Clinical examination of the foot and the ankle. Data collection and interpretation of the pathogenic causal sequence of disorders

SummaryThe clinical examination remains the irreplaceable stage in assessing foot and the ankle disorders. It comprises a complete inventory of the patient's complaints and the data obtained from the physical examination. Afterwards, it should concentrate on establishing consistency between symptoms that can be disparate, to link them in a logical pathogenic causal pattern to be used in developing a treatment programme. These correlations are the most often obvious and only require confirmation with standard X-rays. In the absence of consistency, and if a diagnosis is difficult to establish, recourse to more sophisticated investigations (CT scan, MRI or an intra-articular local anaesthetic test) becomes worthwhile. To achieve maximum value, the physical examination must be based on prerequisite knowledge of functional anatomy, admittedly basic but covering all the bone and joint, ligament, muscle, skin and neurovascular components. All these structures being closely interrelated. This organization allows for remarkable protection mechanisms and the capacity to endure considerable cyclic stress. This interdependence can also command chains of injury difficult to unravel. The examination must thus be methodical and comprehensive: history taking (ranking of symptoms, evaluation of the patient's psychological profile); physical examination, standing, on a podoscope, gait analysis, lying down (trophic disorders, joint range of motion, muscle testing); standard X-rays, always weight bearing. This discursive organization, essential in everyday practice, avoids the sequence “symptom → MRI → surgical indication” which is a professional and intellectual deviance; it enables the development, in terms of advantages against risks, or an appropriate treatment plan in the best conditions.