microsoft powerpoint - ch 4 foot eval part i f07

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Chapter 4Clinical Assessment of Foot & Toe Injuries

Part I

Student Learning Outcomes

Describe the HOPS evaluation model as it pertains to foot and toe injuries

Describe common foot types and malalignments that are associated with foot and toe injuries

Identify ROM, Stress, Special, & Neurological tests used when evaluating foot & toe injuries

General History

Location of pain

Onset of pain

Mechanism of injury

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History

Questions specific to the footchanges in

playing surfacerunning distancerunning durationshoes

do they wear orthotics?

Observation/Inspection

Visual Signs


Observe the foot from all sides (anterior, posterior, medial, lateral)

callusesfoot typemalalignment

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Calluses


Foot Types

Pes planus

Normal

Pes cavus


Foot typesnormal

designed to absorb & dissipate forcessupported and maintained by

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Foot typespes planus

talar head displaces medially & plantarwardoverpronatorassociated with medial tibial stress syndrome


Foot typesPes planus

supple medial longitudinal arch appears normal in non-weight-bearing, but disappears with weight-bearing

rigidabsence of medial longitudinal arch in both and non-weight-bearing



the pronated foot has greater subtalar motion than the supinated foot

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biomechanical factorsweakness of posterior tibialisweakness of anterior tibialisweakness of toe flexorsstretching or weakness of spring ligament


Foot typesPes cavus

inability to absorb forces or dissipate forces


Foot typesPes cavus

associated with stress fxsmetatarsalstibia

associated with claw toes

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Toe AlignmentMorton’s toeclaw toeshammer toehallux valgus

Claw toe

Claw toe Hammer toe Hammer toe

Morton’s toe

Hallux valgus


Morton’s toe2nd metatarsal > 1st metatarsal2nd toe may or may not be longer than the 1st

typically associated withunique callus formationassociated with a variety of forefoot pain syndromes


Claw toeshyperextension of MTPflexion of PIPflexion of DIP

Claw toe Claw toe

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Hammer toehyperextension of the MTPflexion of the PIPhyperextension of the DIP

Hammer toe Hammer toe


Hallux valgusmay be associated with abunion

Hallux valgus


Cornsdistinguished from calluses by their central core

soft -hard -

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Ingrown toenail (paronychia)


Subungual hematomacan be caused by trauma or ill-fitting shoes


Plantar wartmost commonly found on plantar surface of footmay be confused with calluses or hard cornspairing will reveal central core of black dots

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Structural or Functional Malalignmentsrearfoot varusrearfoot valgus

Normal

ValgusVarus Normal


Structural or Functional Malalignmentsforefoot varusforefoot valgus

Forefoot varusForefoot varus


All is not as it may appear…..

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All is not as it may appear…..

Weight bearingSubtalar neutral

Palpation

Bony landmarksTendon insertion sitesLigaments Other soft tissue structures

example: plantar fasciaPulses

Range of Motion

Great toe extension ( °)*AROMPROMRROM

Great toe flexion ( °)AROMPROMRROM

*60-65° great toe extension required for normal gait

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Range of Motion

MMTmay be necessary to test specific muscles that insert within the foot

example:anterior tibialisposterior tibialisperoneal brevis

Stress Tests

Valgus/varus tests great toeother four toes

Glide tests

Special Tests

Feiss’ line

Navicular drop test

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Special Tests

Assessing subtalar neutralrearfoot & forefoot malalignments

Special Tests

Tap test or compression testfx of metatarsal or phalange

Neurological Tests

Foot & toes innervated by L4 – S2 nerve rootsInjury to these nerve roots can cause “radicular” symptoms in the foot & toes

sensorymotor reflexes

}Refer to Lower Quarter Neuro Screening, pg. 16

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Neurological Tests

Local injury to peripheral nerves in foot & toes

Questions?

microsoft powerpoint - ch 4 foot eval part i f07

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