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 Discuss cases concerning common injuries of the Foot and Ankle

Anatomy

Anatomy

Anatomy

Anatomy

Anatomy

Anatomy

Anatomy

History Onset Duration Mechanism Swelling / Ecchymosis Ambulation Hx of previous injury

2 PARTS: 1- ERECT POSITION. 2-SUPINE POSITION.

Inspection. Palpation. Movements. Special tests.

GAIT ANALYSIS Evaluation of the walking cycle INSPECTION OF THE PATIENT’S GAIT: Evaluation of the walking cycle GAIT ANALYSIS

STANCE PHASE 65% SWING PHASE 35% 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

POSTERIOR HEEL STANDING INSPECTION: POSTERIOR HEEL STANDING

FOOT SHAPE

ALL THE TOES SHOULD BE IN GROUND CONTACT IN W. B 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:

Ankle: -dorsiflection -plantar flection. MOVEMENTS: Ankle: -dorsiflection -plantar flection. Subtalar: -inversion -eversion. Midtarsal: -pronation -supination Tarso-metatarsals: move the metatarsals one by one. Toes:

Ankle movements:

Inversion---eversion SUBTALAR: MOVEMENT: MOVE THE HEEL: Inversion---eversion

Midtarsal supination Move the metatarsals one by one

IMPORTANCE OF THE BIG TOE (running, jumping) 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

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

Pes planus: common 20% SPECIAL PATHOLOGIES -May be asymptomatic -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

TARSAL COALSION: MORE COMMON:calcaneo-navicular and subtalar. Special pathologies: TARSAL COALSION: Painful stiff flat foot Usually bilateral, can be unilateral -Stiff subtalar. MORE COMMON:calcaneo-navicular and subtalar. -Request CT scan

INTOING GAIT: SPECIAL PATHOLOGIES: -Internal femoral torsion: exaggerated anteversion. -Internal tibial torsion. -Forefoot adduction.

-PLANTAR FASCIITIS: SPECIAL PATHOLOGIES: ~Any tightness of Achilles tendon. ~Any mechanical foot disorder. ~Any use of bad shoes.

Metatarsalgia

Hallux valgus

Hallux rigidus: O.A 1st MPJ

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