Before conducting physical examination of patients, note things like general appearance, demeanour, nutritional status, asymmetry in appearance etc
All of the body’s systems are evaluated to assess if they contribute to the presenting lower limb problem.
• Respiratory (eg signs of asthma; breathing difficulties; past history of infections; rate and rhythm of respiration; auscultation of lungs)
• Cardiovascular (eg heart complaints; palpitations; murmurs; chest pain; history of rheumatic fever; oedema; inspect neck veins)
• Genitourinary (eg polyuria; nocturia; discolouration)
• Neurological (eg ‘blackouts’; seizures; weakness; paralysis; tremors; involuntary movements; level of consciousness; pupillary reactions)
• Locomotor (eg difficulty with movements; stiffness)
• Endocrine (eg heat or cold intolerance; excessive sweating)
• Mental state (eg orientation towards date, time and place; name of political leader)
Patient will need to be advised in advance why certain questions are being asked and why certain examinations of body systems that they perceive as being unrelated to what they perceive as there foot problem.
Parts of the physical examination may be limited by the ability of the patients to concentrate, their attention span and time restraints may need to focus only on specific aspects. With increased experience of examiners, focus can be placed on tests that are more relevant to the presenting symptoms. An abbreviated assessment of each body system is considered acceptable if no problem is expected as part of that system still need to justify the need not to proceed with a more detailed assessment of that system.
Appropriate referrals will need to be arranged if symptoms are detected that the podiatric clinician is inexperienced and unqualified to diagnose.