Examine the hip, knee, ankle, midfoot, metatarsophalangeal joints and the interphalangeal joints.
Examine each joint in weight bearing fashion, as well as lying down.
For each joint, check for deformity, soft tissue swelling, fluid in the join, focal areas of tenderness and range of motion.
Palpate the joint with one hand while moving it with the other to feel for crepitation.
If swollen, distinguish synovial swelling from pitting edema.
Hip
Inspection
Anatomical landmarks
Greater Trochanter
Muscles around the joint
Quadriceps, Hamstrings, Gluteal muscles
Palpation
Anatomical landmarks
Palpate for tenderness
in the inguinal region
laterally over the trochanteric bursa.
Range of motion. Check hip motion with knee flexed:
Active
Flexion 120o
Extension
External rotation 45o
Internal rotation 40o
Abduction
Adduction
Knee
Inspection
Anatomical landmarks
Limb alignment
Patellar alignment
Muscles around the joint
Quadriceps
Hamstrings
Palpation
Anatomical landmarks for
Focal areas of tenderness of
Bony prominences and contours for fractures
Tibial tubercle
Epicondyles of femur
Margins of Tibia
Musculotendon junctions and tendon insertions for evulsions and tear
Joint line for cartilaginous injuries and arthritis
Range of motion
Flexion (130o)
Extension (0o)
Look for medial and lateral instability.
Suspend legs with patella at equal levels and observe the height of great toes. Uneven height of great toes indicates posterior lag and loss full extension
Flex knee to full extent and compare the distance between heel and buttock. Disparity indicates impaired level of flexion
Ankle
Inspection
Anatomical landmarks
Alignment
Distal fibula
Lateral malleolus
Muscles around the joint
Palpation
Anatomical landmarks for
Talus
Peroneal tendon
Anterior joint line
Medial ligament
Sustentaculum tali
Range of motion
Active
Plantar flexion (45o)
Dorsiflexion (20o)
Inversion
Eversion
Foot
Inspection standing
Anatomical landmarks
Look at the integrity of the plantar arch while the patient is standing.
Medial process of calcaneal tuberosity
Heel foot pad
Attachment of plantar fascia
Muscles around the joint
Palpation
Anatomical landmarks
Look for local tenderness of the Achilles tendon
The bottom of the foot at the calcaneus.
Look for tenderness of the metatarsophalangeal joints and interphalangeal joints.
Range of motion
Active
Check eversion (20o) and inversion (30o) of the midfoot.