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How to Examine Feet?

Published in Foot Examination 3 mins read

Examining feet involves a visual inspection and palpation to identify any abnormalities. Here's a guide on how to properly examine someone's feet:

Visual Inspection

  1. Overall Appearance: Begin by observing the overall appearance of both feet simultaneously. Look for any asymmetry in size or shape.

  2. Arches: Assess the arches from the side. Note any signs of:

    • Pes Planus (Flatfoot): A flattened or collapsed arch.
    • Pes Cavus (High Arch): An abnormally high arch.

  3. Skin: Inspect the skin for:

    • Color changes: Redness (inflammation), pallor (poor circulation), or cyanosis (blueish discoloration due to lack of oxygen).
    • Lesions: Ulcers, blisters, corns, calluses, warts, or fungal infections. Pay close attention to areas between the toes.
    • Scars: Indicate previous injuries or surgeries.
    • Dryness or Cracking: Suggests dehydration or skin conditions.

  4. Swelling (Edema): Look for swelling, particularly around the ankles and feet.

  5. Nail Assessment: Examine the toenails for:

    • Thickness: Thickened nails can indicate fungal infection (onychomycosis).
    • Color: Discoloration can indicate fungal infection or injury.
    • Shape: Ingrown toenails or other deformities.
    • Separation from nail bed (Onycholysis): Can indicate fungal infection, trauma, or psoriasis.

  6. Toe Deformities: Identify any deformities of the toes:

    • Hallux Valgus: Deviation of the big toe towards the other toes. Can involve a bunion.
    • Hallux Varus: Deviation of the big toe away from the other toes (less common).
    • Hallux Rigidus: Stiffness and pain in the big toe joint.
    • Hammer Toe: Bent at the proximal interphalangeal (PIP) joint.
    • Claw Toe: Hyperextension at the metatarsophalangeal (MTP) joint and flexion at the PIP and distal interphalangeal (DIP) joints.
    • Mallet Toe: Flexion at the DIP joint.

Palpation

  1. Temperature: Use the back of your hand to assess the temperature of the feet. Compare both feet. Cold feet can indicate poor circulation.

  2. Pulses: Palpate the dorsalis pedis and posterior tibial pulses to assess blood flow to the feet. Absent or weak pulses may indicate peripheral artery disease.

  3. Tenderness: Gently palpate along the bones, joints, and soft tissues to identify any areas of tenderness.

  4. Joint Range of Motion: Assess the range of motion in the ankle and toes. Look for any limitations or pain.

  5. Capillary Refill: Press on a toenail until it turns white, then release. Observe how quickly the color returns. A slow capillary refill (more than 2-3 seconds) can indicate poor circulation.

Additional Considerations

  • Patient History: Obtain a relevant medical history, including any history of diabetes, peripheral artery disease, arthritis, or neurological conditions.
  • Footwear: Ask about the patient's footwear, as improper shoes can contribute to foot problems.
  • Gait Analysis: Observe the patient's gait (walking pattern) to identify any abnormalities that may contribute to foot pain or deformity.

By following these steps, you can effectively examine feet and identify potential problems that may require further evaluation or treatment.

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