This document provides an overview of the clinical examination of the foot. It describes the anatomy, including the subdivisions and joints of the foot. It outlines the arches, ligaments, and muscles that support the arches. It also discusses the blood supply, venous drainage, and nerve supply of the foot. The document describes the process of taking a history and performing an examination of the foot, including inspection, posture, range of motion testing, footprints, and shoe wear analysis. It lists various conditions that may present in the foot at different stages of life.

1. Clinical Examination of the Foot
Dr. Gautam Sinha
Resident Orthopedics
Dr. Hardas Singh Orthopedic Hospital &
Superspecialty Research Center

2. Anatomy
o Foot is the region of the lower limb
distal to the ankle joint.
o It is the body's point of contact with the
ground and provides a stable platform
for upright stance.
o It also levers the body forward during
walking.
o Subdivided into -
• Rearfoot/Hindfoot - Talus,
Calcaneum
• Midfoot - Navicular, Cuboid, 3
Cuneiforms
• Forefoot- 5 Metatarsals, 14

3. Joints in the Foot :
• Intertarsal Joints
• Subtalar Joints
• Talocalcaneonavicular Joint

4. Arches of the foot :
oAbsorb and distribute downward forces from the body during
standing and moving on different surfaces.
oMedial Longitudinal Arch
oLateral Longitudinal Arch
oTransverse Arch

5. Ligaments and muscle support of the
arches:
Ligaments that support the arches -
o Plantar calcaneonavicular
o Plantar calcaneocuboid
o Long plantar ligaments
o Plantar aponeurosis
Muscles that provide dynamic support for the arches during
walking -
o Tibialis Anterior
o Tibialis Posterior

6. Blood Supply of the Foot :
oBlood supply to the foot is by branches of -
Posterior Tibial A. & Dorsalis Pedis A.
oPosterior Tibial artery enters the sole and
bifurcates into lateral and medial plantar arteries.
oThe lateral plantar artery joins with the terminal
end of the dorsalis pedis artery (the deep plantar
artery) to form the deep plantar arch. Branches
from this arch supply the toes.
oThe dorsalis pedis artery is the continuation of the
anterior tibial artery, passes on the dorsal aspect
of the foot and then inferiorly, as the deep plantar
artery, between metatarsals I & II to enter the sole
of the foot.

7. Venous Drainage of the Foot :
o There are interconnected networks of Deep & Superficial
veins in the foot.
o The deep veins follow the arteries.
o Superficial veins drain into a dorsal venous arch on the
dorsal surface of the foot over the metatarsals
• The Great Saphenous Vein originates from the medial
side of the arch and passes anterior to the medial malleolus
and onto the medial side of the leg.
• The Small Saphenous Vein originates from the lateral side
of the arch and passes posterior to the lateral malleolus
and onto the back of the leg.

8. Nerve Supply of the Foot :
oTibial N.
oDeep Peroneal N.
oSuperficial Peroneal N.
oSural N.
oSaphenous N.

9. History Taking :
• Chief Complaint
• Acute v/s Chronic
• Progression of Symptoms
• Any Previous Injury
• Previous Medical/Surgical Hx
• Medications/Allergies/Personal Hx
• Work (Labor type?)

10. Examination :
Exposure :
• Both shoes and socks off
• Trousers rolled up to the knees at least
Observation :
• Compare weight bearing and non weight bearing position of foot in
- Anterior View
- Posterior View
- Lateral View
- See for - Contour of Foot, Soft Tissue swelling, Bony callosity

11. Inspection :
oGeneral Inspection of the Foot :
• Normally proportioned
• Arachnodactyly, Spider bones in
Marfan’s Syndrome
oInspection of Heel :
• Calcaneal prominence - Exostosis
• Overlying Callus or, Bursitis
• Deformity - Old #, Talipes deformity

12. Inspection :
oInspection of Dorsum :
• Prominence of 5th Metatarsal Base
• Exostosis of 5th Metatarsal Head (both can
be a source of Local pressure symptoms)
• Dorsal Ganglion
• General Condition of Skin & Nails

13. Inspection :
o Inspection of Great Toe :
• Hallux Valgus deformity
• Any Bursa over the MP Jt. -
Bunion
• Discoloration of Jt. w/ Acute
Tenderrness - Gout
• Thickened at MP Jt. - Hallux
Rigidus (OA of 1st MP Jt.)
• Excess Callus under the Great
toe - Hallux Rigidus
• Held in a Flexed position - Hallux
Flexus (due to OA)

14. o Inspection of Great Toe Nail :
• Deformity
• Ingrown w/ Inflammation - Subungual Exostosis
• Uneven in texture & growth - Fungal infection,
Psoriasis
Inspection :

15. Inspection :
o Inspection of Toes :
• Flex the toes & note the relative lengths of the
metatarsals
• Curly Toe - FFD in both MP & IP joints (caused by
Interosseous muscle weakness)
• Claw Toe - Extension in MP Jts. (if all extended - Pes
Cavus, Intrinsic muscle insufficiency)
• Hammer Toe - Flexion at Proximal IP Jt. & Extension at
MP & Distal IP Jts.
• Mallet Toe - Flexion deformity of the Distal IP Jt.
• Hard Corns - Areas of Hyperkeratosis the occur over
Bony prominences, caused by pressure against the
shoes
• Soft Corns - Macerated Hyperkeratosis b/w Toes & not
associated w/ Friction

16. Inspection of Sole :
oHyperhidrosis
oFungal Infections/Athlete’s foot
oUlceration - Pes Cavus, Neurological
disturbance (Trophic ulceration)
oCallus
oPlantar Warts - at the Heel, under the Great toe
& Metatarsal heads
oAny fibrous tissue masses - Dupuytren’s
Contracture (thickening of Plantar fascia)

17. Posture :
oExamined w/ the patient standing
oIntoeing - Torsional deformity of the Tibia
↑Internal Rotation of the Hips
Adduction of the Forefoot
oGenu Valgum - frequently assoc. w/ Valgus Flat Foot
oEversion - Peroneal Spastic Flat foot
Painful lesion on the lateral side of the
foot
Pes Planus

18. Posture :
oInversion :
• Muscle imbalance from
CVA/Neurological d/o
• Hallux Flexus/Hallux
Rigidus
• Pes Cavus
• Residual Talipes deformity
• Painful condition of the
Forefoot
oSplaying :
• Broadening of the Forefoot
• Due to Intrinsic muscle
weakness
• Assoc. w/ Pes cavus,
Callus under the metatarsal
heads, Hallux Valgus, Ant.
Metatarsalgia, Unfit Shoes

19. Medial Arch :
oHigh & Accentauted - Pes Cavus
oObliterated - Pes Planus
Heel :
oValgus Heels - assoc. w/ Pes Planus
oVarus Heels - assoc. w/ Pes Cavus

20. Gait :
• Watch the patient while walking, first Barefooted & then in Shoes
• Examine from Behind, Front & Sides

21. Palpation :
o↑Local Skin Temperature - Rheumatoid Arthritis, Gout
oCirculation :
• Dorsalis Pedis A. - lies just lateral to the EHL tendon & felt by pressing it
against the Middle Cuneiform
• Note any Cyanosis when dependent & any Blanching on elevation -
Arterial Insufficiency

22. Tenderness :
oJack’s Test for Plantar Fascitis :
• Forcibly dorsiflex the great toe to
stretch the plantar fascia
• Tenderness over the heel
attachment of the fascia is
Diagnostic
oDiffuse Tenderness under all
metatarsal heads :
• Ant. Metatarsalgia
• Pes Cavus
• Pes Planus
• Gout
• Rheumatoid Arthritis

23. Tenderness :
o March # - Tenderness on both Plantar &
Dorsal surface of 2nd, 3rd Metatarsal
necks/Shafts
o Plantar digital neuroma - Sharply defined
tenderness b/w 3rd & 4th Metatarsal heads
o Gout :
• Acute Tenderness
• Diffusely spread around whole MP Jt. &
entire Great Toe
• Often have a reddish blue discoloration of
skin around the toe

24. Tenderness :
Tenderness of Great Toenail :
• Subunbual Exostosis – Pain on squeezing the toe in Vertical
plane
• Ingrowing Toe Nail – Pain on side-to-side pressure

25. Range of Motion :
Foot :
• Supination - 35◦
• Pronation - 20◦
• Inversion - 20◦
• Eversion - 10◦
Great Toe :
• Flexion - 40◦
• Extension - 65◦
Interphalangeal Joints :
• Flexion - 60◦
• Extension - 0◦

26. Restriction of Movements :
oRestricted Supination & Pronation : Stiff Subtalar Jts.
oRestricted movements of MP Jts. : Hallux Rigidus
oRestricted movements of Great Toe : # Terminal phalanx
oRestricted movements of Lesser Toes : Gout, RA, Sudeck’s atrophy,
Ischemic
conditions of the foot & leg

27. Foot print :
oHelpful to see the pattern of Weight distribution in the foot
oNote the imprint of the sweaty foot on a Vinyl floor or,
oCan use Ink on paper

28. Inspection of Shoes :
oPatient’s only complaint may be shoe wear.
oIn the Normal sole, wear is fairly even, being maximal across he tread.

29. Conditions first seen in
childhood
Conditions affecting the
Adolescent foot
Conditions affecting the Adult foot
-Talipes Equinovarus
-Talipes Calcaneus
-Skew foot
-Intoeing
-Flat foot
-Pes cavus
-Kohler’s disease
-Sever’s dse
-HalluxValgus
-Peroneal (Spastic) flat foot
-Exostoses
-Hallux Rigidus
-Adult flat foot
-Splay foot
-Anterior Metatarsalgia
-March fracture
-Freiberg’s Dse
-Plantar (Digital) Neuroma (Morton’s
Metatarsalgia)
-Verruca Pedis (Plantar Wart)
-Plantar Fascitis
-MalletToe, HammerToe, ClawToe, Curly
-Toe
-Nail of the GreatToe - Ingrowing,
Onycgogryphosis, Subungual Exostosis,
Melanonychia
-RA
-Gout
-TarsalTunnel Syndrome

30. Thank you…