1. Chapter 4 Clinical Assessment of Foot & Toe Injuries Part II

2. Student Learning Outcomes Identify common toe injuries based on their presenting history, symptoms, visual signs (inspection), & palpation findings Identify special tests that might be used to evaluate these injuries Discuss basic management strategies for dealing with these injuries Discuss anatomical or biomechanical predisposing factors associated with these common toe injuries

3. Location of Pain: Phalanges Injuries to suspect Collateral sprain Fx/Dislocation Hammer toes Claw toes

4. History Location of pain (phalanges) SymptomsOnsetMOI Collateral sprain Acute; trauma Fx/dislocation Acute; trauma compressive forces; Hammer toes Pain in 1 st MTP joint wearing shoes that are too short; pressure of bunion; Claw toes Chronic; gradual onset;

5. Inspection/Observation Location of pain (phalanges) Signs Deformity?Swelling?Discoloration? Collateral sprain NoPossible Fx/dislocation PossibleCommon Hammer toes YesNo Claw toes YesNoTypically not

6. Palpation Location of pain (phalanges) Point tenderness? Deformity?Swelling?Crepitus? Collateral sprain Over involved joint NoCommonNo Fx/dislocation Over fx sitePossibleCommonPossible Hammer toes Over dorsal aspect of PIP Hyperextension of MTP and DIP; flexion of PIP No Claw toes Over dorsal aspect of PIP Flexion of PIP and DIP No

7. Physical Examination Location of pain (phalanges) ROM?Stress Tests? Special Tests? Neurological ? Collateral sprain Typically normal Valgus/Varus stress tests n/a Fx/dislocation May be limited n/a Tap test n/a Hammer toes limitedn/a Claw toes limitedn/a

8. Management Collateral sprain ICE Buddy taping Spring steel innersole

9. Management Fracture/dislocation ICE Buddy taping Spring steel innersole Referral for x-rays

10. Management Hammer toes Passive stretching Ensure that shoes fit properly Use hammer toe splints

11. Range of Motion Toe flexion (75-85  ) AROM PROM RROM Toe extension (35 to 45  ) AROM PROM RROM

12. Predisposing Factors Location of pain Phalanges Collateral sprain Fx – foot structure with decreased ability to dissipate forces (stress fx) Dislocation Hammer toes – shoes that are too short Claw toes – associated with pes cavus foot

13. Management Location of pain Phalanges Collateral sprain Fx Dislocation Hammer toes Claw toes buddy taping spring steel innersole } }

14. Location of Pain: 1 st MTP Injuries/conditions to consider sprain collateral capsule (turf toe) muscle/tendon strain – what muscles? sesmoiditis hallux valgus - bunion hallux rigidus – rigid great toe with limited ROM

15. History Location of pain (1 st MTP) SymptomsOnsetMOI Collateral sprain Pain over MCL or LCL Acute; trauma Capsular (volar) sprain Pain within MTP joint; pain over volar aspect of MTP Acute; trauma Strain/Tendinitis Pain with muscle function; pain with passive stretching of involved muscle/tendon Acute/ Chronic forceful contraction; repetitive stress Sesmoiditis Pain over sesmoiditis Acute/ chronic Hallux valgus Pain at MTP joint Chronic Hallux rigidus Pain at MTP joint

16. Management Great toe (1 st MTP) collateral sprain Ice Collateral tape job Spring steel innersole capsule (turf toe)

17. Management Great toe (1 st MTP) volar/capsule sprain (turf toe) Ice NSAIDs Taping of MTP to prevent hyperextension Spring steel innersole

18. History Location of pain Great toe (1 st MTP) hallux valgus – bunion See textbook for signs, symptoms, palpation, stress/special tests, and management

19. History Location of pain Great toe (1 st MTP) hallux rigidus – rigid great toe with limited ROM

20. History Location of pain Metatarsophalangeal joints (MTP) 2 nd -5 th MTPs  sprain  metatarsalgia Symptoms Increased callus formation (2 nd head) MOI Repetitive stress Trauma to metatarsal arch

21. Inspection/Palpation Location of pain Metatarsophalangeal joints (MTP) 2 nd -5 th MTPs  sprain  metatarsalgia Signs increased callus formation (2 nd head) flattening of metatarsal arch Palpation point tender over 2 nd MTP prominent 2 nd MTP

22. Stress/Special Tests Location of pain Metatarsophalangeal joints (MTP) 2 nd -5 th MTPs  sprain  metatarsalgia Tests?

23. Management Location of pain Metatarsophalangeal joints (MTP) 2 nd -5 th MTPs  sprain  metatarsalgia Treatment ice anti-inflammatories tear drop pad spring steel innersole

24. Questions?