Goal Of Examination
1. Identify possible aetiology
- NM axis
- RA
- trauma
- clubfoot / arthrogryposis
2. Define the deformity & its flexibility
- fixed / flexible forefoot
- fixed / flexible hind foot
- fixed / flexible lesser toes
Look
Aids / shoes
Front
Stork Legs
Lesser toes clawing
Scars
Hands (dorsal wasting intrinsics (CMT 1), rheumatoid hands)
Medial Side
High Medial arch
Plantar flexed first ray
Claw first toe
Behind
Hindfoot varus
Calf muscle bulk
Back
- scoliosis
- cutaneous manifestations spinal dysraphism
Double heel raise
- Heel swings into varus or remains in valgus
- does the medial arch restore
- bilateral suggests neurological
Single heel raise
- Must put patient close to wall
- otherwise will cheat by pushing up or leaning forward against wall
Coleman Block Test
- block under lateral foot
- allow first ray to touch ground
- Assess hindfoot
- If hindfoot varus flexible, heel corrects
- Elimination of forefoot deformity will correct hindfoot deformity if hindfoot flexible
Lateral side
Exclude calcaneo-cavus
Gait
Stiff ankle
Marionette Gait / High stepping
- Fixed equinus (weak Tib ant)(back knee gait)
Tip toe & heel walk
Sit
Examine Sole
- callosities over metatarsal head
Feel
- tenderness
- thickening CPN
Move
- range AKJ
- range STJ
- Silverskiold
- active v passive
Motor examination
- T. Ach strong / plantarflexion
- T. Ant weak / dorsiflexion and inversion
- T. Post strong / plantarflexion and inversion
- PB weak / eversion
First MT
- is plantar flexion correctable
Claw toes
- correctible
Neurological Exam
Abdominal Reflexes
Decreased or absent DTR
- CMT 1
Sensory decrease in 25%