Kin191 A. Ch.4. Foot. Toes. Evaluation. Fall 2007
Upcoming SlideShare
Loading in...5
×
 

Kin191 A. Ch.4. Foot. Toes. Evaluation. Fall 2007

on

  • 1,868 views

 

Statistics

Views

Total Views
1,868
Views on SlideShare
1,865
Embed Views
3

Actions

Likes
1
Downloads
64
Comments
0

2 Embeds 3

http://www.slideshare.net 2
http://www.health.medicbd.com 1

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Kin191 A. Ch.4. Foot. Toes. Evaluation. Fall 2007 Kin191 A. Ch.4. Foot. Toes. Evaluation. Fall 2007 Presentation Transcript

  • FOOT/TOES EVALUATION KIN 191A Advanced Assessment of Lower Extremity Injuries
  • INTRODUCTION
    • EVALUATION
      • HISTORY
      • INSPECTION/OBSERVATION
      • PALPATION
      • ROM TESTING
      • LIGAMENTOUS AND CAPSULAR TESTING
      • NEUROLOGIC EXAMINATION
    • Location of pain
      • Retrocalcaneal
        • Retrocalcaneal bursitis
          • Typically isolated to specific anatomic location
        • Achilles tendinitis
          • Tends to be more diffuse in nature
        • Os trigonum syndrome
          • Will discuss later
    View slide
    • Location of pain
      • Heel
        • Heel spur
          • Bony projection typically from medial calcaneal tubercle
        • Plantar fasciitis
          • May or may not be associated with heel spur, they may occur simultaneously, but may be independent
        • Fat pad contusion
    View slide
    • Location of pain
      • Medial arch
        • Tarsal tunnel syndrome
          • Neuro condition so presents with neuro sx. (radiating, paresthesia)
        • Midfoot sprain
        • Plantar fasciitis
        • Navicular fracture
        • Pes planus/Pes cavus
        • Tibialis posterior tendinitis
  • Pes Planus Pes Cavus
    • Location of pain
      • Lateral arch
        • Fracture of 5 th Metatarsal
        • Peroneal tendinitis
        • Posterior tibial nerve compression
          • Presents with neuro sx.
    • Location of pain
      • Metatarsal
        • Fractures
        • Stress fractures
        • Metatarsalgia
        • Neuromas
    • Location of pain
      • Great toe
        • Hallux valgus
        • Hallux rigidus
        • Sesamoiditis
  • HISTORY
    • Onset and MOI
      • Acute onset
        • Metatarsal/phalangeal fracture
        • Ligamentous/capsular sprain
        • Muscular strain
      • Insidious onset
        • Playing surface
        • Training changes: distance, duration, intensity
        • Footwear changes
  • INSPECTION/OBSERVATION
    • Starts with initial presentation prior to formal evaluation commencement
      • Ambulation
      • Gross deformity
      • Discoloration
      • Swelling
      • Weight bearing vs. non-weight bearing
      • Inspect footwear if possible
    • Foot type
      • Pronated
      • Neutral
      • Supinated
    • Calluses/blisters/corns/warts
    General Inspection of the Foot
    • General toe alignment
      • Morton’s toe
        • Hypertrophy of the second MT
      • Claw toes
        • Hyperextension of the MTP joint and flexion of the PIP and DIP joints
      • Hammer toes
        • Hyperextension of the MTP and DIP joints and flexion of the PIP joints
      • Mallet toes
        • Flexion of the DIP joints
    Inspection of the Toes
  •  
      • Hallux valgus
        • The big toe begins to deviate away from the midline of the foot
        • Bunion
          • A bunion is a painful swelling of the fluid-filled sac (bursa) at the base of the big toe.
          • A smaller bunionette (tailor’s bunion) may form on the 5 th MTP joint
      • Ingrown toenail
      • Subungual hematoma
        • The formation of a hematoma beneath the nail
    • Inspection of the medial structure
      • Medial longitudinal arch
    • Inspection of the lateral structure
      • Fifth metatarsal (length and deviation)
    • Inspection of the plantar surface
      • Plantar warts
    • Inspection of the posterior structures
      • Achilles tendon
      • Calcaneus
    • Non-weight bearing inspection of foot and calcaneal alignment
      • Assessment of talar position
      • Mobility of the first ray
    • Inspection of foot alignment
      • Foot posture
        • Forefoot varus and valgus
        • Rearfoot varus and valgus
      • Plantarflexed 1 st ray
  • Forefoot Varus Rearfoot Varus
  • Forefoot Valgus Rearfoot Valgus
  • Feiss’s Line for Navicular Drop
  • Feiss’ s Line for Navicular Drop
    • PP: Sitting with the feet off the end of the table
    • EP: Positioned at the patient’s feet
    • EVP:
      • With NWB, identifies and marks the apex of the medial malleolus and plantar aspect of the 1 st MTP joint
      • A line is drawn between two marks / Mark the navicular tubercle
      • Stands with the feet approximately 1 ft apart with evenly weighted
      • The new position of navicular is marked
    • PT: A navicular drop 2/3 or greater the distance of the floor
    • IM: Hyperpronated foot
    • Medial Structures
      • First MTP joint (1)
      • First metatarsal (2)
      • First cuneiform (3)
      • Navicular (4)
      • Navicular tuberosity (5)
      • Talar head (6)
      • Sustentaculum tali (7)
      • Spring ligament (8)
      • Medial talar tubercle (9)
      • Calcaneus (10)
      • Medial tendons (11)
        • Flexor hallucis longus
        • Flexor digitorum longus
        • Tibialis posterior
    PALPATION
    • Lateral structures
      • Fifth MTP joint (1)
      • Fifth metatarsals (2)
      • Styloid tuberosity (3)
      • Cuboid (4)
      • Peroneal tubercle (5)
      • Lateral border of the calcaneus (6)
      • Peroneal tendons (7)
    • Dorsal Structures
      • Rays (1) / Cuneiforms (2) / Navicular (3)
      • Dome of the talus (4) / Sinus tarsi (5)
      • Extensor digitorum brevis (6)
      • Inferior extensor retinaculum (7) / Tibialis anterior(8)
      • Extensor hallucis longus (9) /
      • Extensor digitorum longus (10) / Dorsalis pedis pulse (11)
    • Plantar Structures
      • Medial calcaneal tubercle (1)
      • Plantar fascia (2)
      • Intermetatarsal neuroma (3)
      • Metatarsal heads (4)
      • Sesamoid bones of the great toe (5)
  • RANGE OF MOTION TESTING
    • Active Range of Motion (AROM)
    • Passive Range of Motion (PROM)
      • Normal form end-feel: flexion and extension
    • Resisted Range of Motion (RROM)
  •  
  • Goniometry
  • LIGAMENTOUS AND CAPSULAR TESTING
    • Metatarsophalangeal (MTP) and Interphalangeal (IP) joints
    • Intermetatarsal joints
    • Tarsometatarsal joints
    • Midtarsal joints
  • Valgus/Varus Test of MTP/IP Joints
  • Valgus/Varus Test of MTP/IP Joints
    • PP: Supine w/ knee extended or sitting w/ knee flexed
    • EP:
      • Standing or sitting
      • Proximal bone stabilized close to the joint to be tested
      • The bone distal to the joint being tested grasped near the middle of its shaft
    • EVP: Valgus  the distal bone is moved laterally
    • Varus  the distal bone is moved medially
    • PT: Pain/Laxity
    • IM:
      • Valgus test: MCL sprains
      • Varus test: LCL sprains
  • Intermetatarsal Glide Test
  • Intermetatarsal Glide Test
    • PP: Supine w/ knee extended or sitting w/ knee flexed
    • EP:
      • Standing
      • One hand grasps the first MT head
      • Other hand grasps the second MT head
    • EVP: The two MT heads are moved opposite directions
    • (plantarly and dorsally and vice versa)
    • PT: Pain/Laxity
    • IM:
      • Transverse metatarsal ligament, interosseous ligament sprains
      • Pain w/ the presence of laxity: may indicate a neuroma
  • Tarsometatarsal Joint Glide Test
  • Tarsometatarsal Joint Glide Test
    • PP: Supine, knee flexed and the heel stabilized by the edge of
    • the table
    • EP:
      • Standing or sitting
      • One hand grasps the distal tarsal row
      • Other hand grasps the metatarsal being glided
    • EVP: The metatarsal is glided dorsally on the tarsal and then
    • glided plantarly on the tarsal
    • PT: Pain/ ↑ or ↓ glide
    • IM:
      • Increased glide: ligamentous laxity
      • Decrease glide: joint adhesions
  • Midtarsal Joint Glide Test
  • Intermetatarsal Glide Test
    • PP: Supine or sitting , knee flexed and the heel stabilized by
    • the edge of the table
    • EP:
      • Standing or sitting
      • One hand grasps the plantar and dorsal aspect of one tarsal
      • Other hand grasps the adjacent tarsal in a similar manner
    • EVP: One tarsal is glided dorsally and plantarly on the
    • stabilized tarsal
    • PT: Pain/ ↑ or ↓ glide
    • IM:
      • Increased glide: ligamentous laxity
      • Decrease glide: joint adhesions
  • NEUROLOGIC EVALUATION
    • Dermatomes (L4 – S2)
    • Myotomes (L4 – S2)
    • Reflexes (L4-S2)
    • Tinel’s sign (Tarsal Tunnel)
    • Specific nerve testing – sensory/motor
      • Tibial nerve
      • Deep branch of peroneal nerve
      • Superficial branch of peroneal nerve
  •  
  • Peripheral Neurological Symptoms
  • VASCULAR EVALUATION
    • Dorsalis pedis artery (anterior tibial a.)
    • Posterior tibial artery (medial and lateral plantar branches)
    • Capillary refill (nailbeds/toe ends)
    • Skin temperature/color