Transcript EXAMINATION OF THE FOOT AND ANKLE1

EXAMINATION OF
THE FOOT AND
ANKLE
Dr. Mohammed Zaheer Dalati
Senior Registrar
Department of Orthopaedics
College of Medicine
King Khalid University Hospital
Objectives
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Review anatomy of Foot and Ankle.
Discuss key history
Hands on exam
Discuss cases concerning common injuries
of the Foot and Ankle
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
History
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Onset
Duration
Mechanism
Swelling / Ecchymosis
Ambulation
Hx of previous injury
2 PARTS:
1- ERECT POSITION.
2-SUPINE POSITION.
Inspection.
Palpation.
Movements.
Special tests.
INSPECTION OF THE PATIENT’S GAIT:
Evaluation of the
walking cycle
GAIT ANALYSIS
• 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%
Stance phase
GAIT ANALYSIS
Trendelenburg gait
Tip-toe walking
Foot drop walking
Spastic gait
Intoeing/Out toeng gait
Antalgic gait
Inspection in standing position
INSPECTION:
POSTERIOR HEEL STANDING
FOOT SHAPE
ALL THE TOES SHOULD BE IN GROUND
CONTACT IN W.B.(stability of the foot on the
ground)
INSPECTION: of the L.L
Any asymmetry of
length, rotational
problem, or mal
alignment of the
lower limbs.
INSPECTION:
- Deformity, swelling, skin changes, muscle
wasting, asymmetry of length, abnormal
position….
INSPECT ALL ARROUND
INSPECTION:
PLANTAR SKIN
callosity
Palpation:
Bone and joints
Soft tissues
Anatomical landmarks:
-Medial malleolus, 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
PALPATION:
Tenderness, swelling, deformity….
Knowing the anatomy:
MOVEMENTS:
Ankle: -dorsiflection -plantar flection.
Subtalar: -inversion -eversion.
Midtarsal: -pronation -supination
Tarso-metatarsals: move the
metatarsals one by one.
Toes:
Ankle movements:
MOVEMENT:
SUBTALAR:
MOVE THE HEEL:
Inversion---eversion
Midtarsal supination
Move the metatarsals one by one
MOVEMENTS:
IMPORTANCE OF THE BIG TOE
(running, jumping)
Problem of hallux rigidus
EXAMINATION OF THE
SHOES
Special tests
Ankle sprain:
Lateral ligament.
Stress view.
Anterior drawer.
Varus stress test.
Dynamic X-Ray
SPECIAL PATHOLOGIES:
Ligaments injuries:
-Lateral collateral ligament of
the ankle: varus stress view AP.
-Subtalar ligaments: increased
valgus by standing on one leg.
ACHILLES TENDON:
-RUPTURE:(signs in prone position)
~depression.
~absence of rest plantar flexion.
~no plantar flection by
squeezing the calf muscles.
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
Pes cavus
High arch
Varus
Special pathologies:
TARSAL COALSION:
Painful stiff flat foot
Usually bilateral, can be unilateral
-Stiff subtalar.
MORE COMMON:calcaneonavicular and subtalar.
-Request CT scan
SPECIAL PATHOLOGIES:
INTOING GAIT:
-Internal femoral torsion: exaggerated anteversion.
-Internal tibial torsion.
-Forefoot adduction.
SPECIAL PATHOLOGIES:
-PLANTAR FASCIITIS:
~Any tightness of Achilles tendon.
~Any mechanical foot disorder.
~Any use of bad shoes.
Metatarsalgia
Hallux
valgus
Hallux rigidus:
O.A 1st MPJ
THANK YOU