Procedure
- Ask the patient remove all clothing from the legs.
- Assess the spontaneous position with the patient standing.
- Ask the patient to stretch the knees and place the feet slightly apart.
Ventrolateral Side
Stand in front of the patient and inspect the shape and position of the following structures.
Bones and Joints
- Toes (hallux valgus, hammer toes, claw toes, curved toes).
- Feet (transverse arch, pes planotransversus, shifting of weight over the feet).
- Lateral malleolus.
- Lower leg (rotation abnormalities).
- Knees (patella, genu valgum, genu varum).
To assess any genu valgum or varum, ask the patient to place their legs/feet next to each other.
Soft Tissues
- Skin of toes, feet and lower legs (callus, corn, ingrown toenail, mycosis between the toes).
- Muscle contours of the:
- Extensors or dorsal flexors.
- Eversions.
- Tendons of the:
- Extensors.
- Eversion muscles.
Medial Side
Inspect the shape and the position of the following structures.
Bones and Joints
- Metatarsophalangeal joint I (hallux valgus/bunion).
- Feet.
Assess longitudinal arch: Slide your fingers under the longitudinal arch, if possible. You should be able to slide your fingers at least 1.5 cm under the sole of the foot. If necessary, ask the patient to place their foot in front of the other and put weight on it [Figures 92a, 92b].
Figure 92a
Figure 92b
- Navicular bone (tuberosity of navicular bone).
- Calcaneus (sustentaculum tali).
- Medial malleolus.
Soft Tissues
- Skin, in particular the inside of the feet and lower legs.
- Tendons of the inversion muscles.
Dorsal Side
Inspect the posterior side. Ask the patient to make a 180° turn or stand behind the patient. The patient stands with their feet slightly apart [Figure 93].
Figure 93
Bones and Joints
- Lateral malleolus.
- Medial malleolus.
- Calcaneus (varus or valgus position).
- Knees (genu valgum, genu varum, height of knee folds).
To assess any genu valgum or genu varum, ask the patient to place their legs/feet next to each other.
Soft Tissues
- Skin, heels and lower legs.
- Muscle contours of the flexors (plantar flexors).
- Tendons:
- Achilles tendon and grooves (rupture, swelling).
Gait Pattern
Ask the patient to walk and note:
- Symmetry/asymmetry.
- Stride length.
- Distribution of body weight over the left and right leg and foot.
Can the patient do the following without problems:
- Walk on their toes (plantar flexors)?
- Walk on their heels (dorsal flexors)?
- Walk on the inside of their feet (eversion muscles)?
- Walk on the outside of their feet (inversion muscles)?
Plantar Side
Ask the patient to sit on the examination table and inspect the shape and position of the following structures.
Bones and Joints
- Compare with standing position when body weight is distributed over feet.
Soft Tissues
- Skin (callous formation, hyperkeratosis, verrucas).
If there are clear abnormalities on the soles of the feet, the patient should lie in the prone position on the examination table with feet hanging over the edge so that the soles of the feet can be examined more carefully.