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.

Video of forefoot examination