Microsoft PowerPoint - Ch 4 Foot Eval Part I F07
Transcript of 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
Observation/Inspection
Observe the foot from all sides (anterior, posterior, medial, lateral)
callusesfoot typemalalignment
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Observation/Inspection
Calluses
Observation/Inspection
Foot Types
Pes planus
Normal
Pes cavus
Observation/Inspection
Foot typesnormal
designed to absorb & dissipate forcessupported and maintained by
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Observation/Inspection
Foot typespes planus
talar head displaces medially & plantarwardoverpronatorassociated with medial tibial stress syndrome
Observation/Inspection
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
Observation/Inspection
Foot typesPes planus
the pronated foot has greater subtalar motion than the supinated foot
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Observation/Inspection
Foot typesPes planus
biomechanical factorsweakness of posterior tibialisweakness of anterior tibialisweakness of toe flexorsstretching or weakness of spring ligament
Observation/Inspection
Foot typesPes cavus
inability to absorb forces or dissipate forces
Observation/Inspection
Foot typesPes cavus
associated with stress fxsmetatarsalstibia
associated with claw toes
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Observation/Inspection
Toe AlignmentMorton’s toeclaw toeshammer toehallux valgus
Claw toe
Claw toe Hammer toe Hammer toe
Morton’s toe
Hallux valgus
Observation/Inspection
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
Observation/Inspection
Claw toeshyperextension of MTPflexion of PIPflexion of DIP
Claw toe Claw toe
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Observation/Inspection
Hammer toehyperextension of the MTPflexion of the PIPhyperextension of the DIP
Hammer toe Hammer toe
Observation/Inspection
Hallux valgusmay be associated with abunion
Hallux valgus
Observation/Inspection
Cornsdistinguished from calluses by their central core
soft -hard -
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Observation/Inspection
Ingrown toenail (paronychia)
Observation/Inspection
Subungual hematomacan be caused by trauma or ill-fitting shoes
Observation/Inspection
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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Observation/Inspection
Structural or Functional Malalignmentsrearfoot varusrearfoot valgus
Normal
ValgusVarus Normal
Observation/Inspection
Structural or Functional Malalignmentsforefoot varusforefoot valgus
Forefoot varusForefoot varus
Observation/Inspection
All is not as it may appear…..
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Observation/Inspection
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?