Diagnosis of osteochondrosis: examination of the extremities
Last reviewed: 23.04.2024
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When examining the extremities, it is recommended first to determine significant changes that violate the function of the entire limb, then go on to the external examination of the affected area and complete the examination by studying the changes in the above and below segments, noting the musculature and the nature of the compensatory changes.
Among the so-called significant violations include:
- changes in the axis of the limb;
- pathological settings in the joints;
- violation of the mutual arrangement of the joint ends.
Changes in the normal limb axis are observed with lateral curvatures in the joints or during the diaphysis. The axis of the leg passes through the anterior superior ostium of the ilium, the inner edge of the patella and the thumb, located on the straight line connecting these points. The connection of these points of the leg is not straight, but a broken line indicates deformation in the frontal plane.
It should be noted that, in norm, the leg axis remains unchanged both with bent and with the legs straightened in the hip and knee joints.
If there is a deviation of the lower leg in the region of the knee joint to the outside (genu valgum), the foot axis lies outside of the kneecap; at (genu varum) the inverse relations are revealed. Thus, the curvature of the limb at an angle open to the outside is called valgus, and inward - varus.
The normal axis of the arm is a line drawn through the center of the head of the humerus, the center of the head shoulder, the head of the ray and the head of the ulna. When the hand is deformed in the frontal plane, the line of the axis looks like a broken line.
When examining the patient's feet, it is necessary to pay attention to the available deformities, which can occur in 23-25.4% of cases.
At present, it is common to distinguish 6 basic types of deformation of the feet:
- equinus foot;
- heel stop;
- varus stop;
- valyusnaya stop;
- hollow foot;
- flat foot.
Most often, one deformation is combined with the other.
The appearance of equinus feet is characteristic: the foot is in relation to the axis of the shank at an angle sometimes reaching 170-180 °, the heel is sharply raised above the floor, the heel tendon is strained. The heel is small in size, the talus bone protrudes above the skin of the rear of the foot. The head is supported by the heads of metatarsal bones, in the area of which the painful corns develop.
Appearance of the heel foot : the heel is lowered downwards, enlarged in size, omozolal and is the sole support of the foot. Pronation of the heel is often observed. The longitudinal arch of the foot is sharply strengthened both from the inner and the outer side, the configuration of the posterior surface of the shin is changed due to the atrophy of the gastrocnemius muscle, the mobility of the ankle joint is severely impaired.
Varusnaya deformation of the foot is characterized by supination of the heel, lowering the outer edge of the foot, leading the front and deepening the longitudinal arch. Changes occur simultaneously in the ram-but-heel and the shopar joint.
The valgus deformation of the foot is the complete opposite of the varus and is characterized by pronation, retraction of the forefoot and a decrease in the longitudinal arch.
A hollow foot is considered to be a type of deformation, in which the arch of the foot, in contrast to the flat feet, is excessively increased. In addition, heel supination and pronation of the forefoot are noted. The longitudinal arch is enlarged due to both the internal and external arch, the fingers are hammer-shaped deformed. Such deformation depends on the predominance of extensor fingers over flexor muscles. Due to the lowering of the heads of metatarsal bones on the sole, painful stomata are formed. The entire foot is somewhat shortened in length due to an excessive increase in the arch, the anterior part of the foot is somewhat enlarged due to flattening or total absence of the transverse arch.
At a flat foot the preponderance of the muscle-force and the foot is gradually established in the position of pronation. The outer edge of the foot is gradually raised, while the inner edge is lowered and supports the walking or standing. The heel bone also deviates to the outside. The foot appears slightly enlarged and widened in the anterior section. The longitudinal arch of the foot is sharply flattened or completely absent.
Pathological processes in the joints can lead to more or less persistent pathological settings of the entire limb or any segment. For example, in the hip joint, folding, flexor-leading devices are more common; in the knee - flexion, less often - the position of re-opening.
Disturbances in the mutual arrangement of articular ends are usually observed with dislocations of different etiology: traumatic and pathological (distensive, destructive). A dislocation is determined for typical deformations in the joint region and disbalance of the axes of the distal (dislocation) and proximal segments.
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