Ankle and Foot OSCE Examination Quiz

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You have finished the main parts of an ankle and foot examination. What is the best way to complete it?

Thank the patient, wash your hands and summarise your findings, then examine the other ankle and foot and ask the patient to walk, as comparison and gait complete the assessment. Thank the patient, wash your hands and summarise your findings, then check footwear and walking aids, watch the patient walk, and arrange targeted investigations, but skip the nerve and blood-supply examination unless there is an open wound. Thank the patient, wash your hands and summarise your findings, then carry out a full nerve and blood-supply examination of both legs, examine the knee and hip, check footwear and walking aids, consider gait and function, and arrange relevant investigations. Thank the patient, wash your hands and summarise your findings, then assess gait and function and arrange an X-ray of the ankle. Thank the patient, wash your hands and summarise your findings, then perform a full nerve and blood-supply examination of both legs and examine the knee and hip, but consider footwear and walking aids when the patient reports difficulty walking.

A Thank the patient, wash your hands and summarise your findings, then examine the other ankle and foot and ask the patient to walk, as comparison and gait complete the assessment.
B Thank the patient, wash your hands and summarise your findings, then check footwear and walking aids, watch the patient walk, and arrange targeted investigations, but skip the nerve and blood-supply examination unless there is an open wound.
C Thank the patient, wash your hands and summarise your findings, then carry out a full nerve and blood-supply examination of both legs, examine the knee and hip, check footwear and walking aids, consider gait and function, and arrange relevant investigations. ✓
D Thank the patient, wash your hands and summarise your findings, then assess gait and function and arrange an X-ray of the ankle.
E Thank the patient, wash your hands and summarise your findings, then perform a full nerve and blood-supply examination of both legs and examine the knee and hip, but consider footwear and walking aids when the patient reports difficulty walking.

The answer is C: Thank the patient, wash your hands and summarise your findings, then carry out a full nerve and blood-supply examination of both legs, examine the knee and hip, check footwear and walking aids, consider gait and function, and arrange relevant investigations.

Explanation

Why C is correct

See Introduction. Option C is correct. Finishing an ankle and foot examination is more than stopping the physical examination: you thank the patient, wash your hands and summarise what you found, and then say what else you would do. Check the nerves and blood supply of both legs (a neurovascular examination: pulses, temperature, sensation and power), because injury or disease at the ankle can involve the vessels and nerves that run into the foot. Examine the joints above the ankle, the knee and hip, because pain and deformity can come from higher up the limb. Look again at footwear and walking aids, which give clues about chronic problems, and consider the gait and function, since a complete examination needs the patient to stand and walk. Finally, choose investigations to fit your findings, such as an X-ray after an injury or a urate level when gout is suspected. A plain-language aid: look up the leg, check the blood and nerve supply, look at the shoes, and let the findings choose the tests.

Close: thank the patient, wash your hands and summarise the findings
Neurovascular check: nerves and blood supply of both legs
Wider assessment: examine the knee and hip, footwear, walking aids and gait
Investigations: choose them to fit your findings, such as an X-ray after injury or a urate level for gout

Why the other options are incorrect

A. Thank the patient, wash your hands and summarise your findings, then examine the other ankle and foot and ask the patient to walk, as comparison and gait complete the assessment.: This plan limits the assessment to the other ankle and foot and walking, leaving out the neurovascular check, the knee and hip, footwear and walking aids, and investigations; completion requires these wider steps.
B. Thank the patient, wash your hands and summarise your findings, then check footwear and walking aids, watch the patient walk, and arrange targeted investigations, but skip the nerve and blood-supply examination unless there is an open wound.: This plan watches gait and arranges investigations but omits the nerve and blood-supply examination. A full neurovascular check of both legs is required to complete the assessment.
D. Thank the patient, wash your hands and summarise your findings, then assess gait and function and arrange an X-ray of the ankle.: This plan stops after imaging, but completion requires a neurovascular check of both legs, examination of the knee and hip, footwear, walking aids and gait, and investigations chosen to fit the findings. An X-ray addresses bony injury and does not replace these components.
E. Thank the patient, wash your hands and summarise your findings, then perform a full nerve and blood-supply examination of both legs and examine the knee and hip, but consider footwear and walking aids when the patient reports difficulty walking.: This plan includes the neurovascular check and joints above, but it makes footwear and walking aids conditional. They should still be checked as part of completion, so the assessment is incomplete.

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