Study material

1. EXAMINATION OF
THE FOOT AND
ANKLE
Dr. Mohammed Zaheer Dalati
Senior Registrar
Department of Orthopaedics
College of Medicine
King Khalid University Hospital

2. Objectives
• Review anatomy of Foot and Ankle.
• Discuss key history
• Hands on exam
• Discuss cases concerning common injuries
of the Foot and Ankle

3. Anatomy

4. Anatomy

5. Anatomy

6. Anatomy

7. Anatomy

8. Anatomy

9. Anatomy

10. History
• Onset
• Duration
• Mechanism
• Swelling / Ecchymosis
• Ambulation
• Hx of previous injury

11. 2 PARTS:
1- ERECT POSITION.
2-SUPINE POSITION.

12. Inspection.
Palpation.
Movements.
Special tests.

13. INSPECTION OF THE PATIENT’S GAIT:
Evaluation of the
walking cycle
GAIT ANALYSIS

15. • 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%

17. GAIT ANALYSIS
Stance phase

18. Trendelenburg gait

20. Tip-toe walking

22. Foot drop walking

24. Spastic gait

26. Intoeing/Out toeng gait

28. Antalgic gait

29. Inspection in standing position

34. INSPECTION:
POSTERIOR HEEL STANDING

36. FOOT SHAPE

38. ALL THE TOES SHOULD BE IN GROUND
CONTACT IN W.B.(stability of the foot on the
ground)

40. INSPECTION: of the L.L
Any asymmetry of
length, rotational
problem, or mal
alignment of the
lower limbs.

42. INSPECTION:
- Deformity, swelling, skin changes, muscle
wasting, asymmetry of length, abnormal
position….
INSPECT ALL ARROUND

43. INSPECTION:
PLANTAR SKIN
callosity

44. Palpation:
Bone and joints
Soft tissues

45. 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

46. PALPATION:
Tenderness, swelling, deformity….
Knowing the anatomy:

47. MOVEMENTS:
Ankle: -dorsiflection -plantar flection.
Subtalar: -inversion -eversion.
Midtarsal: -pronation -supination
Tarso-metatarsals: move the
metatarsals one by one.
Toes:

49. Ankle movements:

50. MOVEMENT: SUBTALAR:
MOVE THE HEEL:
Inversion---eversion

51. Midtarsal supination→
Move the metatarsals one by one

52. MOVEMENTS:
IMPORTANCE OF THE BIG TOE
(running, jumping)
Problem of hallux rigidus

53. EXAMINATION OF THE
SHOES

54. Special tests

56. Ankle sprain:
Lateral ligament.
Stress view.
Anterior drawer.
Varus stress test.
Dynamic X-Ray

58. SPECIAL PATHOLOGIES:
Ligaments injuries:
-Lateral collateral ligament of
the ankle: varus stress view AP.
-Subtalar ligaments: increased
valgus by standing on one leg.

60. ACHILLES TENDON:
-RUPTURE:(signs in prone position)
~depression.
~absence of rest plantar flexion.
~no plantar flection by
squeezing the calf muscles.

64. SPECIAL PATHOLOGIES
Pes planus: common 20%
-GAIT: UGLY.
-INSPECTION STANDING: HEEL, ARCH, FOREFOOT.
-LIGAMENT LAXITY
-MOVE THE HEELAND THE 1ST METATARSAL.
-EXAMIN THE TENDO ACHILLES
-May be asymptomatic

67. Pes cavus
High arch
Varus

69. Special pathologies:
TARSAL COALSION:
Painful stiff flat foot
Usually bilateral, can be unilateral
-Stiff subtalar.
MORE COMMON:calcaneo-
navicular and subtalar.
-Request CT scan

72. SPECIAL PATHOLOGIES:
INTOING GAIT:
-Internal femoral torsion: exaggerated anteversion.
-Internal tibial torsion.
-Forefoot adduction.

74. SPECIAL PATHOLOGIES:
-PLANTAR FASCIITIS:
~Any tightness of Achilles tendon.
~Any mechanical foot disorder.
~Any use of bad shoes.

76. Metatarsalgia

78. Hallux
valgus

80. Hallux rigidus:
O.A 1st MPJ

81. THANK YOU