The Virtual Foot and Ankle Physical Examination

Abstract

<jats:p> The COVID-19 pandemic has necessitated a rapid and drastic shift for clinicians and patients away from traditional in-person visits and toward Internet-based virtual visits. The adoption of telehealth services is likely to persist in some capacity even as in-person visits resume, given the convenience and efficiency of telehealth consultations for patients and perhaps surgeons. A primary challenge of virtual visits, particularly in the field of orthopedic surgery, is the physical examination. However, for the foot and ankle, routine physical examination maneuvers can be completed virtually with little modification given proper patient instruction. We present a comprehensive virtual foot and ankle examination for telehealth visits, including instructions that can be provided to patients verbatim and a corresponding checklist for provider documentation. </jats:p><jats:p> Level of Evidence: Level V, expert opinion. </jats:p>

Spine surgeon perceptions of the challenges and benefits of telemedicine: an international study

“…Recent manuscripts have sought to address this challenge by publishing guidelines how to conduct effective virtual spine examinations [13,16]. Additionally, efforts to enhance the telemedicine appointment-such as providing instructions for patients prior to the visit on camera/body positioning, clothing, and setting-have shown to increase telemedicine efficiency [17,18]. While this inability to perform physical examinations was a major challenge faced by spine surgeons around the world, it is also interesting to note that 61.4% of survey respondents did not acknowledge the lack of physical examination to be a major challenge.…”

The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review

“… 17 , 18 Patient can also be asked to perform toe-walking and the ability to do so indicates at least 4/5 strength. 67 , 68 Ankle inversion (L5-S1) Patient is asked to perform a lateral foot walk. Ankle eversion (L4-S1) Patient is asked to perform a medial foot walk.…”

“…The camera should be positioned at the level of the patient’s shins when sitting, and on the ground angled towards their feet when standing. 67 , 68 A mobile device rather than a desktop can facilitate camera positioning. In the case of traumatic injuries, clinicians can use the Ottawa Ankle Rule over videoconference to determine whether imaging is needed to evaluate for a foot or ankle fracture.…”

Adaptation of the Foot and Ankle Physical Exam for Telehealth

“…When conducting the virtual exam, clinicians may benefit from the use of a checklist that more carefully details each component of the exam and allows for thorough documentation of results [4].…”