Introduces self
0
1

Confirms name & age of patient
0
1

Explains & gains consent
0
1

Asks if patient suffers from pain, stiffness or reduced range of movement in the ankle and foot
0
1

Washes hands
0
1

Exposes patient’s ankles and feet and the joints above (knees) and asks them to stand
0
1

General inspection around bed and patient (walking aids, obvious scars, wasting or deformities)
0
1

Asks patient to walk to the end of room and turn
0
1

Comments on patient’s speed, the phases of walking, stride length and arm swing
0
1
2
Inspects front for shoulder/hip alignment, limb-limb discrepancy, varus/valgus deformity, wasting of quadriceps
0
1

Inspects back for wasting of muscles (gluteal, calf), scoliosis, wear of shoes
0
1

Inspects sides for fixed flexion deformities and increased kyphosis or lordosis
0
1

Inspects foot closely for skin changes, arch abnormalities, scars, hindfoot deformities, corns, callosities, ulcers, infections, ingrown toenails
0
1

Palpates temperature of ankle and foot
0
1

Palpates joint margin, hindfoot, midfoot and forefoot for tenderness, effusions, oedema
0
1

Tests active dorsal and plantar flexion and flexes further passively if range of movement is restricted. Comments on maximum angle (normal: dorsiflexion - 10 degrees, plantar flexion 40 degrees)
0
1
2
Tests active inversion and eversion using the ankle as a pivot turning the sole towards the midline and away and extends passively if necessary (normal: 30 degrees for both)
0
1
2
Passively tests abduction/external rotation (normal: 40 degrees) and adduction/internal rotation (normal: 25 degrees)
0
1
2
Assesses midtarsal movement holding heel firmly and forefoot in other and moving forefoot up and down, side to side
0
1

Performs Simmond’s test for rupture of Achilles tendon (squeeze calves with patient lying prone and feet hanging off bed, looking for normal reflex plantar flexion)
0
1

Offers examination of hip and knee exam, neurovascular exam and history
0
1

Thanks patient and offers help to redress
0
1

Washes hands
0
1

Offers next step (imaging: 2 plain x rays for bony pathology or CT if indicated, MRI for soft tissue)
0
1

Summarises appropriately with only key findings
0
1

Offers appropriate differential diagnoses
0
1