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DOC Left Lower Leg Exam
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Inspection (swelling, erythema, ecchymosis, warmth, wounds, deformity)
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Inspection Abnormal?
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Inspection ALL NORMAL?
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Swelling?
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Ecchymosis?
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Erythema?
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Increased Warmth?
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Masses?
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Open Wounds?
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Deformity?
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Inspection Comments
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Tenderness (Prox/Mid/Distal 1/3)
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Tenderness Abnormal?
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Tenderness ALL NORMAL?
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Proximal 1/3?
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Mid 1/3?
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Distal 1/3?
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Tenderness Comments
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Range of Motion (Knee flex/ext, Hip flex/ext/abd/add)
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ROM Abnormal?
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ROM ALL NORMAL?
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Decreased Knee ROM?
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Limited Knee Flexion?
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Limited Knee Extension?
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Decreased Ankle ROM?
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Limited Ankle Dorsiflexion?
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Limited Ankle Plantar Flexion?
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ROM Comments
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Strength (EHL, FFL, Tib Ant, Gastroc/Soleus, Inv/Eve)
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Strength Abnormal?
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Strength ALL NORMAL?
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Extensor Hallucis Longus
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Flexor Hallucis Longus
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Tibialis anterior
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Gastroc/soleus
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Strength Comments
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Sensation
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Dorsal foot intact?
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Plantar foot intact?
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Sensation Comments
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Vascular
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Dorsalis Pedis Pulse Palpable?
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Post Tibial Pulse Palpable?
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Vascular Comments
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Compartments
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Compartments Soft?
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Sensation Intact 1st Web Space?
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Pain with Passive Toe Motion?
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Compartment Comments
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Gait (antalgic gate, reciprocal heel/toe w/o asst device)
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Gait Abnormal?
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Gait ALL Normal?
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Antalgic gate?
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Asst devices needed for Reciprocal Heel Toe Gait?
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Assistive Devices?
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Assistive devices
• • •
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Assistive devices
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Gait Comments
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Imaging and Labs
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Tibia/Fibula X-Rays?
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X-Ray Views?
• • •
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Comparison
• • •
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Comparison Date and Comments
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Normal Findings
• • •
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Normal Comments
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Abnormal Findings
• • •
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Abnormal Comments
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Impression:
• • •
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Comments
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Ankle X-Ray?
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Ankle X-Ray Views
• • •
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Comparison
• • •
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Comparison Date and Comments
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Normal Findings
• • •
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Normal Comments
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Abnormal Findings
• • •
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Abnormal Comments
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Impression:
• • •
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Comments:
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Ultrasound Utilized?
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Ultrasound Comments:
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