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Foot and Ankle. Rance L. McClain, D.O., FACOFP Associate Professor – FM Dept. KCUMB-COM. Learning Objectives. Review the diagnosis of the foot and ankle Apply specific osteopathic testing to the diagnosis of the foot and ankle

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foot and ankle

Foot and Ankle

Rance L. McClain, D.O., FACOFP

Associate Professor – FM Dept.

KCUMB-COM

learning objectives
Learning Objectives
  • Review the diagnosis of the foot and ankle
  • Apply specific osteopathic testing to the diagnosis of the foot and ankle
  • Understand the application of osteopathic treatment to the foot and ankle
general
General
  • The foot and ankle is the focal point of total body weight, performing this function both when stationary and with gait
  • Adaptation to the terrain upon which a person stands and walks
general5
General
  • Problems with the foot and ankle can arise from mechanical, pathological, vascular, or inflammatory origins
  • The foot is affected not only by local stresses, but also by systemic diseases
    • Approximately 40% of people have foot and ankle problems
inspection ankle
Inspection - Ankle
  • Range of Motion
    • Plantar flexion: 50 degrees
    • Dorsiflexion 20 degrees
      • Excess motion can cause fibular dysfunction
inspection ankle8
Inspection - Ankle
  • Accessory motions of side-to-side glide, rotation, abduction, and adduction are also present depending on the position of the foot
  • Because the talus is wider anteriorly than posteriorly, the ankle is more mobile in plantarflexion than dorsiflexion
inspection ankle9
Inspection - Ankle
  • Ankle Mortis
    • Relationship of the medial and lateral malleoli causes the ankle articulation to be held in a position of 15 degrees of toeing out
inspection ankle11
Inspection - Ankle
  • Tibiofibular syndesmosis
    • Responsible for maintaining the width of the ankle mortise
    • If torn, the mortise can widen, and the talus becomes unstable
inspection ankle12
Inspection - Ankle
  • Soft Tissue & Edema
    • Medially located deltoid ligament
    • Laterally located anterior & posterior talofibular ligaments, as well as the calcaneofibular ligament
      • Anterior talofibular ligament is highly susceptible to injury
      • Lateral ankle edema inferior and anterior to the lateral malleolus
inspection ankle14
Inspection - Ankle
  • Unilateral swelling is usually trauma, while bilateral swelling is usually indicative of cardiovascular problems (CHF, venous insufficiency, etc.)
inspection ankle16
Inspection - Ankle
  • Vascular
    • Posterior tibial pulse
    • When you progress down to the inspection of the foot, you will also inspect the dorsal pedal pulse
inspection foot
Inspection - Foot
  • How many toes are present and are they deformed
inspection foot18
Inspection - Foot
  • How does the foot contact the floor
    • Pressure points can develop calluses
    • Skin is usually thicker at the weight bearing areas at the heel, the lateral border, and the 1st and 5th metatarsal heads
inspection foot19
Inspection - Foot
  • Can you slide your fingers under the medial arch of the foot
inspection foot20
Inspection - Foot
  • Arches
    • Lateral longitudinal arch
      • Calcaneus, Cuboid, 4th & 5th Metatarsal bones
      • Low arch with limited mobility
      • Transmits weight and thrust to the ground
    • Medial longitudinal arch
      • Calcaneus, Talus, Navicular, Cuneiforms, and 1st-3rd Metatarsals
      • Higher arch, much more mobile. Sustained by the skeletal structures as well as the Plantar Fascia
inspection foot21
Inspection - Foot
  • Inspect the arches with the patient sitting
    • Spastic flat foot will cause the foot to dorsiflex and evert, whereas a normal foot will plantar flex and invert
inspection foot22
Inspection - Foot
  • Range of Motion
    • Calcaneal abduction and adduction at the subtalar articulation
    • Inversion and eversion are combination motions
      • Inversion is calcaneal adduction, navicular rotation, and glide on the talus
      • Eversion is produced by the opposite motions above
inspection foot23
Inspection - Foot
  • Forefoot abduction and adduction
  • Pronation is the motion of the foot and ankle combining calcaneal abduction, forefoot abduction, subtalar- cuboid-navicular eversion, and ankle dorsiflexion
  • Supination consists of calcaneal adduction, subtalar-cuboid-navicular inversion, forefoot adduction, and ankle plantar flexion
shoe inspection
Shoe Inspection
  • Alterations in structure and function will show in the wear and tear on shoes
  • Normal wear from heal strike to toe off gives a transverse crease
shoe inspection26
Shoe Inspection
  • Abnormal wear examples
    • Foot Drop (neurological damage)
      • Dorsiflexors are paralyzed
      • Toe scrapes in ambulation causes scuff marks on the toe box and the front part of the soles
    • Hallux Rigidus (no motion of the 1st MTP joint)
      • Does not allow normal toe off with gait, leading to an oblique crease in the shoes
shoe inspection29
Shoe Inspection
  • Flat Feet (Pes planus)
    • Tend to over pronate and increase wear on the soles of the shoe medially
  • High Arches (Pes cavus)
    • Tend to supinate and increase wear on the lateral aspects of the soles of the shoes
lab treatment section
Lab/Treatment Section
  • Evaluation
    • Dorsiflexion/Plantarflexion
    • Subtalar Abduction/Adduction
    • Calcaneal Inversion/Eversion
    • Navicular (medial) & Cuboid (lateral)
    • Metatarsal motion
    • Phalanges motion
lab treatment section32
Lab/Treatment Section
  • Muscle Energy
    • Dorsiflexion/plantarflexion
    • Subtalar abduction/adduction
    • Calcaneal inversion/eversion
lab treatment section33
Lab/Treatment Section
  • Counterstrain
    • Calcaneal TP (plantar fasciitis)
  • Soft tissue treatment
    • Plantar fascia
  • Lymphatics
    • Effleurage & Pétrissage
lab treatment section34
Lab/Treatment Section
  • HVLA
    • Inversion/eversion calcaneus (ankle traction)
    • Subtalar thrust
    • Dorsal metatarsals treatment
    • Transtarsal thrust
    • Cuboid-Navicular treatment (Hiss whip)
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