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Foot Physical Exam

Hindfoot Alignment
Peek-a-boo heel sign

"Toe-many toes" sign

  Coleman Block Test:  determines if hindfoot varus defomity is fixed or flexible. Place patient's foot on wood block, 2.5 to 4 cm thick, with the heel and lateral border of foot on the block and bearing full weight.  The first, second, and third metatarsals are allowed to hang off the block into plantar flexion and pronation.  If heel varus corrects the hindfoot is flexible and the hindfoot varus is forefoot driven. If hindfoot stays in varus, the hindfoot is fixed and the hindfoot varus is hindfoot driven.  (Coleman S, Clin Orthop 1977;122:60)
  Hindfoot Alignment: normal is 2-5° of valgus.  
‘‘Peek-a-boo heel’’ sign:  heel pad is seen easily from the front with the patient standing and feet aligned straight ahead.  Normally the heel pad is not visible on the medial side of the foot when viewed from the front because of valgus positioning of the normal heel, which places the heel pad behind
the normal hindfoot. (Beals, TC, Foot 1996;6:205)
  Too-many toes sign:  lateral two toes seen when pt standing, facing away from examiner, with feet straight ahead.  Indicates Posterior tibial tendon insufficiency



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