Foot and Ankle Examination

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Foot and Ankle Examination

• A. Amendola, MD
• Professor Dept of Orthopaedic Surgery
• Director , UI Sports Medicine
• University of Iowa

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Clinical Diagnosis

• Gait cycle
• stance phase ( shock dissipation and force
  generation)
• heel strike
• lateral column loading
• foot flat
• load transmission across midfoot (
  pronation ) to medial column
• push off (force generation)

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Clinical Diagnosis

• Gait cycle

Toe off
Foot flat
Heel strike
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Basic Principles Gait cycle

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Clinical Examination

• Physical Exam
• Gait cycle
• Examination
• biomechanical

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Clinical Evaluation
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28-71
A
B
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28-68A
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Clinical Diagnosis

• Introduction
• foot biomechanics
• clinical examination
• approach to diagnosis
• specific situations

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28-67
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Clinical Diagnosis

• Physical Exam
• examination
• biomechanical
• neurologic
• vascular

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Clinical Diagnosis

• Physical Exam
• examination
• biomechanical
• neurologic
• vascular

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Heel Pain Differential diagnosis
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Achilles Tendinopathy
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Imaging
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Retrocalcaneal Bursitis

• Diagnosis
• History and physical examination
• Lateral standing X-ray
• Loss of lucent retrocalcaneal recess (Pavlov)
• osseous erosions around bursa (sero negative)
• MRI
• only if diagnosis difficult / in doubt

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Simple pump bumpskaters heel
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Haglunds Syndrome ( insertional tendinopathy )
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Orthotic Rx

• 1. Retrocalcaneal bursitis / haglunds syndrome

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Anatomy
SPR
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Acute PT Dislocation
From Ian Alexander
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Biomechanics
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Mechanism of Injury

• Both direct and indirect forces
• Axial load / abduction
• Crush injury
• Associated injuries
• Metatarsal fractures
• Diastasis may involve intercuneiform joints
• Navicular or cuboid fractures
• Compartment syndrome

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Making the Diagnosis

• Up to 20 of TMT injuries are missed initially.
• Physical Exam
• Tenderness along the medial TMT joints.
• Stress test by pronating and abducting forefoot.

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Posterior Tibial Tendon

• Anatomy and Physiology
• Biomechanical overload
• Watershed vascular zone
• Most overload problems associated with pes planus
  / accessory navicular
• Differential diagnosis in athletes
• Tenosynovitis
• Longitudinal tears
• Accessory navicular syndrome
• Posterior tibial tendon tear ( rare)

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Posterior Tibial Tendon

• Tenosynovitis( Stage 1)
• Associated with pes planus and mechanical
  overload
• Assess for training errors, and direct trauma to
  the medial aspect of the ankle
• Diagnosis by palpation , tendon function intact (
  heel rise test ),MRI
• Treatment with decreased load, arch support with
  medial forefoot posting orthotic , strengthening
  program

large accessory navicular pre op on xray , fixed
with ORIF ( AP and lat xray )
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Posterior Tibial Tendon

• Non operative treatment decrease load on the
  tendon

From Ian Alexander
large accessory navicular pre op on xray , fixed
with ORIF ( AP and lat xray )
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Chronic Instability and hindfoot varus

• Case 16 yo F chronic instability, lax,
  hindfoot varus

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Chronic Instability and hindfoot varus
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Instability and Hindfoot varus
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Syndesmosis Injuries

• Physical Exam
• Tenderness
• External rotation stress
• test
• Squeeze test
• Stability test

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Chronic Ankle Instability

• Stress Radiography
• Is it Useful?
• Talar tilt
• Anterior drawer

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• Anterior drawer test

Karlsson et al
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• Talar tilt