General Examination of the Foot (Chapter 7)
Abstract
A comprehensive clinical framework for diagnosing foot pathologies, emphasizing a Look, Feel, Move algorithm. The chapter standardizes provocation tests to differentiate between flexible and rigid deformities without immediate reliance on advanced imaging.
The Systematic Look, Feel, Move Protocol
Key Finding
"The Peekaboo sign (medial heel visibility) and Coleman Block Test are critical clinical differentiators for diagnosing cavovarus versus planovalgus deformities and assessing hindfoot flexibility."
Background: Physical examination is often overshadowed by MRI, leading to missed dynamic pathologies. A systematic approach is required to correlate structural deformities (e.g., bunions, pes planus) with functional gait mechanics and neurovascular status.
Methods: The authors outline a sequential examination protocol: Inspection (gait analysis, footwear wear patterns), Palpation (bony landmarks, pulses), and Special Tests (Silfverskiold, Heel Raise, Coleman Block). The protocol integrates neurovascular assessment to rule out tarsal tunnel syndrome and peripheral neuropathy.
Results: The Too Many Toes sign is established as a reliable indicator of posterior tibial tendon dysfunction/planovalgus. A positive Silfverskiold test (improved dorsiflexion with knee flexion) clinically isolates gastrocnemius tightness. The Coleman Block test effectively distinguishes flexible forefoot-driven varus from fixed hindfoot deformities, guiding the choice between osteotomy and fusion.
Conclusion: Mastering the physical exam—specifically dynamic tests like the single-heel raise and block testing—eliminates diagnostic ambiguity. Clinicians must perform these maneuvers to determine deformity reducibility before ordering static imaging.