REIDER PART 217

Chapter 7__Lower Leg> Foot, and Ankle 277

Figurę 7-47. Passive motion of the mctatarsophalangeal joint of the lesser toes (fifth toe). A, Kxtension. B, Flexion.

A B

Figurę 7-48. Passive motion of the distal interphalangeał joints of the lesser toes (third toe). A, Extension. B, Flexion.

joint motion. As in the great toe, loss of motion in the metatarsophalangeal joints has the greatest functional significance. Loss of motion in the interphalangeał joints is common following fracture or in the presence of ham-mcr toe, claw toe, or mallet toe deformities. The primary significance of the associated contractures of these joints is their tcndency to cause friction against the adjacent shoe surfaces and, ultimately, to cause callus or even ulcer formation.

Abduction and adduction of the toes is possible to a iimited degree, although it is not of great functional sig-nificance. As in the hand, abduction is considered motion away from the midline of the foot, rather than the midline of the body. In the foot, abduction is judged in relation to the second toe, which is considered the midline axis of the foot. Motion away from the second toe is considered abduction and motion toward the second toe, adduction. Active abduction may be roughly assessed by asking the patient to spread the toes (Fig. 7-49). This is not normally measurcd in degrees but merely by noting the patienfs ability to scparate the toes. Similarly, active adduction may be documcnted by asking the patient to squeeze the toes together.

■ PALPATION

Palpation is usually performed with the patient seated with the lower part of the leg dangling comfortably off the end or the side of the examination table. For comfort, the examiner is usually seated on a Iow stool. The exam-iner grasps the patienfs foot with one hand to providc