Physical Exam

Lower Extremity Inspection and Palpation

🎬

Video coming September 2026

How to Perform

With the lower limbs exposed, inspect them with the patient lying and standing, comparing sides. Observe the skin color, hair distribution, and any swelling, varicose veins, ulcers, rashes, discoloration, or deformity. Then palpate for temperature, for edema (pressing over the shin and behind the ankle for pitting), for tenderness, and for the peripheral pulses, noting any asymmetry.

How to Interpret

Deep Vein Thrombosis

Asymmetric calf swelling with a measurable difference in calf circumference between the legs

Rule in

Minimally helpful

Rule out

Minimally helpful

Evidence:Strong

Heart Failure

Bilateral pitting edema of the lower legs

Rule in

Somewhat helpful

Rule out

Minimally helpful

Evidence:Strong

Peripheral Arterial Disease

Cool skin temperature of the affected leg or foot on palpation

Rule in

Helpful

Rule out

—

Evidence:Limited

References

Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944-1956. PMID 16234501. doi:10.1001/jama.294.15.1944.
Goodacre S, Sutton AJ, Sampson FC. Meta-analysis: the value of clinical assessment in the diagnosis of deep venous thrombosis. Ann Intern Med. 2005;143(2):129-139. PMID 16027455. doi:10.7326/0003-4819-143-2-200507190-00012.
Khan NA, Rahim SA, Anand SS, Simel DL, Panju A. Does the clinical examination predict lower extremity peripheral arterial disease? JAMA. 2006;295(5):536-546. PMID 16449619. doi:10.1001/jama.295.5.536.
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.