If asked to examine the lower limbs, the biggest giveaway here will be missing toes and a smaller limb with multiple scars
- Notice deformity, missing toes, pes planus, scars (dont panic may be quite a few from previous corrective surgery), LLD, pelvic obliquity, compensatory scoliosis
- “I am suspecting fibula hemimelia, I will go on to look for associated features”
- Walk for gait
- walk to check for short limb gait
- Comment Trendelenberg (PFFD)
- Return for special tests
- Trendelenberg test - PFFD
- if Pes Planus present → tip toe at wall + jack's test expecting rigid pes planus
- Sit down
- j sign (Valgus with patella instability)
- Lie down [examine hip, knee to ankle]
- Limb length: apparent, true, check galeazzi (could be both shortening if there is PFFD)
- Bend knee - acl, pcl, Check collaterals (genu valgum)
- Patellar apprehension
- Ankle range of motion - expect stiffness in ball and socket joint
- Check LL neurovascular
- upper limbs: ulna club hand (radial deviation of forearm) with missing digits
- Complete by taking history from patient to evaluate his function