Foot Assessment
Observation
Bilaterally check for:
-gross deformity -bleeding - swelling -Pes Planus/Pes Cavus - discoloration - toe deformities (claw toe, hammer toe, Morton's toe, hallux valgus, hallux rigidus, mallet toe) -bunions - corns/plantar warts - shoe wear patterns - equinus deformity - forefoot valgus/varus -plantar flexed first ray -postural abnormalities
Bilaterally check for:
-gross deformity -bleeding - swelling -Pes Planus/Pes Cavus - discoloration - toe deformities (claw toe, hammer toe, Morton's toe, hallux valgus, hallux rigidus, mallet toe) -bunions - corns/plantar warts - shoe wear patterns - equinus deformity - forefoot valgus/varus -plantar flexed first ray -postural abnormalities
http://www.montrosefootdoctor.com/foot-anatomy.html
http://www.methodistorthopedics.com/foot-anatomy
http://www.drcwilkes.com/foot-conditions/ankle-conditions/ankle-ligament-tear-ankle-instability/
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http://www.cutestpaw.com/images/pug-googly-eyes/
Palpation
Bony: -Calcaneus -Styloid process of the -Sinus Tarsi 5th MT -Sustentaculum Tali -Metatarsals (1-5) -Medial Calcaneal Tubercle -Metatarsophalangeal joints (1-5) -Peroneal Tubercle -Phalanges [Proximal -Cuboid (5), Middle (4), Distal (5)] -Talar Head -Proximal and Distal IP -Navicular Tubercle joints -IP joint of 1st MT -Sesamoid bones -Cuneiforms (Lateral, Middle, Medial) Soft Tissue: -Tibialis posterior tendon -Calcaneofibular ligament -Flexor halluces longus tendon -Peroneus longus tendon -Flexor digitorum longus tendon -Peroneus brevis tendon -Deltoid ligament -Extensor hallucis longus tendon -Calcaneonavicular ligament -Extensor digitorum longus tendon -Medial longitudinal arch -Extensor digitorum brevis tendon -Transverse arch -Tibialis Anterior tendon -Anterior talofibular ligament -Posterior talofibular ligament |
Range of Motion
MTP Flexion: Normative values: 30-45 degrees Patient Position: Long seated with foot off table Fulcrum: Medial aspect of 1st MTP Proximal Arm: In line with 1st MT Distal Arm: In line with 1st Phalanx End Feel: Firm MTP Extension: Normative values: 50-70 degrees Patient Position: Long seated with foot off table Fulcrum: Medial aspect of 1st MTP Proximal Arm: In line with 1st MT Distal Arm: In line with 1st Phalanx End Feel: Firm |
http://www.scranton.edu/faculty/kosmahl/courses/gonio/lower/pages/meta-plan.shtml
http://www.scranton.edu/faculty/kosmahl/courses/gonio/lower/pages/meta-plan.shtml
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(Magee, 2008, p.11)
Manual Muscle Tests
Metatarsophalangeal (MTP) Flexion
Patient Position: Supine or long seated
Stabilize: Metatarsals
Patient Action: Flex toes while trying to keep IP joints extended
Resistance: Apply resistance on plantar surface of proximal phalanx of the toes in the direction of MTP extension
Gravity Eliminated Position: None
Muscles Tested: Lumbricals and flexor hallucis brevis
Interphalangeal (IP) Flexion
Patient Position: Supine or long seated
Stabilize: Proximal phalanges of toes
Patient Action: Flexes IP joints
Resistance: Apply resistance against middle and distal phalanges
Gravity Eliminated Position: None
Muscles Tested: Flexor digitorum longus and brevis, flexor hallucis longus
Metatarsophalangeal (MTP) Extension
Patient Position: Supine or long seated
Stabilize: Metatarsals
Patient Action: Extends toes through full ROM
Resistance: Apply resistance against dorsum of proximal phalanx of toes
Gravity Eliminated Position: None
Muscles Tested: Extensor digitorum longus and brevis
Interphalangeal (IP) Extension of Great Toe
Patient Position: Supine or long seated
Stabilize: Proximal phalanges of great toe
Patient Action: Extends IP joint of great toe through full ROM
Resistance: Apply resistance against dorsum of distal phalanx of great toe
Gravity Eliminated Position: None
Muscles Tested: Extensor hallucis longus
Metatarsophalangeal (MTP) Flexion
Patient Position: Supine or long seated
Stabilize: Metatarsals
Patient Action: Flex toes while trying to keep IP joints extended
Resistance: Apply resistance on plantar surface of proximal phalanx of the toes in the direction of MTP extension
Gravity Eliminated Position: None
Muscles Tested: Lumbricals and flexor hallucis brevis
Interphalangeal (IP) Flexion
Patient Position: Supine or long seated
Stabilize: Proximal phalanges of toes
Patient Action: Flexes IP joints
Resistance: Apply resistance against middle and distal phalanges
Gravity Eliminated Position: None
Muscles Tested: Flexor digitorum longus and brevis, flexor hallucis longus
Metatarsophalangeal (MTP) Extension
Patient Position: Supine or long seated
Stabilize: Metatarsals
Patient Action: Extends toes through full ROM
Resistance: Apply resistance against dorsum of proximal phalanx of toes
Gravity Eliminated Position: None
Muscles Tested: Extensor digitorum longus and brevis
Interphalangeal (IP) Extension of Great Toe
Patient Position: Supine or long seated
Stabilize: Proximal phalanges of great toe
Patient Action: Extends IP joint of great toe through full ROM
Resistance: Apply resistance against dorsum of distal phalanx of great toe
Gravity Eliminated Position: None
Muscles Tested: Extensor hallucis longus
https://www.youtube.com/watch?v=42W-ZClCA5w
Special Tests
Bump Test •Pt Position: Supine or long seated •Your position: End of table near foot •Action: DF and firmly tap the heel •Positive Indication: Pain at Fx site •Implication: Fx Interdigital Neuorma Test •Pt Position: long seated •Your Position: beside Pt •Action: Squeeze MT heads for 60-120s •Positive Indication: Pain during pressure application between MT 3&4 •Implication: Interdigital/Morton’s Neuroma Feiss Line •Pt Position: Supine or long seated •Your position: Next to Pt •Action: Place a mark on the medial malleolus and base of the first MTP joint and draw a line between them. Note the position of the navicular tuberosity. Have the patient stand with feet 3-6" apart. •Positive Indication: If while seated the navicular tuberosity is below the line then patient has congenital pes planus. If while seated the navicular tuberosity is in line and when standing it drops below the line the patient has congenital pes planus. •Implication: Pes Planus Long Bone Compression •Pt Position: Supine or long seated •Your position: Next to Pt •Action: Apply compressive force along bone being tested (not at Fx site) •Positive Indication: Pain at Fx site •Implication: Fx |
https://www.youtube.com/watch?v=hdMxeW90NpU
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