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