Download Location of pain

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
 Discuss basic management strategies for
dealing with these injuries
 Discuss anatomical or biomechanical
predisposing factors associated with these
common toe injuries
Location of Pain: Phalanges
 Injuries to suspect


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
Collateral sprain
Fx/Dislocation
Hammer toes
Claw toes
History
Location of pain
(phalanges)
Symptoms
Onset
Collateral sprain
Acute;
trauma
Fx/dislocation
Acute;
trauma
Pain in 1st MTP joint
compressive forces;
wearing shoes that are
too short; pressure of
bunion;
Hammer toes
Claw toes
MOI
Chronic;
gradual
onset;
Inspection/Observation
Signs
Location of pain
(phalanges)
Deformity?
Swelling?
Discoloration?
Collateral sprain
No
Possible
Possible
Fx/dislocation
Possible
Common
Common
Hammer toes
Yes
No
No
Claw toes
Yes
No
Typically not
Palpation
Location of pain
(phalanges)
Point
tenderness?
Deformity?
Swelling?
Crepitus?
Collateral sprain
Over involved
joint
No
Fx/dislocation
Over fx site
Possible
Common
Possible
Hammer toes
Over dorsal
aspect of
PIP
Hyperextension
of MTP and DIP;
flexion of PIP
No
No
Claw toes
Over dorsal
aspect of
PIP
Flexion of PIP
and DIP
No
No
Common
No
Physical Examination
Location of pain
ROM?
Stress Tests?
Special
Tests?
Neurological
?
Collateral sprain
Typically
normal
Valgus/Varus
stress tests
n/a
n/a
Fx/dislocation
May be
limited
n/a
Hammer toes
limited
n/a
n/a
n/a
Claw toes
limited
n/a
n/a
n/a
(phalanges)
Tap test
n/a
Management
 Collateral sprain



ICE
Buddy taping
Spring steel innersole
Management
 Fracture/dislocation




ICE
Buddy taping
Spring steel innersole
Referral for x-rays
Management
 Hammer toes



Passive stretching
Ensure that shoes fit properly
Use hammer toe splints
Range of Motion
 Toe flexion (75-85)



AROM
PROM
RROM
 Toe extension (35 to 45)



AROM
PROM
RROM
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
Management
 Location of pain

Phalanges





Collateral sprain
Fx
Dislocation
Hammer toes
Claw toes
}
buddy taping
spring steel innersole

Location of Pain:
st
1
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
History
Location of pain
(1st
MTP)
Symptoms
Onset
Pain over MCL or LCL
Acute;
trauma
Capsular (volar) sprain
Pain within MTP joint; pain
over volar aspect of MTP
Acute;
trauma
Strain/Tendinitis
Pain with muscle function;
pain with passive
stretching of involved
muscle/tendon
Acute/
Chronic
Collateral sprain
Pain over sesmoiditis
Sesmoiditis
Hallux valgus
Hallux rigidus
Pain at MTP joint
Pain at MTP joint
Acute/
chronic
Chronic
MOI
forceful contraction;
repetitive stress
Management
 Great toe (1st MTP) collateral sprain




Ice
Collateral tape job
Spring steel innersole
capsule (turf toe)
Management
 Great toe (1st MTP) volar/capsule sprain (turf
toe)




Ice
NSAIDs
Taping of MTP to
prevent hyperextension
Spring steel innersole
History
 Location of pain

Great toe (1st MTP)


hallux valgus – bunion
See textbook for signs,
symptoms, palpation,
stress/special tests,
and management
History
 Location of pain

Great toe (1st MTP)

hallux rigidus – rigid great toe with limited ROM
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
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
Stress/Special Tests
 Location of pain

Metatarsophalangeal joints (MTP)

2nd -5th MTPs
 sprain
 metatarsalgia
Tests?
Management
 Location of pain

Metatarsophalangeal joints (MTP)

2nd -5th MTPs
 sprain
 metatarsalgia
Treatment
•ice
•anti-inflammatories
•tear drop pad
•spring steel innersole
Questions?