1. EXAMINATION OF THE FOOT AND ANKLE Dr. Mohammed Zaheer Dalati Senior Registrar Department of Orthopaedics College of Medicine King Khalid University Hospital

2. Objectives Review anatomy of Foot and Ankle. Discuss key history Hands on exam Discuss cases concerning common injuries of the Foot and Ankle

3. Anatomy

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

11. 2 PARTS: 1- ERECT POSITION. 2-SUPINE POSITION.

12. Inspection. Palpation. Movements. Special tests.

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

15. 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%

17. GAIT ANALYSIS Stance phase

18. Trendelenburg gait

20. Tip-toe walking

22. Foot drop walking

24. Spastic gait

26. Intoeing/Out toeng gait

28. Antalgic gait

29. Inspection in standing position

34. INSPECTION: POSTERIOR HEEL STANDING

36. FOOT SHAPE

38. ALL THE TOES SHOULD BE IN GROUND CONTACT IN W.B.(stability of the foot on the ground)

40. INSPECTION: of the L.L Any asymmetry of length, rotational problem, or mal alignment of the lower limbs.

42. INSPECTION: - Deformity, swelling, skin changes, muscle wasting, asymmetry of length, abnormal position…. INSPECT ALL ARROUND

43. INSPECTION: PLANTAR SKIN callosity

44. Palpation: Bone and joints Soft tissues

45. 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

46. PALPATION: Tenderness, swelling, deformity…. Knowing the anatomy:

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

49. Ankle movements:

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

51. Midtarsal supination  Move the metatarsals one by one

52. MOVEMENTS: IMPORTANCE OF THE BIG TOE (running, jumping) Problem of hallux rigidus

53. EXAMINATION OF THE SHOES

54. Special tests

56. Ankle sprain: Lateral ligament. Stress view. Anterior drawer. Varus stress test. Dynamic X-Ray

58. SPECIAL PATHOLOGIES: Ligaments injuries: -Lateral collateral ligament of the ankle: varus stress view AP. -Subtalar ligaments: increased valgus by standing on one leg.

60. ACHILLES TENDON: -RUPTURE:(signs in prone position) ~depression. ~absence of rest plantar flexion. ~no plantar flection by squeezing the calf muscles.

64. SPECIAL PATHOLOGIES Pes planus: common 20% -GAIT: UGLY. -INSPECTION STANDING: HEEL, ARCH, FOREFOOT. -LIGAMENT LAXITY -MOVE THE HEEL AND THE 1 ST METATARSAL. -EXAMIN THE TENDO ACHILLES -May be asymptomatic

67. Pes cavus High arch Varus

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

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

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

76. Metatarsalgia

78. Hallux valgus

80. Hallux rigidus: O.A 1 st MPJ

81. THANK YOU