REIDER PART 2
09

Chapter 7 Lowcr Leg, Foot, and Ankle 269

Figurę 7-33. Too-many-toes sign in right foot. A, Left foot B, Right foot.

Figurę 7-34. A and B, Windlass effect.

B

foot on the ground, the patient lifts the ipsilateral knee higher than normal during swing phase. At heel strike, the involved foot often slaps against the ground owing to lack of proper control of the dorsiflexor muscles.

Stiff First Metatarsophalangeal Joint. A patient with a painful or stiff first metatarsophalangeal joint often compensates by supinating the entire foot and walking prcdominantly on its lateral border during stance pha.se (Fig. 7-35A). Such a situation would arise from osteoarthritis of the first metatarsophalangeal joint with secondary hallwc rigidus, for example. This adaptation can be subtle and difficult to detect simply by observing the patients gait. Supplementary examination of the patients shoes may reveal evidence that reflects this gait adaptation. The dorsum of the shoe is asymmetrically creased compared with the other shoe, and inspcction of the heel reveals increased wear on the lateral side. Equinus Contracture. Patients who havc an equinus contracture, with loss of normal ankle dorsiflexion, may exhibit a number of gait abnormalities. They may lift the affected limb higher during swing phase, as in the step-page gait, to facilitate ground clearance, or they may externally rotate the involved limb to decrease the amount of dorsiflexion necessary during stance phase (see Fig. 7-35B). The lack of dorsiflexion may force the ipsilateral knee into hyperextension during midstance, and heel rise on the affected side occurs earlier.

Rangę of Motion

The foot and ankle are a complex mechanism containing many individual joints. For a complete assessment,