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Forefoot Examination
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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.
