Chapter 4Chapter 4

The Foot and Toes continuedThe Foot and Toes continued

Clinical Evaluation of Clinical Evaluation of Foot and Toe InjuriesFoot and Toe Injuries

May involve evaluation of lower extremityMay involve evaluation of lower extremity Athletic Trainer and athlete/patient must Athletic Trainer and athlete/patient must

be preparedbe prepared Evaluation Map, Page 99Evaluation Map, Page 99

HistoryHistory Location of pain (Table 4-5, page 100)Location of pain (Table 4-5, page 100)

Retrocalcaneal painRetrocalcaneal pain Heel painHeel pain Medial arch painMedial arch pain Metatarsal painMetatarsal pain Greta toe painGreta toe pain Lateral arch painLateral arch pain

Onset and mechanism of injuryOnset and mechanism of injury Acute onsetAcute onset Insidious onsetInsidious onset

Playing surface, distance, duration, shoesPlaying surface, distance, duration, shoes

InspectionInspection

Begins immediatelyBegins immediately Gross deformity, swelling, rednessGross deformity, swelling, redness Inspect footwear for wear patterns and Inspect footwear for wear patterns and

appropriatenessappropriateness Weight-bearing vs. non-weight-bearingWeight-bearing vs. non-weight-bearing

General Inspection of the General Inspection of the FootFoot

Foot Type (pronated, neutral, supinated)Foot Type (pronated, neutral, supinated) Figure 4-11, page 102Figure 4-11, page 102 Table 4-6, page 103Table 4-6, page 103 Box 4-1, page 104Box 4-1, page 104

Calluses and blistersCalluses and blisters Improperly fitting shoes, poor biomechanics, Improperly fitting shoes, poor biomechanics,

or underlying bony or soft tissue dysfunctionor underlying bony or soft tissue dysfunction

Inspection of the ToesInspection of the Toes

General toe alignment (Box 4-2, pg 105)General toe alignment (Box 4-2, pg 105) Morton’s alignmentMorton’s alignment Claw toesClaw toes Hammer toesHammer toes Hallux abducto valgusHallux abducto valgus CornsCorns Ingrown toenail (Figure 4-12, page 104)Ingrown toenail (Figure 4-12, page 104) Subungual hematoma (Figure 4-13, page 106)Subungual hematoma (Figure 4-13, page 106)

Inspection of StructuresInspection of Structures

Medial Medial Medial longitudinal archMedial longitudinal arch

Weight-bearing vs. non-weight-bearingWeight-bearing vs. non-weight-bearing

LateralLateral Fifth metatarsalFifth metatarsal

DorsalDorsal

Inspection of StructuresInspection of Structures

Plantar SurfacePlantar Surface Plantar warts (Figure 4-14, page 106)Plantar warts (Figure 4-14, page 106)

Verruca vulgarisVerruca vulgaris Calloused skin, excessive stressCalloused skin, excessive stress ““stepping on a pebble”stepping on a pebble”

Inspection of Posterior Inspection of Posterior StructuresStructures

Achilles TendonAchilles Tendon Relationship/alignment to tibiaRelationship/alignment to tibia Figure 4-15, page 107Figure 4-15, page 107

CalcaneusCalcaneus Retrocalcaneal exostosis (“pump bump”)Retrocalcaneal exostosis (“pump bump”) Figure 4-16, page 107Figure 4-16, page 107

Non-Weight-Bearing Non-Weight-Bearing Inspection of Foot and Inspection of Foot and Calcaneal AlignmentCalcaneal Alignment

Assessment of talar positionAssessment of talar position Subtalar neutral positionSubtalar neutral position Alignment of forefoot and rearfootAlignment of forefoot and rearfoot

Mobility of the first rayMobility of the first ray Pes planus = hypermobilityPes planus = hypermobility Pes cavus = rigid rayPes cavus = rigid ray

Inspection of Foot Inspection of Foot AlignmentAlignment

Forefoot vs. rearfootForefoot vs. rearfoot Weight-bearing, non-weight-bearing and/or Weight-bearing, non-weight-bearing and/or

bothboth Figure 4-18, page 107Figure 4-18, page 107 Foot PostureFoot Posture

Subtalar joint in neutral positionSubtalar joint in neutral position Box 4-3, page 109Box 4-3, page 109

Plantarflexed first rayPlantarflexed first ray Pes cavus, genu varum, it is NOT forefoot valgusPes cavus, genu varum, it is NOT forefoot valgus

PalpationPalpation

Patient positioningPatient positioning Refer to list of Clinical ProficienciesRefer to list of Clinical Proficiencies Utilize pages 108 – 112 in textbookUtilize pages 108 – 112 in textbook