Introduce and expose the patient's lower limbs. Check for any walking aids and note any special shoes/footwear.

Look
Inspect whilst standing and while supine

• Skin: Scars, swelling, erythema, calluses, ulcers, nails for fungal infections or in-growing nails, between toes

• Muscle: Calf wasting, fasciculations
• Bone & Joint: Deformities (pes planus - flat foot, pes cavus - high-arch, hammer toes, talipes equinovarus - clubbing of feet, bunion at 1st MTP joint, bunionette at 5th MTP Joint)

Check the back of their legs

Feel
With the patient lying supine compare sides.

• Temperature: compare sides with the back of your hand
• Palpate Joint Margins: tenderness over bony prominences including individual MTP joints, interphalangeal joints, lateral/medial malleoli and heel.
• Feel for any swelling, lumps or bony deformity

Move

Active then passive movements. The ankle and foot joint is a collection of four joints: ankle joint (plantar/dorsiflexion), subtalar joint (inversion/eversion), midtarsal joint (lateral/medial roatation), MTP/IP Joints (toe flexion/extension).

• Dorsiflexion (0-45° ): bend ankle to point toes up to your head
• Plantarflexion (0-20° ): bend ankle to point toes down to the ground
• Inversion (0-30° ): turn the sole inwards towards the midline
• Eversion (0-20° ): turn the sole outwards away from the midline
• Midtarsal Joint Rotation: isolate the heel with one hand then hole the toes and move the foot through medial and lateral rotation about the tarsus.
• Toe Flexion/Extension: Straighten and curl up the toes

Special Tests
Achilles Tendon Rupture

• Simmond's Test: With knee flexed squeeze the patient's calves. If the Achilles tendon is ruptured there will be no plantarflexion on the affected side.