REIDER PART 205

Chan er 7 Lower Leg, Foot, and Ankle 265

B C

Figurę 7-27. A, Ulcerations of the plantar aspcct of the foot. B, Plantar wart. C, Tinea pedis.

infection. In these cases, careful cvaluation is needed to difFerentiate infected ulcerations or decp abscesses from early neuropathic arthropathy. In the advanced stages of Charcot s arthropathy, the foot is deformed but has nor-mal skin color and minimal sweiling. At times, the result-ant deformity may include a bony prominence that leads to secondary uleeration of the overlying soft tissues. Rocker bottom deformity may sometimes be secn in a nondiabetic person in association with a congenital anomaly or malunited fracture.

Hindfoot. Assessment of standing foot and ankle align-ment continues from the posterior aspect. The standing patient is asked to face away from the examiner.

The alignment of the hindfoot with the lower leg is then evaluated. This alignment is assessed by estimating or measuring the angle formed by a linę bisecting the calf with another linę bisecting the heel (Fig. 7-32A). Normally, the midline of the heel is at 5° to 10° of valgus in relation to the midline of the calf. Excessive valgus may occur following calcaneus fracture, in the presence of advanced degenerative or rheumatoid arthritis or Charcots arthropathy, or in association with severe pes planus (Fig. 7-32B). A varus inclination of the heel can be seen following a malunited fracture of the calcaneus or ankle, or in the presence of neuropathic arthropathy or other neurologie disorders (Fig. 7-32C).

While conducting the posterior inspection, the examiner should look past the heel to the forefoot and