You will be asked to examine the foot
- Description of inspection
- From front "Patient has pes planus with supinated and abducted forefoot"
- Associated mild hallux valgus?
- From side "presence of skin creases on lateral aspect suggesting chronic subfibular impingement"
- From back "Hindfoot valgus, too many toes sign". Presence of forefoot abduction/ too many toe signs (usually only see little toe. Too many toes = see all 4 toes. = at least stage 2
- Medially "suggestion of edema along Post tib tendon"
- Describe Gait = Flat on ground contact with loss of 3rd rocker lack of push off, consistent with loss of PTT function
- 2 Tests for flat feet
- 1. Tip toe test
- Go to wall, tip toe both legs. if correctible then go to do single leg. if not correctible, dont bother [correctible means = stage 1/2; uncorrectible = stage 3 rigid]
- assess if correctible hindfoot
- 2. Jack's test = Dorsiflex big toe should cause medial arch to elevate due to windlass effect if subtalar joint is flexible
- If correctible = not rigid = stage 1/2
- Determine stage 1/2 by check if can do single leg tip toe. If cannot do single leg = stage 2
- Sit patient down
- Look around the room for orthosis, prosthesis, walking aid, shoe ➔ PICK up the shoe and look at the insole and any wedges
- Look at foot plantar aspect
- Palpate tendons and structures
- Posterior tibialis tendon to navicular
- Peroneal tendons to 5MT
- Pes cavus feel - Lateral arch pain
- pes plan us - feel Medial arch pain
- Hallux valgus - feel toe
- Hallux rigidus - feel toe
- Assess ROM
- Ankle ROM + Silverskoid test
- Subtalar joint
- Chopart joint
- Midfoot/ lisfranc joint -
- Big toe - 1st TMTJ, 1st MTPJ, 1st IPJ
- Palpate Other things
- Lesser toe deformities - check flexibility by pushing the forefoot in plantar and dorsiflexion to see if toes move by tenodesis effect
- Palpate and Check tendon function and for transfers
- Pes Planus - PT weak, AT and FDL for transfers
- Check Sensation
- Check DPN, saphenous nerves, sural, SPN, medial, lateral plantar nerves
- Beighton score
Principle of correctiblity
