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Diagnosis of osteochondrosis: examination of the extremities
Last reviewed: 08.07.2025
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When examining the limbs, it is recommended to first determine significant changes that disrupt the function of the entire limb, then move on to an external examination of the affected area and finish the examination by studying changes in the upper and lower segments, while noting the condition of the muscles and the nature of compensatory changes.
The so-called significant violations include:
- changes in limb axis;
- pathological settings in the joints;
- violation of the mutual arrangement of the articular ends.
Changes in the normal axis of the limb are observed with lateral curvatures in the joints or along the diaphysis. The axis of the leg passes through the anterior superior iliac spine, the inner edge of the kneecap and the big toe, located on a straight line connecting these points. The connection of these points of the leg is not a straight line, but a broken line indicates a deformation in the frontal plane.
It should be noted that normally the axis of the leg remains unchanged both when the leg is bent and when the hip and knee joints are straightened.
In the presence of an outward deviation of the tibia in the knee joint area (genu valgum), the axis of the leg lies outward from the kneecap; with (genu varum), the opposite relationship is revealed. Thus, curvature of the limb at an angle open outward is called valgus, and inward - varus.
The normal arm axis is a line drawn through the center of the humeral head, the center of the capitate eminence of the humerus, the head of the radius, and the head of the ulna. When the arm is deformed in the frontal plane, the axis line appears as a broken line.
When examining a patient’s feet, it is necessary to pay attention to existing deformities, which can occur in 23-25.4% of cases.
Currently, it is customary to distinguish 6 main types of foot deformation:
- equinus foot;
- heel foot;
- varus foot;
- valgus foot;
- hollow foot;
- flat foot.
Most often, one deformation is combined with another.
The appearance of the equinus foot is characteristic: the foot is at an angle to the axis of the shin, sometimes reaching 170-180°, the heel is sharply raised above the floor, the Achilles tendon is tense. The heel is small, the talus protrudes above the skin of the dorsum of the foot. The support is provided by the heads of the metatarsal bones, in the area of which painful calluses develop.
Appearance of the heel foot: the heel is lowered downwards, increased in size, callused and is the sole support of the foot. Heel pronation is often observed. The longitudinal arch of the foot is sharply strengthened both on the inner and outer sides, the configuration of the back of the leg is changed due to atrophy of the gastrocnemius muscle, the mobility of the ankle joint is sharply impaired.
Varus foot deformity is characterized by supination of the heel, lowering of the outer edge of the foot, adduction of the forefoot, and deepening of the longitudinal arch. Changes occur simultaneously in the talocalcaneal and Chopart joints.
Valgus foot deformity is the complete opposite of varus foot deformity and is characterized by pronation, abduction of the forefoot and a lowering of the longitudinal arch.
A hollow foot is considered to be a type of deformation in which the arch of the foot, as opposed to flat feet, is excessively enlarged. In addition, supination of the heel and pronation of the forefoot are noted. The longitudinal arch is enlarged due to both the inner and outer arches, the toes are hammer-shaped. This deformation depends on the predominance of the extensors of the toes over the flexor muscles. Due to the lowering of the heads of the metatarsal bones, painful corns form on the sole. The entire foot is somewhat shortened in length due to the excessive increase in the arch, the forefoot is somewhat widened due to the flattening or complete absence of the transverse arch.
With a flat foot, the pronator muscles take over and the foot gradually moves into a pronation position. The outer edge of the foot gradually rises, and the inner edge falls and serves as a support when walking or standing. The heel bone also deviates outward. The foot appears somewhat enlarged and widened in the anterior section. The longitudinal arch of the foot is sharply flattened or completely absent.
Pathological processes in joints can lead to more or less stable pathological settings of the entire limb or any segment. For example, in the hip joint, flexion, flexion-adduction settings are more common; in the knee joint - flexion, less often - hyperextension position.
Violations of the mutual arrangement of the articular ends are usually observed in dislocations of various etiologies: traumatic and pathological (distension, destructive). Dislocation is determined by typical deformations in the joint area and disruption of the relationship of the axes of the distal (dislocation) and proximal segments.
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