13.16. Movements: Examine the mobility of the toes, foot and ankle.
13.17. Gait: Examine the gait, with and withoul shoes. If indicated, screen the ankles, knees, hips and spine; examine the circulation, and carry out a neurological examination. Note the footprint and examine the shoes.
13.18. Investigations: Study the results of special investigations, e.g. radiographs, serum uric acid, sedimentation rate, rheumatoid factor etc.
13.19. Inspection: General: Note whether the foot is normally proportioned. If not, look at the hands and assess the rest of the skeleton. In Marian's syndrome, for example, the feet are long and thin (arachnodactyly, spider bones).
13.20. Inspection: Heel: Is there (A) a calcaneal prominence ('calcaneal exostosis') with overlying callus or bursitis? (Note that where the exostosis is primarily lateral it is known as a Haglund deformity.) Is there deformity of the heel, suggesting old fracture or (B) talipes deformity?
13.21. Inspection: Dorsum (1): Is there
(A) prominence of the fifth metatarsal base?
(B) an 'exostosis' from prominence of the fifth metatarsal head? (The latter is sometimes known as a bunionette or tailor's exostosis.) Both can be a source of local pressure symptoms.
13.22. Inspection: Dorsum (2): Is there (A) a cuneiform exostosis? (B) a dorsal ganglion?
13.23. Inspection: Dorsum (3): Note the general state of the skin and nails. If there is any evidence of ischaemia, a full cardiovascular examination is required. In all cases, the presence of the dorsalis pedis pulse should be sought routinely.
13.24. Inspection: Great toe (1): Note any hallux valgus deformity. If the deformity is severe, the great toe may under- or override the second, and it may pronate. The second toe may sublux at the MP joint. Always reassess any valgus deformity of the great toe with the foot weightbearing.
13.25. Inspection: Great toe (2): Note the presence of any bursa over the MP joint (bunion) and whether active inflammatory changes are present (from friction or infection). Discoloration of the joint with acute tenderness is suggestive of gout.
Was this article helpful?