FRCEM Revision Guide • Musculoskeletal OSCE Stations • St Emlyn's

Examiner / observer · 1 of 3

Ankle and foot examination

Preparation · History and inspection

Provide a couch, chair and safe walking space. Use a comfortable consenting partner; agree which tests will be described rather than performed if pain, injury or practical limits intervene.

History and inspection

Asks about the problem, occupation, trauma and recent illness.

Observes gait only when safe with usual aids; does not require walking for suspected fracture or acute painful injury. Key step

Compares scars, skin changes, wasting, arches and toe deformity from front, back and sides.

Inspects the sole for plantar bruising and the spaces between toes.

St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 1 of 3

Examiner / observer · 2 of 3

Ankle and foot examination

Palpation and movement · Forefoot

Palpation and movement

Compares warmth, swelling, tenderness and crepitus, assessing relevant foot/ankle bones and proximal fibula.

Assesses relevant ligament tenderness and selects syndesmotic testing for a clinical question.

Compares active, safe gentle passive and resisted dorsiflexion, plantarflexion, inversion and eversion with heel support.

Assesses toe movement where indicated and stops when pain or suspected injury limits examination.

Achilles tendon

For Simmonds–Thompson, positions prone with feet free, squeezes the calf and compares plantarflexion.

Recognises that reduced/absent plantarflexion supports Achilles rupture and preserved voluntary plantarflexion does not exclude it. Key step

Forefoot

For possible Morton’s neuroma, gently compresses the forefoot and relevant plantar web space, identifying usual pain/paraesthesia and any click.

St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 2 of 3

Examiner / observer · 3 of 3

Ankle and foot examination

Trauma assessment · Finish

Trauma assessment

After trauma, assesses malleoli, navicular, fifth-metatarsal base, midfoot and proximal fibula as appropriate.

Treats plantar bruising as concerning for Lisfranc injury and recognises that Ottawa rules do not exclude every tendon, ligament or midfoot injury. Key step

Completion

Selects relevant knee assessment and documents neurovascular findings, pain limits and further care; does not add routine rectal examination.

Finish

Thanks the patient.

Restores comfort and offers help with dressing where needed.

Ask the candidate

What injuries remain possible despite reassuring findings? Preserved plantarflexion does not exclude Achilles rupture, and Ottawa rules are not an exclusion test for all important injuries.

How would you present your examination? Describes location, function, neurovascular findings, test limits and the reason for protection, imaging, review or referral.

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St Emlyn’s · FRCEM · Practice aid, not an official mark schemeObserver 3 of 3

Ankle and foot examination

Your task

Starting information

Ankle and foot examination

Ankle and foot examination

Preparation

History and inspection

Ankle and foot examination

Palpation and movement

Achilles tendon

Forefoot

Ankle and foot examination

Trauma assessment

Completion

Finish

Ask the candidate

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