Checklist

WIPER

• Patient standing in shorts or underwear; ankles and feet exposed with shoes and socks removed.

• Access is required to the spine, hip and knees to carry out a full biomechanical assessment.

Physiological parameters

Gait

• Antalgic gait

• Walking aids or orthotics

• Observation of footwear

Look

• Skin: scars, erythema, corns and callosities, skin or toe nail changes

• Soft tissues: swelling, proximal disuse muscle atrophy

• Bone:

• foot: deformity, asymmetry, pes cavus, pes planus, equinus ankle, everted foot

• heel: calcaneal valgus/varus

• toes: toes number and alignment, overriding toes, hammer toes, hallux valgus, bunions

Feel

• Skin: temperature, tenderness, sensation

• Soft tissues:

• anterior: extensor tendons, pulses, capillary refill time

• sides: lateral and medial tendons and ligaments; sinus tarsi

• posterior: Achilles tendon

• plantar aspect: plantar fascia

• Bone:

• bone and joint contours: proximal fibular head and neck; talus and calcaneum

• Ottawa ankle rules for suspected ankle fractures

Move

• Active:

• plantarflexion/dorsiflexion

• eversion/inversion

• Passive:

• plantarflexion/dorsiflexion

• eversion/inversion

• Resisted:

• ankle plantarflexion/ankle dorsiflexion

• big toe flexion/big toe dorsiflexion

• inversion/eversion

Special tests (* = essential tests)

• Coleman block test*

• Anterior drawer test*

• Talar tilt – medial and lateral tilt of talus while holding the heel (test medial and lateral ligaments)*

• Neuroma squeeze test (for Morton's neuroma)*

• Tinel's sign

• Simmonds – Thompson test

• To complete the examination…

• Examine the joint above (knee) and the joint below (mid and forefoot).

• Check full neurovascular status of the lower limb.

• Order appropriate radiographs and further imaging.