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EXAMINATION OF THE FOOT AND ANKLE. Dr. Mohammed Zaheer Dalati Senior Registrar. Department of Orthopaedics College of Medicine King Khalid University Hospital. Objectives. Review anatomy of Foot and Ankle. Discuss key history Hands on exam

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examination of the foot and ankle
EXAMINATION OF THEFOOT AND ANKLE

Dr. Mohammed Zaheer Dalati

Senior Registrar

Department of Orthopaedics

College of Medicine

King Khalid University Hospital

objectives
Objectives
  • Review anatomy of Foot and Ankle.
  • Discuss key history
  • Hands on exam
  • Discuss cases concerning common injuries of the Foot and Ankle
history
History
  • Onset
  • Duration
  • Mechanism
  • Swelling / Ecchymosis
  • Ambulation
  • Hx of previous injury
slide11

2 PARTS:

1- ERECT POSITION.

2-SUPINE POSITION.

slide12

Inspection.

Palpation.

Movements.

Special tests.

slide13

INSPECTION OF THE PATIENT’S GAIT:

Evaluation of the walking cycle

GAIT ANALYSIS

slide15

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%
slide17

Stance phase

GAIT ANALYSIS

slide34

INSPECTION:

POSTERIOR HEEL STANDING

slide40

INSPECTION: of the L.L

Any asymmetry of length, rotational problem, or mal alignment of the lower limbs.

slide42

INSPECTION:

- Deformity, swelling, skin changes, muscle wasting, asymmetry of length, abnormal position….

INSPECT ALL ARROUND

slide43

INSPECTION:

PLANTAR SKIN

callosity

slide44

Palpation:

Bone and joints

Soft tissues

slide45

Anatomical landmarks:

-Medialmalleolus, 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

slide46

PALPATION:

Tenderness, swelling, deformity….

Knowing the anatomy:

slide47

MOVEMENTS:

Ankle: -dorsiflection -plantar flection.

Subtalar: -inversion -eversion.

Midtarsal: -pronation -supination

Tarso-metatarsals: move the metatarsals one by one.

Toes:

slide50

SUBTALAR:

MOVEMENT:

MOVE THE HEEL:

Inversion---eversion

slide51

Midtarsal supination

Move the metatarsals one by one

slide52

MOVEMENTS:

IMPORTANCE OF THE BIG TOE (running, jumping)

Problem of hallux rigidus

slide56

Ankle sprain:

Lateral ligament.

Stress view.

Anterior drawer.

Varus stress test.

Dynamic X-Ray

slide58

SPECIAL PATHOLOGIES:

Ligaments injuries:

-Lateral collateral ligament of the ankle: varus stress view AP.

-Subtalar ligaments: increased valgus by standing on one leg.

slide60

ACHILLES TENDON:

-RUPTURE:(signs in prone position)

~depression.

~absence of rest plantar flexion.

~no plantar flection by

squeezing the calf muscles.

slide64

SPECIAL PATHOLOGIES

Pes planus: common 20%

-GAIT: UGLY.

-INSPECTION STANDING: HEEL, ARCH, FOREFOOT.

-LIGAMENT LAXITY

-MOVE THE HEEL AND THE 1ST METATARSAL.

-EXAMIN THE TENDO ACHILLES

-May be asymptomatic

slide67

Pes cavus

High arch

Varus

slide69

Special pathologies:

TARSAL COALSION:

Painful stiff flat foot

Usually bilateral, can be unilateral

-Stiff subtalar.

MORE COMMON:calcaneo-navicular and subtalar.

-Request CT scan

slide72

SPECIAL PATHOLOGIES:

INTOING GAIT:

-Internal femoral torsion: exaggerated anteversion.

-Internal tibial torsion.

-Forefoot adduction.

slide74

SPECIAL PATHOLOGIES:

-PLANTAR FASCIITIS:

~Any tightness of Achilles tendon.

~Any mechanical foot disorder.

~Any use of bad shoes.

slide80

Hallux rigidus:

O.A 1st MPJ

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