Foot Objective assessment

1: Has the patient suffered an injury?
Yes = go to 17; No = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot?
Yes = go to 3; No = Fracture

3: Is the pain around the ankle area?
Yes = go to 7; No = go to 4

4: Ottawa rules positive and unable to walk 4 steps?
Yes = go to 5; No = Fracture

5: Is there swelling both sides of the achilles that fills the dip between malleolus and achilles?
Yes = go to 6; No = Intracapsular injury

6: Pain with or without laxity on testing medial and lateral ligaments of the ankles?
Yes = go to 7; No = Ligament sprain

7: Is the pain in the heel area?
Yes = go to 10; No = go to 8

8: Did the injury involve a fall heavily onto the heel?
Yes = Bruised heel; No = go to 9

9: Can they bear weight on the heel with a flat foot?
Yes = go to 10; No = Calcaneal fracture

10: Is there pain in the calf or achilles - this includes a short duration pain at the time of injury?
Yes = go to 14; No = go to 11

11: Squeeze calf, does foot move up and down? (Thomson’s test)
Yes = go to 12; No = Ruptured achilles

12: Can they walk with the heel down?
Yes = Calf strain; No = go to 13

13: Is there a gap palpable in the calf muscle and/or bruising?
Yes = Calf strain; No = Torn calf

14: Foot pain?
Yes = go to 1; No = go to 15

15: Can they take weight through the foot, ie stand evenly??
Yes = go to 16; No = Fractured foot bones

16: Is there pain when applying local pressure to the bone?
Ligament injury; No = Fractured foot bones

17: Any injury? Any heat anywhere?
Yes = go to 20; No = go to 18

18: Is there any cut or break in the skin of that leg?
Yes = go to 19; No = Suspected infection

19: Is pain and swelling confined to one local joint? (at ankle, toe or foot)
Yes = Cellulitis; No = Gout/ arthritis

20: Is it possible to palpate the area of pain on sides of foot and pain on resistance or on stretching?
Yes = go to 21; No = Tendinopathy

21: Is there pain in Achilles area on palpation of tendon, or pain on resistance, or possible thickening?
Yes = go to 22; No = Achilles tendinopathy

22: Is the painful calf swollen and warm to touch?
Yes = go to 24; No = go to 23

23: Is there pain with passive dorsiflexion? (Homans sign)?
Yes = go to 12; No = DVT suspected

24: Pain from mid foot to toes?
Yes = go to 29; No = go to 25

25: Does squeezing metatarsal heads reproduce the pain?
Yes = go to 28; No = go to 26

26: Is tenderness felt at 4th and 5th metatarsals when weightbearing? Compare to opposite side
Yes = go to 27; No = Stress fracture

27: Pins and needles and altered sensation? Third or fourth toes can be off and on related to walking.
Yes = go to 28; No = Morton's neuroma

28: Pain felt in metatarsal heads (balls of feet) on walking?
Yes = go to 29; No = Metatarsalgia

29: Heel pain under foot?
Yes = go to 1; No = go to 30

30: Worse in a.m. on first few steps, eases then increases again with increasing time on feet?
Yes = Heel spur; No = go to 31

31: Tender at Plantar Fascia attachment?
Yes = END; No = Plantar fasciitis


Looking from the front, is there a new deformity of the lower leg, ankle or foot?


Is there swelling both sides of the achilles that fills the dip between malleolus and achilles?


Pain with or without laxity on testing medial and lateral ligaments of the ankles?


Is there pain in the calf or achilles - this includes a short duration pain at the time of injury?


Squeeze calf, does foot move up and down? (Thomson’s test)


Is pain and swelling confined to one local joint? (at ankle, toe or foot)


Is it possible to palpate the area of pain on sides of foot and pain on resistance or on stretching?


Is there pain in Achilles area on palpation of tendon, or pain on resistance, or possible thickening?


Is tenderness felt at 4th and 5th metatarsals when weightbearing? Compare to opposite side


Pins and needles and altered sensation? Third or fourth toes can be off and on related to walking.


Worse in a.m. on first few steps, eases then increases again with increasing time on feet?