- Inspection:
- look at shoes for signs of abnormal wear;
- inspect standing foot and ankle alignment from behind;
- note arch height;
- Assessment of Gait:
- always examine the soles of the patient's shoes for signs of asymmetrical wear;
- look for side to side asymmetry or abnormal contact w/ the ground;
- note whether gait is heel to toe (normal), flat foot, or toe to heel (c/w
equinus contracture);
- distinguish between Trendelenburg vs antalgic gait;
- note whether hammer or claw toe deformities are present during gait cycle;
- Ankle Joint:
- note presence of ankle effusion by noting the fullness on either side of the Achilles tendon;
-
ankle dorsiflexion; (see:
equinus contracture:)
- in pts with pes planus, the examiner frequently finds that a shortened triceps surae will prevent
sufficient dorsiflexion of foot to allow the heel, if held in inversionn, to contact floor;
- to check the degree of shortening, initiate forceful dorsiflexion of foot with the heel in full inversion;
- dorsiflexion injures:
-
anterior impingement syndorme
- anterior tibiofibular sprain:
- typically results from pure dorsiflexion injury, whereas common lateral ligament complex
sprain usually has inversion mechanism;
-
ankle plantar flexion:
-
diff dx of posterior ankle pain;
- pain may occur when the pt points the toe, and may lack 10 deg of plantar flexion as compared to the opposite ankle;
-
ankle stability:
-
anterior drawer test
- evaluates the
anterior talofibular ligament (look for diff. of 8 mm)
- inversion (supination) test
- w/ ankle in plantarflexion: evaluates
ATFL;
- in neutral / slight dorisflexion: evaluates
calcaneofibular ligament;
- eversion test:
- in neutral evaluates superficial
Deltoid Ligament complex
- external rotation stress test evaluates
syndesmotic ligaments and
additionally - the deep
deltoid ligament -
-
syndesmostic sprain:
- ROM of Hindfoot and Forefoot:
- functional hindfoot valgus is measured by noting the relationship of the leg to the hindfoot while the
the patient is viewed from behind (w/ patient standing);
- functional hindfoot varus is measured by having the patient raise up on the forefoot;
-
exam of the subtalar joint:
- note position of the hindfoot relative to the forefoot;
- patient is examined sitting with the knee flexed;
- dorsiflex the ankle to a neutral position, and then evert and invert the subtalar joint
until the navicular is centralized under the talar head;
- observe the position of the forefoot relative to the hindfoot;
- if exam reveals a fixed or limited inversion and erversion, it is important to see how this is manifested in the wt bearing foot;
- 2 common patterns:
- a rigid forefoot eversion (valgus) with associated flexible hindfoot inversion (varus) pattern, presenting as a pes cavus foot;
- a rigid hindfoot eversionn (valgus) wiht compensatory forefoot inversion (varus), presenting as a pes planus foot;
-
windlass Action:
- normally dorsiflexion of the toes increases the tension of the plantar aponeurosis, which causes
the longitudinal arch to rise;
- failure of the longitudinal arch to do so suggests the presences of prolonged pes planus with
attendant abnormal stretching and elongation of the plantar aponeurosis;
Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.
- no varus or valgus of the hindfoot;
- w/ pt standing on tiptoe, no calcaneal inversion;
- no plantar tenderness
- no plantar callus
- no hallux valgus or rigidus
- no hammer toe or claw toes
