Basic Format Foot Assessment Checklist Template
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Basic Format Foot Assessment Checklist

Prepared By: [Your Name]


Visual Inspection

  • 1. Check for any cuts, blisters, or abrasions

  • 2. Inspect for signs of redness or swelling

  • 3. Look for any calluses or corns

Palpation

  • 1. Palpate for any increased temperature in the foot

  • 2. Check for tenderness or pain during palpation

  • 3. Identify areas of swelling through touch

Range of Motion

  • 1. Assess the range of motion in the ankle joint

  • 2. Evaluate flexibility of the toes

  • 3. Test dorsiflexion and plantarflexion capability

Sensation Testing

  • 1. Perform light touch sensation test

  • 2. Conduct vibration sense evaluation

  • 3. Test proprioception in the foot

Vascular Assessment

  • 1. Check capillary refill time

  • 2. Evaluate pedal and posterior tibial pulses

  • 3. Inspect for signs of poor circulation


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