From the Guidelines
When examining a foot injury, key findings include inspection of the skin, assessment of foot deformities, neurological assessment, and vascular assessment, which are crucial in determining the specific injury and guiding management decisions. Begin by inspecting for visible abnormalities, such as swelling, bruising, and deformity, then palpate to locate painful areas, particularly over bones and joints 1. Assess range of motion, noting any limitations or pain with movement. A neurovascular examination is crucial, including checking pulses (dorsalis pedis and posterior tibial), capillary refill, sensation, and motor function, as well as assessing for loss of protective sensation using a 10-g monofilament test 1.
Some key points to consider when examining a foot injury include:
- Inspection of the skin for visible abnormalities, such as ulcers, callus, or pre-ulcerative lesions
- Assessment of foot deformities, such as limited joint mobility or structural abnormalities
- Neurological assessment, including sensation, motor function, and reflexes
- Vascular assessment, including pulses, capillary refill, and signs of peripheral arterial disease
- Assessment of range of motion and weight-bearing ability
According to the most recent guidelines, a comprehensive foot evaluation should include a detailed history and physical examination, including inspection of the foot, assessment of foot deformities, and neurovascular examination 1. The examination should also include an assessment of risk factors for foot ulcers and amputations, such as loss of protective sensation, peripheral arterial disease, and history of previous foot ulcers or amputations. These examination findings guide appropriate management decisions, including whether imaging is needed and what treatment approach is most suitable.
From the Research
Exam Findings for Foot Injuries
The clinical examination of the foot and ankle is crucial in diagnosing and treating foot injuries 2, 3, 4. The following points are key to a thorough examination:
- The examination should be done with the patient in both weight-bearing and non-weight bearing positions 2.
- An evaluation of the patient's gait should be included in the examination 2, 3.
- Reproduction of a patient's symptoms is essential in making a correct diagnosis 2.
- A thorough physical examination should include inspection, palpation, range of motion, and special tests when applicable 3, 4.
Key Components of Foot Exam
The examination of the foot and ankle should assess the entirety of patient disorders, including:
- Bones
- Joints
- Muscles
- Neurovasculature
- Surrounding soft tissue structures 3 A focused history and physical examination can help determine the need for imaging and whether an injury is stable or unstable, requiring operative intervention 4.
Outcomes of Foot Injuries
Foot fractures and complex trauma of the foot can result in significant residual disability and affect quality of life 5. The Visual Analogue Scale Foot and Ankle (VASFA), the Foot Function Index (FFI), and the 12-Item Short Form Survey (SF-12) can be used to evaluate outcomes in patients with foot injuries 5.
Clinical Examination Guide
A comprehensive clinical examination guide for foot and ankle problems can be useful for residents, family doctors, and other healthcare professionals dealing with foot and ankle problems in adults 6.