Prepare patient

1. Introduction
2. Position with knees to toes exposed

General Principles of Joint Exam

1. Check if any pain, then look, feel, move, measure & compare with other side, & assess function.

Look

General inspection

1. Obvious other joint disease

Specific

1. Muscle wasting
2. Skin – Scars, swelling, inflammation
3. Toenails – pitting (psoriasis)
4. Deformities – hallux valgus, clawing, toe crowding (all common in RA) sausage toes (psoriasis, Reiter’s, ankylosing spondylitis)
5. Arches of foot – transverse & longitudinal
6. Calluses over metatarsal heads

Feel

1. Tenderness and swelling around malleoli, Achilles tendon: (for RA nodules, tendonitis or rupture)
2. 1st MTPJ: Acute gout (inflammation, tophi)
3. Sole of foot: Plantar fasciitis (heel), Morton’s neuromas (just proximal to 3rd & 4th MTPJs)

Move

Talar (ankle) joint

1. (grasp midfoot in one hand and support back of ankle with other)
   1. Dorsiflexion (20º)
   2. Plantar flexion (50º)

Subtalar joint

1. (grasp forefoot in one hand and fix ankle with other)
   1. Inversion & Eversion – note tenderness

Midtarsal joint

1. (grasp forefoot in one hand and fix hindfoot with other)
   1. Twist forefoot – note tenderness

MTPJs

1. Squeezing 1st & 5th joints together – note tenderness

IPJs

1. Flexion & extension – note tenderness

Function

1. Simmond’s test for Achilles rupture.
2. Ability to walk/Gait