EXAMINATION OF HALLUX VALGUS
Posted by nazishg on May 15, 2009
CLINICAL EXAMINATION OF HALLUX VALGUS:
FOR DIAGRAM CHECK NORMAN BROWSE FIGURE 6.6 PAGE 167
THIS IS AGAIN A VERY IMPORTANT AND COMMON CASE IN THE ORTHOPAEDICS BAY OF MRCS CLINICAL EXAM. LOOK CAREFULLY ESPECIALLY FOR SCARS. AND TREATMENT IS VERY IMPORTANT IN THIS.
TO PATIENT:
HELLO MR. PETER. MY NAME IS DR NAZISH. HOW ARE YOU FEELING TODAY.REPLY ACCORDINGLY?
MAY I EXAMINE YOUR FEET PLEASE?
THANK YOU. LET ME JUST DRAW THE CURTAINS TO ENSURE PRIVACY. I HAVE ALREADY WASHED MY HANDS.
COULD YOU PLEASE ROLL UP YOUR TROUSERS TO EXPOSE BOTH ANKLES AND FEET? AND NOW PLEASE SIT DOWN FACING ME.
ARE YOU COMFORTABLE SIR?
DO YOU MIND IF I TALK ABOUT YOU TO THE EXAMINERS.
I AM JUST GOING TO HAVE A LOOK FIRST OF ALL.
ACT:
KNEEL DOWN AND BE AT LEVEL OF PATIENT AND OBSERVE.
TO EXAMINER:
THERE IS ON INSPECTION IN THIS GENTLEMAN MARKED/ MODERATE/SLIGHT LATERAL DEVIATION AND MEDIAL ROTATION OF HALLUX BILATERALLY/ ON RT OR LF SIDE WITH PROMINENCE OF MEDIAL SIDE OF HEAD OF FIRST METATARSAL BONE WORSE ON THE RIGHT SIDE.
TYPICAL ASSOCIATED FEATURES SEEN HERE INCLUDE WIDENING OF FOREFOOT, BUNION, CROWDING OF TOES AND OVERLAPPING OF 2ND TOE.
THE THIRD TOE IS HAMMER TOE WITH FIXED FLEXION OF PIPJ AND WITH MIDDLE PHALANX POINTING DOWNWARDS. THE SKIN OVERLYING THE MEDIAL SIDE OF HEAD OF FIRST METATARSAL BONE IS/ IS NOT RED AND THERE IS/ IS NO EVIDENCE OF CORNS AND CALLOSITIES OVER THE SKIN OF THE FLEXED PIPJ. THE REST OF THE FOOT APPEARS TO BE NORMAL AND THERE IS/ IS NO EVIDENCE OF ANY SCAR.
AND NOW I WOULD LIKE TO LOOK AT THE OTHER FOOT.
TO PATIENT:
NOW SIR PLEASE RAISE YOUR FOOT SO THAT I CAN SEE THE UNDERSIDE OF IT.
TO EXAMINER:
THE SKIN ON SOLE OF FOOT UNDER METATARSAL HEADS SHOWS/ SHOWS NO EVIDENCE OF CALLOSITIES.
AND NOW THE OTHER FOOT.
TO PATIENT:
I AM JUST GOING TO FEEL YOUR FOOT. DOES IT HURT AT ALL? I WILL BE VERY GENTLE.
ACT: CHECK TEMPERATURE WITH BACK OF YOUR HAND OVER BUNION AND COMPARE WITH SURROUNDING SKIN.
TO EXAMINER:
THE OVERLYING SKIN IS NOT WARM.
ACT:
NOW PLACE ONE HAND ON DORSUM OF FOOT AND COMPRESS MTPJ. LOOK AT PATIENTS FACE AND ALSO ASK IF IT IS TENDER.
NOTE:
IF YOU CANNOT UNDERSTAND HOW TO DO THIS CHECK BARBARA BATES CLINICAL EXAMINTION CD.
TO PATIENT:
IS IT TENDER SIR?
AND NOW THE OTHER FOOT.
TO EXAMINER:
TENDERNESS OVER MTPJ IS NOT PRESENT.
TO PATIENT:
I WILL NOW CHECK FOR MOVEMEMNTS. LET ME JUST STABILIZE THE ANKLE WITH ONE HAND AND SUPPORT YOUR HEEL WITH MY OTHER HAND. NOW PLEASE TURN YOUR HEEL INWARDS AND OUTWARDS.
NOTE:
IF YOU DON’T KNOW HOW TO DO IT. PLEASE CHECK OUT BARBARA BATES CLINICAL EXAMINATION CD WHICH IS EASILY AVAILABLE AT WINCO BOOK STALL OPPOSITE DOW MEDICAL COLLEGE IN KARACHI.
TO EXAMINER:
I AM TESTING FOR INVERSION AND EVERSION AT SUBTALAR JOINT.
AND NOW THE OTHER SIDE.
INVERSION AND EVERSION AT SUBTALAR JOINTS IS NORMAL.
TO PATIENT:
LET ME JUST HOLD/STABILIZE YOUR HEEL AND NOW PLEASE MOVE REST OF YOUR FOREFOOT INWARDS AND OUTWARDS. THANK YOU.
I AM ASSESSING INVERSION AND EVERSION OF FOREFOOT AND NOW THE OTHER FOOT.
TO EXAMINER:
INVERSION AND EVERSION AT FOREFOOT IS NORMAL.
TO PATIENT:
FINALLY PLEASE BEND YOUR TOES DOWNWARDS AND NOW UPWARDS.
I AM ASSESSING ANY HYPER MOBILITY.
AND NOW THE OTHER SIDE.
TO EXAMINER:
NO HYPERMOBILITY IS SEEN. HENCE INSTABILITY IS NOT PRESENT.
TO PATIENT:
THANK YOU SIR.
TO EXAMINER:
TO COMPLETE MY EAMINATION I WOULD LIKE TO EXAMINE SHOES OF PATIENT AS ANY ABNORMALITY OF WEIGHTBEARING WILL BE EVIDENT FROM THE TYPE OF SHOES THE PATIENT WEARS. I WOULD ALSO LIKE TO SEE THE PATIENT WALK AND ASK FEW QUESTIONS TO ASSESS THE EFFECT OF THIS CONDITION ON PATIENTS LIFE.
THIS PATIENT HAS MARKED HALLUX VALGUS WITH NO FUNCTIONAL IMPAIRMENT.
I WOULD LIKE TO WASH MY HANDS.
NOTE:
CLAW TOES: HYPER EXTENSION OF MTPJ AND FLEXION OF IPJ.
