The Lower Extremities
Examination of the Lower Extremities
The lower extremities are examined unclothed, standing, and in all positions of functions, with the aid of enough light and the support of a table.
1. Stand on the leg to be tested and bend forward horizontally, putting the other leg straight out behind. Reversing this action, bend backward with the free leg straight out forward. Pain and limited motion in the hip indicates probably arthritis within the joint, or rheumatism around the joint.
2. Examine motion of the knee. Cup both hands over one knee in a sitting position, then lift and swing the leg and
foot back and forth as far as possible. A grating sensation or limited motion of the knee probably indicates arthritis.
3. Examine the ankle motion. Bend the ankle in all directions as far as possible. Painful motion or soreness about this joint, means probable arthritis.
4. Examine blood circulation in the foot. Feel the pulse at the dorsal artery located just beside the highest bone on the top
Fig. 135. The extremities have no glands or body-serving structure within them. They serve the body in its external needs, and are capable of fantastic abilities, as well as many diseases.
of the foot. A strong pulse in this artery indicates good circulation in the legs; its absence may mean circulatory difficulty. Observe also any swelling of the lower leg, ankle and foot which “pits” on deep finger pressure. This can be a sign of heart or kidney disease.
5. Examine the veins of the legs. Lie down with the feet elevated for several minutes and observe the disappearance of nearly all veins. Quickly stand erect and see if the veins fill rapidly into enlarged tortuous knots. Varicose veins will fill rapidly on standing, but normal veins fill slowly, taking about a full minute or more. Examine the skin just above the inner ankle joint for any long standing sore or ulcer, usually the result of varicose veins.
6. Examine the skin sensation of the legs and feet. Run the fingertips lightly over the legs and feet and note any areas of numbness, burning, heat, coldness or pain. Unusual or improper sensations often point to nerve disease in the leg or elsewhere in the body.
7. Standing with the heels flat and the knees locked, bend over and attempt to touch the floor. Soreness in the back of the thighs that travels downward into the calves may mean sciatica.
8. Sit on a table with the legs hanging down. Tap quickly just below the knee cap with a book edge, and note the presence or absence of the kicking reflex in the leg. It is absent in some forms of thyroid disease, pernicious anemia and nerve disease. It is normally absent in very few people.
9. Examine the foot and note any growth or thickening enlargements at the toe joints, side and soles of the foot.
These conditions are corns, callouses, bunions or planter warts.