Foot clinical guide

Clinical guide

To help the student understand how the assessments work, these diagnostic guides outline the path that the assessments take that lead to relevant treatment...

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Fracture

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? Yes = Fracture

Fracture treatment

Fracture ankle/tarsal

1: Has the patient suffered an injury? Yes = go 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? Yes = go to 4

4: Ottawa rules positive and unable to walk 4 steps. Yes = Fracture ankle/tarsal

Fracture ankle/tarsal treatment

Intracapsular injuryn

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? Yes = go to 4

4: Ottawa rules positive and unable to walk 4 steps. No = go to 5

5: Is there swelling both sides of the achillies that fills the dip between malleolus and achilles? Yes = Intracapsular injury

Intracapsular injury treatment

Ankle ligament sprain

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? Yes = go to 4

4: Ottawa rules positive and unable to walk 4 steps. No = go to 5

5: Is there swelling both sides of the achilles that fills the dip between malleolus and achilles? No = go to 6

6: Pain with or without laxity on testing medial and lateral ligaments of the ankles? Yes = Ankle ligament sprain

Ankle ligament sprain treatment

Bruised heel

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? No = go to 7

7: Is the pain in the heel area? Yes = go to 8

8: Did the injury involve a fall heavily onto the heel? Yes = Bruised heel

Bruised heel treatment

Calcaneal fracture

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? No = go to 7

7: Is the pain in the heel area? Yes = go to 8

8: Did the injury involve a fall heavily onto the heel? Yes = go to 9

9: Can they bear weight on the heel with a flat foot? No = Calcaneal fracture

Calcaneal fracture treatment

Ruptured achilles

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? No = go to 7

7: Is the pain in the heel area? No = go to 10

10: Is there pain in the calf or achilles - this includes a short duration pain at the time of injury? Yes = go to 11

11: Squeeze calf, does foot move up and down? No = Ruptured achilles

Ruptured achilles treatment

Mild Calf strain

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? No = go to 7

7: Is the pain in the heel area? No = go to 10

10: Is there pain in the calf or achilles - this includes a short duration pain at the time of injury? Yes = go to 11

11: Squeeze calf, does foot move up and down? Yes = go to 12

12: Can they walk with the heel down? Yes = Mild Calf strain

Mild Calf strain treatment

Calf tear

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? No = go to 7

7: Is the pain in the heel area? No = go to 10

10: Is there pain in the calf or achilles - this includes a short duration pain at the time of injury? Yes = go to 11

11: Squeeze calf, does foot move up and down? Yes = go to 12

12: Can they walk with the heel down? No = go to 13

13: Is there a gap palpable in the calf muscle? Yes = Calf tear

Calf tear treatment

Moderate calf strain

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? No = go to 7

7: Is the pain in the heel area? No = go to 10

10: Is there pain in the calf or achilles - this includes a short duration pain at the time of injury? Yes = go to 11

11: Squeeze calf, does foot move up and down? Yes = go to 12

12: Can they walk with the heel down? No = go to 13

13: Is there a gap palpable in the calf muscle? Yes = Moderate calf strain

Moderate calf strain treatment

Fracture foot bones

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? No = go to 7

7: Is the pain in the heel area? No = go to 10

10: Is there pain in the calf or achilles - this includes a short duration pain at the time of injury? No = go to 14

14: Foot pain? Yes = go to 15

15: Can they take weight through the foot, ie stand evenly? No = Fracture foot bones

Fracture foot bones treatment

Fracture

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? No = go to 7

7: Is the pain in the heel area? No = go to 10

10: Is there pain in the calf or achilles - this includes a short duration pain at the time of injury? No = go to 14

14: Foot pain? Yes = go to 15

15: Can they take weight through the foot, ie stand evenly? Yes = go to 16

16: is there pain when applying local pressure to the bone? Yes = Fracture

Fracture treatment

Ligament/joint injury

1: Has the patient suffered an injury? Yes = go to 2

2: Looking from the front, is there a new deformity of the lower leg, ankle or foot? No = go to 3

3: Is the pain around the ankle area? No = go to 7

7: Is the pain in the heel area? No = go to 10

10: Is there pain in the calf or achilles - this includes a short duration pain at the time of injury? No = go to 14

14: Foot pain? Yes = go to 15

15: Can they take weight through the foot, ie stand evenly? Yes = go to 16

16: is there pain when applying local pressure to the bone? Yes = Ligament/joint injury

Ligament/joint injury treatment

Infection

1: Has the patient suffered an injury? No = go to 17

17: No Injury? Hot? Yes = go to 18

18: Is there any cut or break in the skin of that leg? Yes = Infection

Infection treatment

Gout/inflammatory conditions

1: Has the patient suffered an injury? No = go to 17

17: No Injury? Hot? Yes = go to 18

18: Is there any cut or break in the skin of that leg? No = go to 19

19: Is pain confined to one joint and swelling? (at ankle, toe or foot) Yes = Gout/inflammatory conditions

Gout/inflammatory conditions treatment

Cellulitis

1: Has the patient suffered an injury? No = go to 17

17: No Injury? Hot? Yes = go to 18

18: Is there any cut or break in the skin of that leg? No = go to 19

19: Is pain confined to one joint and swelling? (at ankle, toe or foot) No = Cellulitis

Cellulitis treatment

Tendinopathy

1: Has the patient suffered an injury? No = go to 17

17: No Injury? Hot? No = go to 20

20: Is it possible to palpate the area of pain on sides of foot and pain on resistance? Yes = Tendinopathy

Tendinopathy treatment

Achilles tendinosis

1: Has the patient suffered an injury? No = go to 17

17: No Injury? Hot? No = go to 20

20: Is it possible to palpate the area of pain on sides of foot and pain on resistance? Yes = go to 21

21: Pain in Achilles area on palpation tendon, possible thickening? Yes = Achilles tendinosis

Achilles tendinosis treatment

DVT suspected

1: Has the patient suffered an injury? No = go to 17

17: No Injury? Hot? No = go to 20

20: Is it possible to palpate the area of pain on sides of foot and pain on resistance? No = go to 21

21: Pain in Achilles area on palpation tendon, possible thickening? No = go to 22

22: Is the painful calf swollen? Yes = go to 23

23: Is there pain with passive dorsiflexion? ( Homans sign) Yes = DVT suspected

DVT suspected treatment

Stress fracture

1: Has the patient suffered an injury? No = go to 17

17: No Injury? Hot? No = go to 20

20: Is it possible to palpate the area of pain on sides of foot and pain on resistance? No = go to 21

21: Pain in Achilles area on palpation tendon, possible thickening? No = go to 22

22: Is the painful calf swollen? No = go to 24

24: Pain from mid foot to toes? Yes = go to 25

25: Does squeezing metatarsal heads reproduce the pain? Yes = go to 26

26: Tender reproducing pain felt 4th and 5th metatarsals compare to opposite side. Yes = Stress fracture

Stress fracture treatment

Morton's Neuroma

1: Has the patient suffered an injury? No = go to 17

17: No Injury? Hot? No = go to 20

20: Is it possible to palpate the area of pain on sides of foot and pain on resistance? No = go 21

21: Pain in Achilles area on palpation tendon, possible thickening? No = go to 22

22: Is the painful calf swollen? No = go to 24

24: Pain from mid foot to toes? Yes = go to 25

25: Does squeezing metatarsal heads reproduce the pain? Yes = go to 27

27: Pins and needles and altered sensation, third or fourth toes can be off and on related to walking. Yes = Mortons Neuroma

Mortons Neuroma treatment

Metatarsalgia

1: Has the patient suffered an injury? No = go to 17

17: No Injury? Hot? No = go to 20

20: Is it possible to palpate the area of pain on sides of foot and pain on resistance? No = go to 21

21: Pain in Achilles area on palpation tendon, possible thickening? No = go to 22

22: Is the painful calf swollen? No = go to 24

24: Pain from mid foot to toes? Yes = go to 25

25: Does squeezing metatarsal heads reproduce the pain? No = go to 28

28: Pain felt in metatarsal heads (balls of feet) on walking? Yes = Metatarsalgia

Metatarsalgia treatment

Fat pad irritation

1: Has the patient suffered an injury? No = go to 17

17: No Injury? Hot? No = go to 20

20: Is it possible to palpate the area of pain on sides of foot and pain on resistance? No = go to 21

21: Pain in Achilles area on palpation tendon, possible thickening? No = go to 22

22: Is the painful calf swollen? No = go to 24

24: Pain from mid foot to toes? No = go to 29

29: Heel pain under foot? Yes = go to 30

30: Worse in a.m. on first few steps, eases then increases again with increasing time on feet? Yes = Fat pad irritation

Fat pad irritation treatment

Plantar fasciitis

1: Has the patient suffered an injury? No = go to 17

17: No Injury? Hot? No = go to 20

20: Is it possible to palpate the area of pain on sides of foot and pain on resistance? No = go to 21

21: Pain in Achilles area on palpation tendon, possible thickening? No = go to 22

22: Is the painful calf swollen? No = go to 24

24: Pain from mid foot to toes? No = go to 29

29: Heel pain under foot? Yes = go to 30

30: Worse in a.m. on first few steps, eases then increases again with increasing time on feet? Yes = go to 31

31: Tender at Plantar Fascia attachment? Yes = Plantar fasciitis

Plantar fasciitis treatment

Anatomy (print-out version)

1. Bones: tibia, medial malleolus, talus, navicular, cuneiforms, sesamoids, fibula, lateral malleolus, calcaneous, cuboid, metatarsals, phalanges

2. Bones - phalanges, metatarsals, cuboid, cuneiforms, navicular, talus, calcaneous

3. Bones - calcaneous, fibula, talus, cuboid

4. Bones - calcaneous, sustentaculum tali of calcaneous, navicular bone

5. Muscles: gastrocnemius, soleus, plantaris

6. Muscles: flexor hallucis longus, fleor digitorum longus, tibialis posterior

7. Muscles: tibialis anterior, extensor hallucis longus, extensor digitorum longus

8. Muscles: peronius longus, peronius brevis, extensor digitorum brevis

9. Muscles: abductor digiti minimi, flexor digitorum brevis, abductor hallucis

10. Muscles (plantar) flexor hallucis brevis, lumbricales, quadratus plantae

11. Muscles: peroneus longus, tibialis anterior, peroneus brevis, extensor digitorum longus, plantaris, gastrocnemius, soleus, achilles tendon

12. Muscles tibialis anterior, extensor digitorum, peroneal longus, achilles, tibialis posterior, tibilais anterior, flexor hallucis longus, extensor digitorum longus

+1. Muscles: Gastrocnemius: plantar flexes foot and ankle joint and flexes leg at knee

+2. Muscles: Tibialis posterior: plantar flexes and inverts foot

+3. Muscles: Soleus: plantar flexes foot at ankle joint

+4. Muscles : Tibialis anterior: dorsiflexes (lifts up) foot and ankle joint and supinates (inverts) foot