Physical examination of the foot and ankle by orthopaedic and accident and emergency clinicians

Our aim was to test the knowledge of clinicians in the Orthopaedic clinic and in the Emergency department of the surface anatomical landmarks that should be examined routinely in the assessment of foot and ankle injuries. A survey of 109 clinicians was conducted. Each participant was asked to palpate six important surface landmarks. Two participants failed to identify even a single landmark. Of 109 assessed only 27% correctly identified all six landmarks. The mean number of landmarks correctly identified by each clinician was 4.1 with a standard deviation of 1.5 and range of 0-6. The knowledge of surface anatomy overall by junior Orthopaedic and Emergency clinicians was found to be very poor. Clinicians are becoming more reliant on potentially unnecessary and expensive imaging investigations. They have neglected the basic art of physical examination based on a sound knowledge of human anatomy. At present, the authors believe that the anatomical teaching that should begin in undergraduate medicine is inadequate.