Chapter 4

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Chapter 4 Clinical Assessment of Foot & Toe Injuries

Part I

Student Learning Outcomes

 Describe the HOPS evaluation model as it pertains to foot and toe injuries

 Describe common foot types and malalignments that are associated with foot and toe injuries

  Identify ROM, Stress, Special, & Neurological tests used when evaluating foot & toe injuries

General History

 Location of pain    

 Onset of pain  

 Mechanism of injury    

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History

 Questions specific to the foot  changes in

  playing surface   running distance/

duration   running intensity   shoes

 do they wear orthotics?

Observation/Inspection

 Visual Signs      


 Observe the foot from all sides (anterior, posterior, medial, lateral)   calluses   foot type   malalignment

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 Calluses


 Foot Types

Pes planus

Normal

Pes cavus


 Foot types   normal

  designed to absorb & dissipate forces   supported and maintained by

     

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 Foot types   pes planus

  talar head displaces medially & plantarward   overpronator  


 Foot types   Pes planus

  supple  

  rigid  



  the pronated foot has greater subtalar motion than the supinated foot

  requires more muscle work to maintain stance stability than the supinated foot

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  biomechanical factors        


 Foot types   Pes cavus

  inability to absorb forces or dissipate forces


 Foot types   Pes cavus

  associated with stress fxs   metatarsals   tibia

  associated with claw toes

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 Toe Alignment   Morton’s toe   claw toes   hammer toe   hallux valgus

Claw toe

Claw toe Hammer toe Hammer toe

Morton’s toe

Hallux valgus


 Morton’s toe   2nd metatarsal > 1st metatarsal   2nd toe may or may not be longer than the 1st   typically associated with

unique callus formation   associated with a

variety of forefoot pain syndromes

     


 Claw toes   hyperextension of MTP   flexion of PIP   flexion of DIP

Claw toe Claw toe

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 Hammer toe   hyperextension of the MTP   flexion of the PIP   hyperextension of the DIP

Hammer toe Hammer toe


 Hallux valgus   may be associated with a

bunion

Hallux valgus


 Corns   distinguished from calluses by their central core

  soft - between the toes   hard – on top, side, or bottom of foot or toes

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  Ingrown toenail (paronychia)


 Subungual hematoma   can be caused by trauma or ill-fitting shoes


 Plantar wart   most commonly found on plantar surface of foot   may be confused with calluses or hard corns   pairing will reveal central core of black dots

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 Structural or Functional Malalignments   rearfoot varus   rearfoot valgus

Normal

Valgus Varus Normal


 Structural or Functional Malalignments   forefoot varus   forefoot valgus

Forefoot varus Forefoot valgus


 All is not as it may appear…..

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 All is not as it may appear…..

Weight bearing Subtalar neutral

Palpation

 Bony landmarks  Tendon insertion sites   Ligaments  Other soft tissue structures

  example: plantar fascia  Pulses

   

Range of Motion

 Great toe extension ( °)*   AROM   PROM   RROM

 Great toe flexion ( °)   AROM   PROM   RROM

*60-65° great toe extension required for normal gait

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Range of Motion

 MMT   may be necessary to test specific muscles that

insert within the foot   example:

  anterior tibialis   posterior tibialis   peroneal brevis

Stress Tests

 Valgus/varus tests   great toe   other four toes

 Glide tests   intertarsal   tarsometatarsal   intermetatarsal

Special Tests

 Feiss’ line  

 Navicular drop test  

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Special Tests

 Assessing subtalar neutral   rearfoot & forefoot malalignments

Special Tests

 Tap test or compression test   fx of metatarsal or phalange

Neurological Tests

 Foot & toes innervated by L4 – S2 nerve roots

  Injury to these nerve roots can cause “radicular” symptoms in the foot & toes   sensory   motor   reflexes

} Refer to Lower Quarter Neuro Screening, pg. 16

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Neurological Tests

  Local injury to peripheral nerves in foot & toes   Tinel’s sign (__________________________)   webspace between 1st and 2nd toes (_______

_________________________)   “pencil test” (_________________)

Questions?

Documents

Chapter 4