Part II The Foot/ Foot Assessment
Foot Assessment- HOPS
History
 Generic history questions
o Is this the first time?
o Mechanism of Injury (______________)
o Sudden or slow onset
o What type of pain (sharp, tingling, burning, etc)
 Questions specific to the foot
o ________________________ of pain - heel, foot, toes, arches?
o Training surfaces or changes in footwear?
o Changes in training, volume or type?
o Does ___________________________ increase discomfort?
Observations- ALWAYS do Bilateral Comparison
 Does patient favor a foot, limp, or is unable to bear weight?
 Swelling
 Does foot color change w/ weight bearing?
 Is there pes planus (_________________ )/cavus (_____________________)?
 How is foot alignment?
 Are there structural deformities?
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Structural Deformity
o Subtalar Neutral
 Draw line bisecting leg from start of Achilles tendon to distal end of
calcaneus
 Palpate the talus, inverting and everting foot so talus produces even
pressure under index finger and thumb
 Results in subtalar neutral
Shoe Wear Patterns
o _________________________ tend to wear out shoe under
_________________________________________
 Individuals often mistakenly perceive wear on the outside edge of the heel
as being the result of over-pronation
o Wear on the lateral border of the shoe is a sign of excessive supination
 Heel counter and forefoot should also be examined
Questions
What are some specific history questions for the foot?
______________________________________________________________________________
______________________________________________________________________________
Describe the 3 observational tests
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Describe the wear pattern on for shoes for pronation, supination and neutral
______________________________________________________________________________
______________________________________________________________________________
Observation Lab
Palpation: Bony landmarks
Medial calcaneus
Calcaneal dome
Medial malleolus
Sustentaculum tali
Talar head
Navicular tubercle
First cuneiform
First metatarsal and
metatarsophalangeal joint
First phalanxlandmarks
Lateral calcaneus
Lateral malleolus
Sinus tarsi
Peroneal tubercle
Cuboid bone
Pulses
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Styloid process
Fifth metatarsal
Fifth metatarsophalangeal
joint
Fifth phalanxand softissue
Second, third and fourth
metatarsals,
metarsophalangeal joints,
phalanges
Third and fourth cuneiform
Metatarsal heads
Medial calcaneal tubercle
Sesamoid bonesand sssue
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus
Calcaneonavicular
ligament
Medial longitudinal arch
Plantar fascia
Transverse arch
Peroneus tertius
Extensor hallucis longus
Extensor digitorum longus
tendon
Extensor digitorum brevis
tendon
Tibialis anterior tendon
Peroneus longus & Brevis
tendon
Must ensure proper circulation to foot
Can be assessed at posterior ___________________________________ pedis arteries
Dorsalis pedis pulse felt between extensor digitorum and hallucis longus tendons
Posterior tibial located behind medial malleolus along Achilles tendon
Palpation Lab
Special Tests Movement
o Extrinsic and intrinsic foot muscles should be assessed for pain, AROM, PROM,
RROM
Manual Muslce Testing (MMT)
 Extensor Digitorum Longus & Brevis
o Patient is __________________________ on the examining table with the lower
leg supported position
o Examiner places toes 2-5 are in ____________________________
o Foot is stabilized in slight _________________________________
o Resistance is supplied for ___________________ seconds
 Extensor Hallucis Longus
o Athletic trainer passively places the great toe in ___________________________
o The foot is stabilized __________________________ to the MP joint in slight
plantar flexion
o Resistance is applied to the _______________________ surface
 Flexor Digitorum Longus
o Examiner passively places toes 2-5 in ________________________
o Foot is stabilized by the metatarsals with the foot in a ______________________
position
o Resistance is supplied to the __________________________ side
 Flexor Hallucis Longus
o Examiner passively places the great toe in _________________________
o Foot stabilized proximal to the MP joint in a _____________________________
position is maintained
o Resistance is supplied to the ______________________ surface
Tinel’s Sign
 Tapping over posterior ___________________ nerve producing tingling distal to area
 Numbness & paresthesia may indicate presence of tarsal tunnel syndrome
Morton’s Test
 Foot in supine position
 Transverse pressure (squeeze) applied to ______________________________________
causing pain in forefoot
 Positive sign may indicate neuroma (bulging of a nerve) or metatarsalgia (pain in ball of
foot)
Neurological Assessment
 Reflexes and cutaneous distribution of nerves must be tested
 Skin sensation and alteration should be noted
 __________________________ reflexes (such as Achilles) should elicit a response when
gently tapped
 Sensation can be tested by running hands over all surfaces of foot and ankle