Case 13 Polio Foot


Case 13
Polio Foot
What Happened ?                                            When and How it Happened ?
Introduction ownself
Exposure – Upto Umbilicus 
Hand scrubbing
Look- Standing Patient

Comment on Footwears / Calipers –Below knee
Attitude of the limb
Alignment       -           Front        Both shoulders and Pelvis are leveled,
                                                     No wasting of Quadriceps muscles
                                                      Patella facing forward and at equal height
Leg –Genu vlagum  , foot and toes look normal with normal         
overlying skin or clawing of toes

Wasting of Muscles on anterolateral muscle compartment             (Anterior + Peronei group of muscles )
                                    Side           Elbows straight overlying greater trochanter
     Knee flexed or Straight , Foot Equinus deformity
      Foot Cavus deformity
                                    Back               
      Spinal curvature is maintained with no kyphoscoliosis
      Normal overlying skin on back with no dimpling , tuft of hair
      and swelling
      Calf symmetrical with normal overlying skin
      Heel has – Normal varus or Valgus or Excess Varus deformity

Gait                                         Equinus  /Normal / trendelenburg
Squating                                  heel at the same level

Check Lumbar region before lying down the patients
Lie down Patient
After lying down check plantar surface of the feet.
Feel
                                                Temperature
                                                Superficial Palpation – leg , ankle , hindfoot, forefoot
Deep Palpation – tibia, Medial Malleolus , Calcaneum,First Metatarsal , Phalanges , other Metatarsals , Navicle , Lateral Malleolus, Fibula
Movement                               Plantarflexion / Dorsiflexion – cup the heel during measurement
                                                Inversion / Eversion- lock talus
LLD
Measure Foot Size –
Medial Side       Medial Malleolus to Heel Tip
Medial Malleolus to Ist MT Head
Lateral Side      Lateral Malleolus – Heel Tip
                        Lateral Mallolus to 5th MT head
Ligamentous Stability – MCL
                                    LCL
                                   


Neurovascular Assessment

Sensory Examination               Dorsum , Ist Web Space , Plantar Surface of Feet  - intact in Polio
Motor Examination
Power of the Muscles –                       TA / EHL /EDC ;
TP/ Gastrosoleus / FHL;
Peronei
Also check power of Hamstrings ,
Reflexes
Special Tests –
                        Trendelenburg
                        Ober’s Test
                       

Vascular Examination – DPA / PTA

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