CLIENT ASSESSMENT FOOT BY JOAN WATT, MA MCSP MSMA

INTRODUCTION Foot assessment is often necessary because actions, movements and problems of the feet can cause symptoms in other regions of the body. The same fundamental assessment pattern is followed as discussed in previous articles (1-4), with a subjective examination focusing on the relevant history and an objective examination centred on the following: n Inspection of equipment n Observation n Measurement n Functional activities n Palpation n Specific tests.

INSPECTION OF EQUIPMENT It is often helpful to start the objective assessment of the foot by inspecting the patient’s footwear. Don’t forget to check shoes worn regularly as well as sports shoes. Differing wear patterns can indicate problems and reveal

biomechanical flaws. Gait analysis and correction to footwear, including providing orthotics, is the province of the specialist podiatrist. It is vital to refer the patient to a podiatrist if examination of footwear demonstrates any marked abnormal wear pattern. Remember that asymmetrical wearing of the shoes can be an indication of leg-length discrepancy.

OBSERVATION Have a good look at each foot at rest. Remember: claw toe, hammer toe, hallux valgus, hallux rigidus, athlete’s foot and ingrown toenail can all lead to alteration of movement and a change of gait pattern. All of these problems, as well as the symptoms reported by the patient, must be treated.

Check for the following: n The Achilles tendon from behind: medial curving of this tendon indicates overpronation (Figure 1). n Particular areas of blisters, corns or callus formation: these indicate areas of pressure and are possibly causes of problems or the result of another problem. Failure to address the causes of callus formation, blisters and corns can lead to recurrent symptoms. n Obvious deformity, swelling, contours and bruising.

MEASUREMENT Range of movement See Box 1. Size of feet Some people have as much as one full size difference

Figure 1: Medial curving of the Achilles tendon

ASSESSMENT OF THE FOOT

Joan Watt continues her series of regional assessments with an examination of the foot, highlighting observations and clinical and functional tests and linking the foot to biomechanical problems that may present elsewhere.

between their feet, and this can lead to problems with shoe fit.

FUNCTIONAL ACTIVITIES Ask the patient to walk forwards, backwards and sideways. Check foot placement and alignment for any anomalies. Ask the patient to stand on each foot in turn, to hop on the spot, and to alternately rise on the toes and heels in weight- bearing. All of these tests can help to identify the presence of overuse injury if there is asymmetry, localized pain, instability or functional problems. If applicable to the patient’s activities, ask the patient

to run, weave, jog, sprint, jump, run in a figure-of-eight, and perform stop-and-start movements. Note any areas of hesitation, pain, discomfort or protection of one side. Ask about the types of surface on which the patient

normally walks, trains and competes. Hard, resistant surfaces can produce different problems from springy, mushy surfaces. Camber bias can produce one-sided symptoms.

PALPATION As well as checking areas by palpation and doing specific tests, it is worthwhile checking foot pulses and temperature. These may be indicators of circulatory problems, which can contribute to symptoms and may require referral to the appropriate specialist.

SPECIFIC TESTS

If assessment of other areas has led to the need for a foot assessment, keep previous results to hand and refer to them as required. As with all areas, there are numerous tests that can be used to assess the feet. The following are a few of the most helpful and commonly required tests.

BOX 1: FOOT JOINT RANGE-OF-MOTION VALUES Talotibial joint

Plantar flexion: 40o

Subtalar joint Metatarso-

phalangeal joint Interphalangeal

joint www.sportEX.net 9

Inversion: 30o Flexion: 75o

Flexion: 60o Eversion: 15o Extension: 35o Extension: 20o Dorsiflexion: 20o

STRICTLY AC- TIVE