Chapter 4
       Clinical Assessment of
       Foot & Toe Injuries


       Part I




Student Learning Outcomes

Describe...
History
Questions specific to the foot
   changes in
      playing surface
      running distance
      running duration
 ...
Observation/Inspection

Calluses




Observation/Inspection

Foot Types




                                              ...
Observation/Inspection

Foot types
   pes planus
    talar head displaces medially & plantarward
    overpronator
    asso...
Observation/Inspection

Foot types
  Pes planus
    biomechanical factors
       weakness of posterior tibialis
       wea...
Observation/Inspection

       Toe Alignment
             Morton’s toe
             claw toes
             hammer toe
    ...
Observation/Inspection

Hammer toe
  hyperextension of the MTP
  flexion of the PIP
  hyperextension of the DIP




      ...
Observation/Inspection

Ingrown toenail (paronychia)




Observation/Inspection

Subungual hematoma
  can be caused by tra...
Observation/Inspection

Structural or Functional Malalignments
  rearfoot varus
  rearfoot valgus




                    ...
Observation/Inspection

          All is not as it may appear…..




Subtalar neutral                                     ...
Range of Motion

MMT
  may be necessary to test specific muscles that
  insert within the foot
     example:
        anter...
Special Tests

Assessing subtalar neutral
  rearfoot & forefoot malalignments




Special Tests

Tap test or compression t...
Neurological Tests

Local injury to peripheral nerves in foot & toes




      Questions?




                            ...
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Microsoft PowerPoint - Ch 4 Foot Eval Part I F07

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Microsoft PowerPoint - Ch 4 Foot Eval Part I F07

  1. 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. 2. History Questions specific to the foot changes in playing surface running distance running duration 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. 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. 4. Observation/Inspection Foot types pes planus talar head displaces medially & plantarward overpronator associated with medial tibial stress syndrome Observation/Inspection Foot types Pes planus supple medial longitudinal arch appears normal in non- weight-bearing, but disappears with weight- bearing rigid absence of medial longitudinal arch in both and non- weight-bearing Observation/Inspection Foot types Pes planus the pronated foot has greater subtalar motion than the supinated foot 4
  5. 5. Observation/Inspection Foot types Pes planus biomechanical factors weakness of posterior tibialis weakness of anterior tibialis weakness of toe flexors stretching or weakness of spring ligament 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. 6. Observation/Inspection Toe Alignment Morton’s toe claw toes hammer toe hallux valgus Hallux valgus Morton’s toe Claw toe Hammer toe Hammer toe Claw 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. 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 may be associated with a bunion Hallux valgus Observation/Inspection Corns distinguished from calluses by their central core soft - hard - 7
  8. 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. 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 varus Forefoot varus Observation/Inspection All is not as it may appear….. 9
  10. 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. 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 Special Tests Feiss’ line Navicular drop test 11
  12. 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 reflexes } Refer to Lower Quarter Neuro Screening, pg. 16 12
  13. 13. Neurological Tests Local injury to peripheral nerves in foot & toes Questions? 13

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