FOOT & ANKLE EXAMINATION WORKSHOP€¦ · FOOT & ANKLE EXAMINATION WORKSHOP Morteza Khodaee, ......
Transcript of FOOT & ANKLE EXAMINATION WORKSHOP€¦ · FOOT & ANKLE EXAMINATION WORKSHOP Morteza Khodaee, ......
5/14/2014
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FOOT & ANKLE EXAMINATION WORKSHOPMorteza Khodaee, MD, MPHAshley Chrisman, PAUniversity of Colorado School of MedicineMay 17, 2014
ANATOMYHindfoot
Inferior Tibiofibular JointSyndesmosis type with minimum movementAnt. & post. inferior tibiofibular, transverse tibiofibular, and interosseus ligament
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ANATOMYHindfoot
Talocrural (Ankle) JointFormed by Talus, Med. & Lat MalleoliUniaxial and modified hinged typePlantar flexion to 50° and dorsiflexion to 20°ATF & PTF, and calcaneofibular lig. laterallyDeltoid lig. medially
ANATOMYHindfoot
Subtalar (Talocalcanean) JointFormed by talus, calcaneus, navicular, and cuboidSupination 45°-60° and pronation 15°-30°
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ANATOMY
Midfoot
Chopart’s Joint
Midtarsal joints between the talus-calcaneus and the navicular-cuboidMinimum movement
ANATOMY ForefootTarsometatarsal (Lisfranc’s) JointsIntermetatarsal JointsMetatarsophalangeal Joints
Toe extension, lateral four toes (MTP 40°), big toe (MTP 70°)Toe flexion, lateral four toes (MTP 40°), big toe (MTP 45°)
Interphalangeal JointsToe extension, lateral four toes (PIP 0°, DIP 30°), big toe (IP 0°)Toe flexion, lateral four toes (PIP 35°, DIP 60°), big toe (IP 90°)
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EVALUATIONHistoryMechanism of InjuryPresence of transient or fixed deformity of the foot & ankle at the time of injuryLevel of activities after the injury
EVALUATIONHistorySwelling or bruising (ecchymosis)Pain characters (location, intensity, type, duration, aggravating and alleviating factors)History of previous injury
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PHYSICAL EXAMINATIONObservationLateral View
a. Calcanealapophysitis (Sever’s)
b. Achilles tendinosisc. Achilles ruptured. Retrocalcaneal
bursitise. Post. ankle
impingementf. Calcaneofibular ligg. Sinus tarsih. Ant. talofibular ligi. Ant. ankle
impingementj. Avulsion Fx of 5th MT
c
PHYSICAL EXAMINATIONObservationMedial View
e. Tarsal tunnel syndromef. Med. ankle spraing. Entrapment site 1st branch
of lat. plantar n.h. Entrapment site of med.
plantar n.
a. Calcaneal apophysitis(Sever’s)
b. Achilles tendinosisc. Achilles ruptured. Retrocalcaneal bursitis
a
bc
d
e f
gh
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PHYSICAL EXAMINATIONObservation
Dorsal Foot & Anklea. Ant. ankle impingementb. Lat. talar dome OCDc. Navicular stress fractured. Lisfranc spraine. Ant. tarsal tunnel syndromef. Bunionetteg. Bunionh. Hallux rigidusi. Avascular necrosis of 2nd MT headj. Morton’s neuromak. Paronychia
a
e
i
k
jh
c
f
d
g
PHYSICAL EXAMINATIONObservation
Plantar Foot & Ankle
a.Plantar fat padb.Plantar fasciitisc.Avulsion fracture of the
5th MTd.Stress fracture of the 3rd
MTe.Stress fracture of the 2nd
MTf. Sesamoiditisg.Metatarsalgia
a
f
e d
c
b
ggg g
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PHYSICAL EXAMINATION
Observation
Swelling
Ecchymosis
PHYSICAL EXAMINATIONObservation
(Cont’)
Deformities
Ankle Dislocation Ankle ganglion cyst
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PHYSICAL EXAMINATION
Observation
Non-weight-bearing (open-chain)
Weight-bearing (closed-chain)
PHYSICAL EXAMINATIONObservation (Cont’)
Pes planus (flat foot)
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PHYSICAL EXAMINATIONObservation (Cont’)
Left Achilles tendon rupture
PHYSICAL EXAMINATIONObservation (Cont’)
Pes cavus (hollow foot)Splay foot (broadening of the
forefoot)
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Observation (Cont’)
Bunion (hallux valgus, callus, thickened bursa, and exostosis)
PHYSICAL EXAMINATION
PHYSICAL EXAMINATIONObservation (Cont’)
Bunionette (tailor’s bunion) and Plantar Callus
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PHYSICAL EXAMINATION
Observation (Cont’)Hallux Rigidus(stiff big toe)
Mostly due to osteoarthritis of 1st MTP
PHYSICAL EXAMINATION
Observation (Cont’)
Hammer Toe
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PHYSICAL EXAMINATIONRange of Motion (active & passive)
Ankle plantar flexion 50°Ankle dorsiflexion 20°Supination 45°-60° (inversion, adduction, and plantar flexion)Pronation 15°-30° (eversion, abduction, and dorsiflexion)Resisted Isometric Movements
Supination Pronation
PHYSICAL EXAMINATIONPalpation
Medial & lateral malleoliMedial & lateral ligament complexesBase of 5th metatarsalDistal tibiofibuar jointTalus, calcaneus, navicular, cuneiform, and cuboid bonesAchilles tendonPeroneal tendonsMetatersal bonesMTP, PIP, and DIP jointsNeurovascular exam (DP & PT pulses, cap refill, sensation)
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PHYSICAL EXAMINATIONSpecial Tests
Thompson test for Achilles tendon rupture
Negative
PHYSICAL EXAMINATIONThompson test
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PHYSICAL EXAMINATION
Special Tests (Cont’)
Anterior drawer test (anterior talofibular ligament integrity test)
PHYSICAL EXAMINATIONAnterior drawer test
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PHYSICAL EXAMINATIONAnterior drawer test - prone
PHYSICAL EXAMINATION
Special Tests (Cont’)
Talar tilt testAssessing CF lig in anatomic (90°) positionAssessing ATF ligwhen ankle is plantar flexed (inversion stress test)
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PHYSICAL EXAMINATIONTalar tilt test
PHYSICAL EXAMINATIONSpecial Tests (Cont’)
Squeeze test of the leg (distal tibiofibularcompression test) for syndesmosis injury
positive, if elicits pain over the distal anterior syndesmosis
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PHYSICAL EXAMINATION
Special Tests (Cont’)
Coronal (side-to-side) drawer or Cotton test for syndesmosis injury
PHYSICAL EXAMINATION
Special Tests (Cont’)
External rotation stress test for syndesmosis injury
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PHYSICAL EXAMINATIONSpecial Tests
(Cont’)
Dorsiflexion-eversion test to reproduce the symptoms of tarsal tunnel syndromeTinel’s sign at the ankle
PHYSICAL EXAMINATIONSpecial Tests (Cont’)
Homans’ signPain in the calf with passive and forced dorsiflexion of ankle
Peroneal tendons subluxation/dislocation test
Peroneus lungus (resisted eversion in a dorsiflexed ankle)Peroneus brevis (resisted dorsiflexion of 1st metatarsal in an everted foot)