30. The lower limbs

Examination of the lower limbs comprises examination of the hips, knees, ankles and feet. Make sure that the patient is sufficiently unclothed, so that the connections between the joints and any left-right differences can be observed. There is no need to remove underwear. The examination should be carried out in the following order: movement assessment, isometric muscle tests, clinical palpation and any other tests indicated. The patient should be observed throughout the examination to determine the ranges of motion and any movement limitations, so make frequent eye contact with the patient. Also ask about pain when appropriate. It is important to carry out the tests correctly and to make sure you stabilise the trunk to enable you to make a correct assessment of such things as ranges of motion and stability. Any abnormalities found from physical examination should always be interpreted in light of the patient’s context (from history-taking). Physical examination findings will more reliable if those from history-taking, inspection, movement assessment, specific tests and palpation combined are consistent with the diagnosis.