Forefoot Examination: Difference between revisions

Revision as of 07:39, 28 June 2021

Forefoot examination in isolation is a thorough assessment of the hallux and the lesser toes from the dorsum and plantar aspects as well as their tips

Gait

Observe particularly the last phase of stance of gait for forefoot problems
Limp
Calcaneal varus or valgus
Marked pronation or supination
Forefoot valgus (forefoot strikes on first MTP) or varus (first MTP often fails to make solid contact).

Shoes - wear pattern

Hindfoot - assess for relevant pathology as hindfoot problems can lead to gait abnormality and forefoot overload

Malalignment - looking from behind, should be mildly valgus
Restricted dorsiflexion
Unable to single heel raise - tibialis posterior insufficiency or hindfoot or subtalar motion stiffness.

General Inspection

Callosities - under metatarsal heads (metatarsal overload) or tips of digits or medial hallux or lateral fifth toe. These can be indicators of painful areas for footwear or during weightbearing activity
Malalignment - of digits and crowding or clawing of the lesser toes
Nail deformities and condition
Wasting, swelling, or tenderness of joints
Erythema, sensory abnormalities, ulcers

Passive Movement

Range of motion - hindfoot, ankle, midfoot, hallux, lesser toes
Deformities - are they correctable

Palpation

Peripheral pulses
Tenderness - of MTPJs or digits with palpation or pain with movement

Mulder's click

Firm palpation with knuckle applied to webspace between affected heads
The other hand applies compressive force across metatarsal heads
Looking for clicking and replication of pain in Morton's neuroma.

Video of forefoot examination

@@ Line 1: / Line 1: @@
 Forefoot examination in isolation is a thorough assessment of the hallux and the lesser toes from the dorsum and plantar aspects as well as their tips
-'''Gait''' - observe particularly the last phase of stance for forefoot problems
+'''Gait'''
+*Observe particularly the last phase of stance of [[Gait|gait]] for forefoot problems
+*Limp
+*Calcaneal varus or valgus
+*Marked pronation or supination
+*Forefoot valgus (forefoot strikes on first MTP) or varus (first MTP often fails to make solid contact).
-'''Hindfoot''' - assess for relevant pathology such as malalignment and restricted dorsiflexion which can lead to gait abnormality and forefoot overload
+'''Shoes''' - wear pattern
-'''Callosities''' - under metatarsal heads (metatarsal overload) or tips of digits or medial hallux or lateral fifth toe. These can be indicators of painful areas for footwear or during weightbearing activity
+'''Hindfoot''' - assess for relevant pathology as hindfoot problems can lead to gait abnormality and forefoot overload
+*Malalignment - looking from behind, should be mildly valgus
+*Restricted dorsiflexion
+*Unable to single heel raise - tibialis posterior insufficiency or hindfoot or subtalar motion stiffness.
-'''Malalignment''' - of digits and crowding or clawing of the lesser toes
+'''General Inspection'''
+*Callosities - under metatarsal heads (metatarsal overload) or tips of digits or medial hallux or lateral fifth toe. These can be indicators of painful areas for footwear or during weightbearing activity
+*Malalignment - of digits and crowding or clawing of the lesser toes
+*Nail deformities and condition
+*Wasting, swelling, or tenderness of joints
+*Erythema, sensory abnormalities, ulcers
-'''Tenderness''' - of MTPJs or digits with palpation or pain with movement
+'''Passive Movement'''
+*Range of motion - hindfoot, ankle, midfoot, hallux, lesser toes
+*Deformities - are they correctable
-'''Deformities''' - are they correctable
+'''Palpation'''
+*Peripheral pulses
+*Tenderness - of MTPJs or digits with palpation or pain with movement
+'''Mulder's click'''
+*Firm palpation with knuckle applied to webspace between affected heads
+*The other hand applies compressive force across metatarsal heads
+*Looking for clicking and replication of pain in Morton's neuroma.
+[https://vimeo.com/188756744 Video of forefoot examination]
-'''Mulder's click''' - Firm palpation with knuckle applied to webspace between affected heads, the other hand applies compressive force across metatarsal heads, looking for clicking and replication of pain in Morton's neuroma.
 [[Category:Examination]]