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Chapter 4

Chapter 4. Clinical Assessment of Foot & Toe Injuries Part II. Student Learning Outcomes. Identify common toe injuries based on their presenting history, symptoms, visual signs (inspection), & palpation findings Identify special tests that might be used to evaluate these injuries

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Chapter 4

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  1. Chapter 4 Clinical Assessment of Foot & Toe Injuries Part II

  2. Student Learning Outcomes • Identify common toe injuries based on their presenting history, symptoms, visual signs (inspection), & palpation findings • Identify special tests that might be used to evaluate these injuries • Discuss basic management strategies for dealing with these injuries • Discuss anatomical or biomechanical predisposing factors associated with these common toe injuries

  3. Location of Pain: Phalanges • Injuries to suspect • Collateral sprain • Fx/Dislocation • Hammer toes • Claw toes

  4. History

  5. Inspection/Observation

  6. Palpation

  7. Physical Examination

  8. Management • Collateral sprain • ICE • Buddy taping • Spring steel innersole

  9. Management • Fracture/dislocation • ICE • Buddy taping • Spring steel innersole • Referral for x-rays

  10. Management • Hammer toes • Passive stretching • Ensure that shoes fit properly • Use hammer toe splints

  11. Range of Motion • Toe flexion (75-85) • AROM • PROM • RROM • Toe extension (35 to 45) • AROM • PROM • RROM

  12. Predisposing Factors • Location of pain • Phalanges • Collateral sprain • Fx – foot structure with decreased ability to dissipate forces (stress fx) • Dislocation • Hammer toes – shoes that are too short • Claw toes – associated with pes cavus foot

  13. Management • Location of pain • Phalanges • Collateral sprain • Fx • Dislocation • Hammer toes • Claw toes } • buddy taping • spring steel innersole }

  14. Location of Pain: 1st MTP • Injuries/conditions to consider • sprain • collateral • capsule (turf toe) • muscle/tendon strain – what muscles? • sesmoiditis • hallux valgus - bunion • hallux rigidus – rigid great toe with limited ROM

  15. History

  16. Management • Great toe (1st MTP) collateral sprain • Ice • Collateral tape job • Spring steel innersole • capsule (turf toe)

  17. Management • Great toe (1st MTP) volar/capsule sprain (turf toe) • Ice • NSAIDs • Taping of MTP to prevent hyperextension • Spring steel innersole

  18. History • Location of pain • Great toe (1st MTP) • hallux valgus – bunion • See textbook for signs, symptoms, palpation, stress/special tests, and management

  19. History • Location of pain • Great toe (1st MTP) • hallux rigidus – rigid great toe with limited ROM

  20. History • Location of pain • Metatarsophalangeal joints (MTP) • 2nd -5th MTPs • sprain • metatarsalgia • Symptoms • Increased callus formation (2nd head) • MOI • Repetitive stress • Trauma to metatarsal arch

  21. Inspection/Palpation • Location of pain • Metatarsophalangeal joints (MTP) • 2nd -5th MTPs • sprain • metatarsalgia • Signs • increased callus formation (2nd head) • flattening of metatarsal arch • Palpation • point tender over 2nd MTP • prominent 2nd MTP

  22. Stress/Special Tests • Location of pain • Metatarsophalangeal joints (MTP) • 2nd -5th MTPs • sprain • metatarsalgia Tests?

  23. Management • Location of pain • Metatarsophalangeal joints (MTP) • 2nd -5th MTPs • sprain • metatarsalgia • Treatment • ice • anti-inflammatories • tear drop pad • spring steel innersole

  24. Questions?

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