The Foot!

OBJECTIVE ASSESSMENT
OBSERVATION:
Walking/Standing/Lying
Swelling/Redness (Rubor)/Ecchymosis/Deformity
Posterior/Anterior/Lateral/Medial
Medial, Lateral and transverse arches

TOUCH
Temperature/texture

PALPATION:
 Medial tubercle of calcaneus
 Sustentaculum tali
 Tuberosity of navicular
 Base of 5th metatarsal
 Fibularis (Peroneus) tendon
 Shafts of metatarsals
 Heads of metatarsals
 Sesamoid bones

MOVEMENTS:
Active Physiological –
 Plantarflexion/Dorsiflexion (covered under ankle assessment)
 Inversion/Eversion - sub-talar with foot in neutral position
(covered under ankle assessment)
 Inversion/Eversion - mid-tarsal joint with foot in plantarflexion
(covered under ankle assessment)
 NB: Supination = Inversion, plantarflexion & adduction
 NB: Pronation = Eversion, dorsiflexion & abduction
  Flexion/Extension of the hallux
 Flexion/Extension of the digits

What is the purpose of the test?

What are we looking for?
How would you tell if normal/abnormal findings?

Passive Physiological –
 Plantarflexion/Dorsiflexion (covered under ankle assessment)
 Inversion/Eversion - sub-talar with foot in neutral position
(covered under ankle assessment)
 Inversion/Eversion - mid-tarsal joint with foot in plantarflexion
(covered under ankle assessment)
 NB: Supination = Inversion, plantarflexion & adduction
 NB: Pronation = Eversion, dorsiflexion & abduction
 Flexion/Extension of the hallux
 Flexion/Extension of the digits

What is the purpose of the test?

What are we looking for?
How would you tell if normal/abnormal findings?

PASSIVE ACCESSORY MOVEMENTS:

Mid Tarsal – A/P

MTPJ – A/P, P/A, Longitudinal Caudad and Cephalad, Rotation
IP – A/P, P/A, Longitudinal Caudad and Cephalad, Rotation

What is the purpose of the test?

What are we looking for?
How would you tell if normal/abnormal findings?

RESISTED (MANUAL MUSCLE TESTING):

 Dorsiflexion (ankle assessment)
 Plantarflexion (ankle assessment)
 Inversion (ankle assessment)
 Eversion (ankle assessment)
 Digits (toes) Flexion (as a group)
 Digits (toes) Extension (as a group)
 Hallux (Big Toe) Extension
What is the purpose of the test?
What are we looking for?
How would you tell if normal/abnormal findings?
How would I modify the test for specific muscles?

MUSCLES:
Anterior Compartment
- Tibialis Anterior
- Extensor Hallucis Longus
- Extensor Digitorum Longus

Lateral Compartment
- Peroneus longus & brevis ~ as a group.

Posterior Compartment: Deep

- Tibialis Posterior
- Flexor Hallucis Longus
- Flexor Digitorum Longus

Posterior Compartment: Superficial

- (Soleus)
- (Gastrocnemius)

Foot
-Abductor Hallucis
-Adductor Hallucis
-Flexor Hallucis Brevis
-Lumbricals
-Plantar Interossei
-Dorsal Interossei

JOINTS ABOVE AND BELOW

Active movements only – ankle (talocrural) and inferior tibiofibular joints

SPECIAL TESTS
 Tinel’s Test – posterior tibial nerve – DF, EV and Toe Ext
 Knee to Wall Test
  Static & dynamic proprioception - SLB (eyes open and closed) and
Star Excursion
 Toe weight bearing (Sesamoid injury and Lisfranc’s)
 Piano key test

NEUROLOGICAL AND VASCULAR ASSESSMENT

 Pulses – posterior tibial and dorsalis pedis