Foot Pain Assessment in Physiotherapy
Foot pain is
a common issue that can significantly impact a person's daily activities and
quality of life. In physiotherapy, assessing foot pain involves understanding
the specific area of the foot affected, the hindfoot, midfoot, and forefoot.
Each region can have distinct causes and require different assessment
techniques.
Hindfoot Pain
The hindfoot
comprises of the calcaneus (heel bone) and the talus. Pain in this area can be due
to various conditions such as:
- Plantar Fasciitis
- Fat Pad Contusion
- Calcaneal Fractures
- Medial Calcaneal Nerve Entrapment
- Lateral Plantar Nerve Entrapment
- Regional Complex Pain Syndrome type 1 (after knee or ankle injury)
- Tarsal Tunnel Syndrome
- Talar Stress Fracture
- Retrocalcaneal Bursitis
Clinical Assessment of Hindfoot Pain
Patient History
- Symptoms: Patients often report heel pain, particularly in the morning or after prolonged periods of standing or walking.
- Onset and Duration: Determine if the pain started gradually or suddenly and its duration.
- Activity Level: Assess if activities like running or jumping exacerbate the pain.
Physical Examination
- Observation: Check for swelling, redness, or deformities around the heel and Achilles tendon.
- Palpation: Palpate the plantar fascia, Achilles tendon, and calcaneus to identify tender points.
- Range of Motion (ROM): Assess the ROM of the ankle joint, particularly dorsiflexion and plantarflexion.
- Strength Testing: Evaluate the strength of the calf muscles and the stability of the ankle.
Special Tests
- Windlass Test: Assess for plantar fasciitis by dorsiflexing the big toe and observing for pain.
- Thompson Test: Squeeze the calf to check for Achilles tendon rupture.
- Tinel’s Sign: Tap over the tibial nerve to check for tarsal tunnel syndrome.
Diagnostic Imaging
- X-rays: To identify bone spurs or fractures.
- MRI or Ultrasound: For soft tissue injuries like plantar fasciitis or Achilles tendinopathy.
- Functional Tests
- Single Leg Balance: Assess stability and proprioception.
- Functional Movements: Heel raises and other activities to evaluate pain during functional tasks.
Midfoot Pain
The midfoot
consists of the navicular, cuboid, and cuneiform bones. Pain in this area can
result from conditions such as:
- Navicular Stress Fracture
- Midtarsal Joint Sprain
- Extensor Tendinopathy
- Cuneiform Stress Fracture
- Cuboid Stress Fracture
- Lisfranc Joint Injury (fracture or dislocation)
- Tibialis Posterior Tendinopathy
- Plantar Fascia Strain
- Peroneal Tendinopathy
- Abductor Hallucis Strain
- Cuboid Syndrome
- Tarsal Coalition (in adolescents)
- Kohler's Disease (in young children)
- Accessory Navicular Bone
Clinical Assessment of Midfoot Pain
Patient History
- Symptoms: Patients may report pain in the middle of the foot, particularly when walking or running.
- Onset and Duration: Determine if the pain is acute (e.g., from trauma) or chronic.
- Activity Level: Assess if specific movements or activities trigger the pain.
Physical Examination
- Observation: Look for swelling, bruising, or deformities in the midfoot region.
- Palpation: Palpate the navicular, cuboid, and cuneiform bones to identify tender areas.
- Range of Motion (ROM): Assess the ROM of the midfoot joints.
- Strength Testing: Evaluate the strength of the intrinsic foot muscles and the stability of the midfoot.
Special Tests
- Midfoot Squeeze Test: Compress the midfoot to check for pain, indicating potential arthritis or Lisfranc injury.
- Navicular Drop Test: Assess for overpronation and its impact on midfoot pain.
Diagnostic Imaging
- X-rays: To identify fractures or joint abnormalities.
- MRI or CT Scan: For detailed imaging of soft tissue and bone injuries.
Functional Tests
- Single Leg Balance: Assess midfoot stability and proprioception.
- Functional Movements: Walking on toes and heels to evaluate pain during dynamic tasks.
Forefoot Pain
The forefoot
includes the metatarsal bones and phalanges. Pain can result from various conditions listed below:
- Corns, Calluses
- Onychocryptosis
- Freiberg's Osteochondritis
- Joplin's Neuritis
- Complex Regional Pain Syndrome Type 1 (after ankle or knee injury)
- Synovitis of the MTP Joints
- First MTP joint sprain
- Subungual Hematoma
- Hallux Abducto-Valgus
- Hallux Limitus
- Morton's Neuroma
- Sesamoid Pathology
- Fracture of the Fifth Metatarsal
- Stress Fracture of the Sesamoid
- Toe Clawing
- Plantar Wart
- Subungual Exostosis
- Stress Fracture of the Base of the Second Metatarsal
- Synovitis of the Metatarsal-Cuneiform Joint
Clinical Assessment of Forefoot Pain
Patient History
- Symptoms: Patients often report pain in the ball of the foot or between the toes.
- Onset and Duration: Determine if the pain started suddenly or has been a gradual onset.
- Activity Level: Assess if activities like running or wearing high heels exacerbate the pain.
Physical Examination
- Observation: Check for swelling, redness, or deformities like bunions or hammertoes.
- Palpation: Palpate the metatarsal heads and spaces between them to identify tender areas.
- Range of Motion (ROM): Assess the ROM of the toes and metatarsophalangeal joints.
- Strength Testing: Evaluate the strength of the toe flexors and extensors.
Special Tests
- Mulder’s Sign: Compress the foot and palpate between the metatarsal heads to check for Morton’s neuroma.
- Tinel’s Sign: Tap over the dorsal aspect of the foot to identify nerve irritation.
- Metatarsal Squeeze Test: Compress the forefoot to check for pain, indicating potential metatarsalgia.
Diagnostic Imaging
- X-rays: To identify fractures, deformities, or joint abnormalities.
- MRI or Ultrasound: For soft tissue injuries like Morton’s neuroma or tendinopathies.
Functional Tests
- Single Leg Balance: Assess forefoot stability and proprioception.
- Functional Movements: Toe raises and walking on the balls of the feet to evaluate pain during dynamic tasks.
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