Dr. Barry Teaches the Exam of the Foot and Ankle
May 30, 2014
Thank you to Dr. Michele Barry for leading the Stanford 25 session last week on the foot and ankle exam. Residents were taught the basics of the exam and then practiced on each other. Dr. Barry trained in Rheumatology at Yale and now serves as the Director of the Johnson & Johnson Global Health Scholars Program at Stanford. Please read below for some take-home points of the foot and ankle exam from Dr. Barry.
Inspection: Look at the soles of the shoe and look for the pattern of wear. A person with normal gait and no foot deformity should have wear on the lateral aspect of the shoe. Deformities associated with foot and ankle will present as wear on soles at other areas of shoes. Look at lower extremities for hair pattern, purpura, LCV.
Palpation: Pain with movement, without movement, ROM (inversion=10 degrees, eversion=20 degrees). Evaluate the laxity of the joints in each foot and ankle. Strength and flexibility should be symmetrical, but if person has previous a fracture, injury, weakness one foot and/or ankle may have greater laxity on the affected side.
Eponyms of the Foot:
Lover’s Heel: Disease of Achilles tendon associated with gonococcal tenosynovitis, assess by performing squeeze test and ankle draw.
Policeman’s Heel: Pain from pressing over the heel of the foot that may be relieved by rolling the ball of the foot over a plastic coke bottle.
In this session, we shared our experiences with teaching the physical exam at the bedside. Our participants got into groups and came up with their own bedside teaching example to share with everyone.
This year, the medical student interest group created a “Clinical Pearl Award” that challenged medical students to create a clinical pearl through an essay, a step-by-step photo guide or a video demonstration.
Dr. Verghese was invited to speak at the TED Global in Edinburgh, Scotland in 2011. He spoke about the importance of the physical exam and how we physicians are in danger of losing the connection with our patients as we focus more on technology and the electronic medical record.