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Chapter 4. Clinical Assessment of Foot & Toe Injuries Part II. Student Learning Outcomes. Identify common toe injuries based on their presenting history, symptoms, visual signs (inspection), & palpation findings Identify special tests that might be used to evaluate these injuries

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Chapter 4

Chapter 4

Clinical Assessment of

Foot & Toe Injuries

Part II


Student learning outcomes
Student Learning Outcomes

  • Identify common toe injuries based on their presenting history, symptoms, visual signs (inspection), & palpation findings

  • Identify special tests that might be used to evaluate these injuries

  • Discuss basic management strategies for dealing with these injuries

  • Discuss anatomical or biomechanical predisposing factors associated with these common toe injuries


Location of pain phalanges
Location of Pain: Phalanges

  • Injuries to suspect

    • Collateral sprain

    • Fx/Dislocation

    • Hammer toes

    • Claw toes






Management
Management

  • Collateral sprain

    • ICE

    • Buddy taping

    • Spring steel innersole


Management1
Management

  • Fracture/dislocation

    • ICE

    • Buddy taping

    • Spring steel innersole

    • Referral for x-rays


Management2
Management

  • Hammer toes

    • Passive stretching

    • Ensure that shoes fit properly

    • Use hammer toe splints


Range of motion
Range of Motion

  • Toe flexion (75-85)

    • AROM

    • PROM

    • RROM

  • Toe extension (35 to 45)

    • AROM

    • PROM

    • RROM


Predisposing factors
Predisposing Factors

  • Location of pain

    • Phalanges

      • Collateral sprain

      • Fx – foot structure with decreased ability to dissipate forces (stress fx)

      • Dislocation

      • Hammer toes – shoes that are too short

      • Claw toes – associated with pes cavus foot


Management3
Management

  • Location of pain

    • Phalanges

      • Collateral sprain

      • Fx

      • Dislocation

      • Hammer toes

      • Claw toes

}

  • buddy taping

  • spring steel innersole

}


Location of pain 1 st mtp
Location of Pain: 1st MTP

  • Injuries/conditions to consider

    • sprain

      • collateral

      • capsule (turf toe)

    • muscle/tendon strain – what muscles?

    • sesmoiditis

    • hallux valgus - bunion

    • hallux rigidus – rigid great toe with limited ROM



Management4
Management

  • Great toe (1st MTP) collateral sprain

    • Ice

    • Collateral tape job

    • Spring steel innersole

    • capsule (turf toe)


Management5
Management

  • Great toe (1st MTP) volar/capsule sprain (turf toe)

    • Ice

    • NSAIDs

    • Taping of MTP to prevent hyperextension

    • Spring steel innersole


History2
History

  • Location of pain

    • Great toe (1st MTP)

      • hallux valgus – bunion

      • See textbook for signs, symptoms, palpation, stress/special tests, and management


History3
History

  • Location of pain

    • Great toe (1st MTP)

      • hallux rigidus – rigid great toe with limited ROM


History4
History

  • Location of pain

    • Metatarsophalangeal joints (MTP)

      • 2nd -5th MTPs

        • sprain

        • metatarsalgia

  • Symptoms

  • Increased callus formation (2nd head)

  • MOI

  • Repetitive stress

  • Trauma to metatarsal arch


Inspection palpation
Inspection/Palpation

  • Location of pain

    • Metatarsophalangeal joints (MTP)

      • 2nd -5th MTPs

        • sprain

        • metatarsalgia

  • Signs

  • increased callus formation (2nd head)

  • flattening of metatarsal arch

  • Palpation

  • point tender over 2nd MTP

  • prominent 2nd MTP


Stress special tests
Stress/Special Tests

  • Location of pain

    • Metatarsophalangeal joints (MTP)

      • 2nd -5th MTPs

        • sprain

        • metatarsalgia

Tests?


Management6
Management

  • Location of pain

    • Metatarsophalangeal joints (MTP)

      • 2nd -5th MTPs

        • sprain

        • metatarsalgia

  • Treatment

  • ice

  • anti-inflammatories

  • tear drop pad

  • spring steel innersole