Department of Podiatry

Biomechanical Examination Form

Outline

clinic scheme

patient questioning / history

describing pain

assessment

measurement issues

Year 3 clinic scheme

four clinics:

surgery

new patients / biomechanics / primary care

vascular/ neurological

paediatrics

all new patients undergo a general initial assessment

if biomechanical case, then refer to biomechanical assessment

if appropriate, orthoses are prescribed and issued

not all NPs are orthoses patients!

Patient questioning

presenting complaint

pt. c/o: arch pain, B/F

pt. expresses concern re: 'flat feet'

referred by chiropractor to assess foot mechanics

relevant medical history

previous Tx, surgery, systemic disorders

site of pain / lesions

shade in painful areas, indicating referral patterns

HK, HDs, exostoses, etc.

try to elicit pain

palpation, Mulder's click, Tinel's sign, against muscular resistance

think anatomically

think of differential diagnoses

Pain

when does it occur?

eg: heel pain first thing in the morning > enthesopathy

what makes it better / worse?

eg: massaging forefoot often relieves pain associated with Morton's neuroma

description

neurological symptoms include: tingling, shooting, pins and needles

vascular: burning, throbbing

dull ache: chronic inflammation / overuse

visual analog pain scale

most widely used pain scale

useful to assess effectiveness of Tx over time

no pain to worst pain ever

Biomechanical assessment

supine, prone, WB, dynamic, muscle testing

if normal: NAD (no abnormality detected) or WNL (within normal limits)

Specific protocol to remember:

hip rotation: McCrea technique

genicular position: paediatric cases only

LLD: test for structural and functional

tibial position: test with STJN

manual muscle testing: Kendall grading system

Factors influencing prognosis

prognosis is a judgement of the expected outcome of the treatment

with mechanical foot pathology, prognosis is affected by:

severity of complaint

chronicity

patient compliance

weight

patient's level of activity

planal dominance

osseus restraining mechanism

footwear

available range of motion

 

Clinical measurement

based on morphological paradigm

structure > function

reliability

consistency of a measurement, or repeatability over time or between different examiners

validity

evidence that a technique measures what it is supposed to measure

Problems with podiatric measurements

unreliability

validity of rearfoot measurements and subtalar joint neutral

poor predictors of dynamic function

Clinical measurement

Studies:

up to +/- 8 degrees of error in the measurement of NCSP and RCSP

(Menz, 1993)

reliability improves slightly with the use of a device to mark calcaneal bisections

(Sfinas, 1994)

poor inter-tester reliability of observational rearfoot gait analysis from video

(Keenan, 1994)

up to +/- 10 degrees of error in the measurement of malleolar torsion

(Raspovic, 1992)

however,

reliability improves slightly with experience

Clinical measurement

research is currently being undertaken to assess alternative measurements of the rearfoot

navicular drop

composite measure of foot pronation

more reliable than calcaneal bisection marking

may indciate talo-navicular joint function (more valid ?)

good indicator of dynamic motion of the rearfoot

take-home message: don't base all management decisions on measurements alone

assess and treat one patient in two hours

provided with medical Hx, but not continuation sheets (second year exam)

patient questioning

treat patient

present patient in S.O.A.P format

'cheat sheets' acceptable, but no notes allowed

MIMs, Merck manual

padding and strapping manual, materia medica

Content Approved by: Head of Podiatry
Page maintained by: Podiatry Webmaster
Last Updated: August 20th, 2002