The foot and ankle physical examination begins with a thorough visual inspection. Begin by noting the athlete's training shoes if possible. The size, type, and condition of the shoe should be appropriate for the training being done. The force across the foot for each foot strike is approximately 3 times the body weight during running, occurring approximately 3000 times every mile for the average jogger.1 Obviously, a shoe's ability to absorb force is critical for injury prevention. After 500 miles, remember that a shoe retains less than 60% of its cushion.2 Also, note any abnormal wear patterns. Normally, the heel has a slight tendency to have more wear laterally. Excessive medial sole wear along the heel may indicate overpronation. In a similar fashion, a large degree of distal sole wear over the metatarsals can indicate an equinus contracture or may simply be secondary to the athlete's normal running style. Comparison with the other shoe is helpful, especially if complaints are unilateral and the shoe wear is not symmetric.
Next, make sure that both legs are visible from the knee down. The patient should begin standing, first facing away from and then toward the examiner. As always, throughout the examination, compare any findings with the contralateral side to check for asymmetry. Note the alignment of the hindfoot. As viewed from behind, the heel should be neutral (Fig. 65-1). In addition, provided the knees both face directly forward, the same number of toes should be visible on the lateral side. With pes planus conditions (e.g., posterior tibialis dysfunction), an increased number of toes will be seen on the lateral side. This "too many toes" sign is usually accompanied by a valgus position of the heel. On double heel rise, the hindfoot should move into a position of relative varus (Fig. 65-2). Failure to do so is most often consistent with a posterior tibialis tendon dysfunction. Likewise, inability to perform a single heel rise (while keeping the knee in extension) may indicate the same pathology of the Achilles tendon-gastrocsoleus complex, or a bony abnormality. If a varus position of the hindfoot is noted on initial examination, a Coleman lateral block test should be performed (see later discussion).
Next, the patient should face the examiner. Note overall alignment of the hind-, mid-, and forefoot and the status of the midfoot arch. The talar head may be abnormally protruded medially with a flatfoot deformity. Crossover and hammer toes, hallux valgus, and other distal pathology are best observed in a weight-bearing position. Finally, have the patient walk while carefully watching symmetry, ability to achieve a plantigrade foot, avoidance patterns, and flow of the stance phase (heel strike to toe off).
Inspect the feet as the athlete sits on the examination table. Take note of calluses on the side and undersurface of the foot. Note areas of swelling and contusion and reinspect the arch for comparison with the weight-bearing state. An arch that remains flat even while non-weight bearing may indicate a fixed deformity such as a tarsal coalition.
Was this article helpful?
Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.