Chapter 4 The Foot and Toes continued

Clinical Evaluation of Foot and Toe Injuries  May involve evaluation of lower extremity  Athletic Trainer and athlete/patient must be prepared  Evaluation Map, Page 99

History  Location of pain (Table 4-5, page 100)  Retrocalcaneal pain  Heel pain  Medial arch pain  Metatarsal pain  Greta toe pain  Lateral arch pain  Onset and mechanism of injury  Acute onset  Insidious onset  Playing surface, distance, duration, shoes

Inspection  Begins immediately  Gross deformity, swelling, redness  Inspect footwear for wear patterns and appropriateness  Weight-bearing vs. non-weight-bearing

General Inspection of the Foot  Foot Type (pronated, neutral, supinated)  Figure 4-11, page 102  Table 4-6, page 103  Box 4-1, page 104  Calluses and blisters  Improperly fitting shoes, poor biomechanics, or underlying bony or soft tissue dysfunction

Inspection of the Toes  General toe alignment (Box 4-2, pg 105)  Morton’s alignment  Claw toes  Hammer toes  Hallux abducto valgus  Corns  Ingrown toenail (Figure 4-12, page 104)  Subungual hematoma (Figure 4-13, page 106)

Inspection of Structures  Medial  Medial longitudinal arch  Weight-bearing vs. non-weight-bearing  Lateral  Fifth metatarsal  Dorsal

Inspection of Structures  Plantar Surface  Plantar warts (Figure 4-14, page 106)  Verruca vulgaris  Calloused skin, excessive stress  “stepping on a pebble”

Inspection of Posterior Structures  Achilles Tendon  Relationship/alignment to tibia  Figure 4-15, page 107  Calcaneus  Retrocalcaneal exostosis (“pump bump”)  Figure 4-16, page 107

Non-Weight-Bearing Inspection of Foot and Calcaneal Alignment  Assessment of talar position  Subtalar neutral position  Alignment of forefoot and rearfoot  Mobility of the first ray  Pes planus = hypermobility  Pes cavus = rigid ray

Inspection of Foot Alignment  Forefoot vs. rearfoot  Weight-bearing, non-weight-bearing and/or both  Figure 4-18, page 107  Foot Posture  Subtalar joint in neutral position  Box 4-3, page 109  Plantarflexed first ray  Pes cavus, genu varum, it is NOT forefoot valgus

Palpation  Patient positioning  Refer to list of Clinical Proficiencies  Utilize pages 108 – 112 in textbook