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Chapter 4

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  • 1. Chapter 4 Clinical 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     1
  • 2. History   Questions specific to the foot   changes in   playing surface   running distance/ duration   running intensity   shoes   do they wear orthotics? Observation/Inspection   Visual Signs       Observation/Inspection   Observe the foot from all sides (anterior, posterior, medial, lateral)   calluses   foot type   malalignment 2
  • 3. Observation/Inspection   Calluses Observation/Inspection   Foot Types Pes cavus Pes planus Normal Observation/Inspection   Foot types   normal   designed to absorb & dissipate forces   supported and maintained by       3
  • 4. Observation/Inspection   Foot types   pes planus   talar head displaces medially & plantarward   overpronator   Observation/Inspection   Foot types   Pes planus   supple     rigid   Observation/Inspection   Foot types   Pes planus   the pronated foot has greater subtalar motion than the supinated foot   requires more muscle work to maintain stance stability than the supinated foot 4
  • 5. Observation/Inspection   Foot types   Pes planus   biomechanical factors         Observation/Inspection   Foot types   Pes cavus   inability to absorb forces or dissipate forces Observation/Inspection   Foot types   Pes cavus   associated with stress fxs   metatarsals   tibia   associated with claw toes 5
  • 6. Observation/Inspection   Toe Alignment   Morton’s toe   claw toes   hammer toe   hallux valgus Hallux valgus Morton’s toe Claw toe Claw toe Hammer toe Hammer toe Observation/Inspection   Morton’s toe   2nd metatarsal > 1st metatarsal   2nd toe may or may not be longer than the 1st   typically associated with unique callus formation   associated with a variety of forefoot pain syndromes       Observation/Inspection   Claw toes   hyperextension of MTP   flexion of PIP   flexion of DIP Claw toe Claw toe 6
  • 7. Observation/Inspection   Hammer toe   hyperextension of the MTP   flexion of the PIP   hyperextension of the DIP Hammer toe Hammer toe Observation/Inspection   Hallux valgus   maybe associated with a bunion Hallux valgus Observation/Inspection   Corns   distinguished from calluses by their central core   soft - between the toes   hard – on top, side, or bottom of foot or toes 7
  • 8. Observation/Inspection   Ingrown toenail (paronychia) Observation/Inspection   Subungual hematoma   can be caused by trauma or ill-fitting shoes Observation/Inspection   Plantar wart   most commonly found on plantar surface of foot   may be confused with calluses or hard corns   pairing will reveal central core of black dots 8
  • 9. Observation/Inspection   Structural or Functional Malalignments   rearfoot varus   rearfoot valgus Normal Varus Normal Valgus Observation/Inspection   Structural or Functional Malalignments   forefoot varus   forefoot valgus Forefoot valgus Forefoot varus Observation/Inspection   All is not as it may appear….. 9
  • 10. Observation/Inspection   All is not as it may appear….. Subtalar neutral Weight bearing Palpation   Bony landmarks   Tendon insertion sites   Ligaments   Other soft tissue structures   example: plantar fascia   Pulses     Range of Motion   Great toe extension ( °)*   AROM   PROM   RROM   Great toe flexion ( °)   AROM   PROM   RROM *60-65° great toe extension required for normal gait 10
  • 11. Range of Motion   MMT   may be necessary to test specific muscles that insert within the foot   example:   anterior tibialis   posterior tibialis   peroneal brevis Stress Tests   Valgus/varus tests   great toe   other four toes   Glide tests   intertarsal   tarsometatarsal   intermetatarsal Special Tests   Feiss’ line     Navicular drop test   11
  • 12. Special Tests   Assessing subtalar neutral   rearfoot & forefoot malalignments Special Tests   Tap test or compression test   fx of metatarsal or phalange Neurological Tests   Foot & toes innervated by L4 – S2 nerve roots   Injury to these nerve roots can cause “radicular” symptoms in the foot & toes }   sensory   motor Refer to Lower Quarter Neuro Screening, pg. 16   reflexes 12
  • 13. Neurological Tests   Local injury to peripheral nerves in foot & toes   Tinel’ssign (__________________________)   webspace between 1st and 2nd toes (_______ _________________________)   “pencil test” (_________________) Questions? 13