch, legs overhanging;
- Observe feet again, comparing one with the other
- Look for nail changes, alignment, swelling, clawing or calluses.
- Look on plantar side for callus formation.
- For temperature – over forefoot and ankle
- Check for presence of peripheral pulse
- Gently squeeze across the MTP joints, watching patient’s face for discomfort.
- Palpate the midfoot and ankle for tenderness
- Actively and passively, movements of inversion and eversion at the sub-talar joint
- Movements of plantar flexion and dorsi-flexion a the big toe and ankle joint
To finish you might want to assess the patient’s gait, check joints above and perform neuro-vascular examination.
- Hammertoes; extended at the MTP, hyper flexed at the PIP and extended at DIP
- Claw Toes; extended at MTP but flexed at both PIP and DIP.
- Hallux Valgus (Bunion) – lateral deviation of the big toe (hallux) at the MTP. Toe may or may not sit under/over the second toe. The ‘bunion’ is the apparent bulge at the MTP cause by the deviation of the toe. Often painful, may have some joint tenderness and redness. More common in women. Thought to be mostly genetic, although poorly fitting footwear may be a contributing factor.
State you would examine the joints above (as injury of distal) joints may be due to a problem with more proximal joints. Thank patient, wash hands and present findings.