examination of the foot and ankle dr. mohammed zaheer dalati senior registrar department of...

EXAMINATION OF THE FOOT AND

ANKLEDr. Mohammed Zaheer Dalati

Senior RegistrarDepartment of Orthopaedics

College of Medicine

King Khalid University Hospital

Objectives

• Review anatomy of Foot and Ankle.

• Discuss key history

• Hands on exam

• Discuss cases concerning common injuries of the Foot and Ankle

Anatomy

Anatomy

Anatomy

Anatomy

Anatomy

Anatomy

Anatomy

History

• Onset

• Duration

• Mechanism

• Swelling / Ecchymosis

• Ambulation

• Hx of previous injury

2 PARTS:

1- ERECT POSITION.

2-SUPINE POSITION.

Inspection.

Palpation.

Movements.

Special tests.

INSPECTION OF THE PATIENT’S GAIT:

Evaluation of the walking cycle

GAIT ANALYSIS

• STANCE PHASE 65%– Contact Period - heel strike to forefoot loading

– Midstance Period - forefoot loading to heel raise

– Propulsive Period - heel raise to toe off

• SWING PHASE 35%

GAIT ANALYSISStance phase

Trendelenburg gait

trendelenburg gait.flv

Tip-toe walking

Foot drop walking

Spastic gait

Intoeing/Out toeng gait

Antalgic gait

Inspection in standing position

INSPECTION:

POSTERIOR HEEL STANDING

FOOT SHAPE

ALL THE TOES SHOULD BE IN GROUND CONTACT IN W.B.(stability of the foot on the ground)

INSPECTION: of the L.L

Any asymmetry of length, rotational problem, or mal alignment of the lower limbs.

INSPECTION:

- Deformity, swelling, skin changes, muscle wasting, asymmetry of length, abnormal position….

INSPECT ALL ARROUND

INSPECTION:

PLANTAR SKIN

callosity

Palpation:Bone and joints

Soft tissues

Anatomical landmarks:-Medial malleolus, lateral malleolus, Achilles tendon, calcaneal tuberosity, peroneal tendon, tibialis posterior tendon, tibialis anterior tendon, plantar fascia, base of 5th metatarsal, 1st MP joint, metatarsal heads……..etc

PALPATION:

Tenderness, swelling, deformity….

Knowing the anatomy:

MOVEMENTS:

Ankle: -dorsiflection -plantar flection.

Subtalar: -inversion -eversion.

Midtarsal: -pronation -supination

Tarso-metatarsals: move the metatarsals one by one.

Toes:

Ankle movements:

MOVEMENT: SUBTALAR:

MOVE THE HEEL:

Inversion---eversion

Midtarsal supination

Move the metatarsals one by one

MOVEMENTS:

IMPORTANCE OF THE BIG TOE (running, jumping)

Problem of hallux rigidus

EXAMINATION OF THE SHOES

Special tests

Ankle sprain:

Lateral ligament.

Stress view.

Anterior drawer.

Varus stress test.

Dynamic X-Ray

SPECIAL PATHOLOGIES:

Ligaments injuries:

-Lateral collateral ligament of the ankle: varus stress view AP.

-Subtalar ligaments: increased valgus by standing on one leg.

ACHILLES TENDON:

-RUPTURE:(signs in prone position)

~depression.

~absence of rest plantar flexion.

~no plantar flection by

squeezing the calf muscles.

SPECIAL PATHOLOGIES

Pes planus: common 20%

-GAIT: UGLY.

-INSPECTION STANDING: HEEL, ARCH, FOREFOOT.

-LIGAMENT LAXITY

-MOVE THE HEEL AND THE 1ST METATARSAL.

-EXAMIN THE TENDO ACHILLES

-May be asymptomatic

Pes cavusHigh arch

Varus

Special pathologies:

TARSAL COALSION:

Painful stiff flat foot

Usually bilateral, can be unilateral

-Stiff subtalar.

MORE COMMON:calcaneo-navicular and subtalar.

-Request CT scan

SPECIAL PATHOLOGIES:

INTOING GAIT:

-Internal femoral torsion: exaggerated anteversion.

-Internal tibial torsion.

-Forefoot adduction.

SPECIAL PATHOLOGIES:

-PLANTAR FASCIITIS:

~Any tightness of Achilles tendon.

~Any mechanical foot disorder.

~Any use of bad shoes.

Metatarsalgia

Hallux valgus

Hallux rigidus:

O.A 1st MPJ

THANK YOU