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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


Examination of the foot and ankle

2 PARTS:

1- ERECT POSITION.

2-SUPINE POSITION.


Examination of the foot and ankle

Inspection.

Palpation.

Movements.

Special tests.


Examination of the foot and ankle

INSPECTION OF THE PATIENT’S GAIT:

Evaluation of the walking cycle

GAIT ANALYSIS


Examination of the foot and ankle

  • 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%


Examination of the foot and ankle

Stance phase

GAIT ANALYSIS









Examination of the foot and ankle

INSPECTION:

POSTERIOR HEEL STANDING




Examination of the foot and ankle

INSPECTION: of the L.L of the foot on the ground)

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


Examination of the foot and ankle

INSPECTION: of the foot on the ground)

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

INSPECT ALL ARROUND


Examination of the foot and ankle

INSPECTION: of the foot on the ground)

PLANTAR SKIN

callosity


Examination of the foot and ankle

Palpation: of the foot on the ground)

Bone and joints

Soft tissues


Examination of the foot and ankle

Anatomical landmarks: of the foot on the ground)

-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


Examination of the foot and ankle

PALPATION: of the foot on the ground)

Tenderness, swelling, deformity….

Knowing the anatomy:


Examination of the foot and ankle

MOVEMENTS: of the foot on the ground)

Ankle: -dorsiflection -plantar flection.

Subtalar: -inversion -eversion.

Midtarsal: -pronation -supination

Tarso-metatarsals: move the metatarsals one by one.

Toes:


Examination of the foot and ankle

Ankle movements: of the foot on the ground)


Examination of the foot and ankle

SUBTALAR: of the foot on the ground)

MOVEMENT:

MOVE THE HEEL:

Inversion---eversion


Examination of the foot and ankle

Midtarsal supination of the foot on the ground)

Move the metatarsals one by one


Examination of the foot and ankle

MOVEMENTS: of the foot on the ground)

IMPORTANCE OF THE BIG TOE (running, jumping)

Problem of hallux rigidus


Examination of the foot and ankle

EXAMINATION OF THE SHOES of the foot on the ground)


Special tests
Special tests of the foot on the ground)


Examination of the foot and ankle

Ankle sprain: of the foot on the ground)

Lateral ligament.

Stress view.

Anterior drawer.

Varus stress test.

Dynamic X-Ray


Examination of the foot and ankle

SPECIAL PATHOLOGIES: of the foot on the ground)

Ligaments injuries:

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

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


Examination of the foot and ankle

ACHILLES TENDON: of the foot on the ground)

-RUPTURE:(signs in prone position)

~depression.

~absence of rest plantar flexion.

~no plantar flection by

squeezing the calf muscles.


Examination of the foot and ankle

SPECIAL PATHOLOGIES of the foot on the ground)

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


Examination of the foot and ankle

Pes cavus of the foot on the ground)

High arch

Varus


Examination of the foot and ankle

Special pathologies: of the foot on the ground)

TARSAL COALSION:

Painful stiff flat foot

Usually bilateral, can be unilateral

-Stiff subtalar.

MORE COMMON:calcaneo-navicular and subtalar.

-Request CT scan


Examination of the foot and ankle

SPECIAL PATHOLOGIES: of the foot on the ground)

INTOING GAIT:

-Internal femoral torsion: exaggerated anteversion.

-Internal tibial torsion.

-Forefoot adduction.


Examination of the foot and ankle

SPECIAL PATHOLOGIES: of the foot on the ground)

-PLANTAR FASCIITIS:

~Any tightness of Achilles tendon.

~Any mechanical foot disorder.

~Any use of bad shoes.


Examination of the foot and ankle

Metatarsalgia of the foot on the ground)


Examination of the foot and ankle

Hallux valgus of the foot on the ground)


Examination of the foot and ankle

Hallux rigidus: of the foot on the ground)

O.A 1st MPJ


Thank you

THANK YOU of the foot on the ground)