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Midfoot Anatomy, Pathology and Physical Examination

February 01, 2013

Contributors: Saskia Van Bouwel, MD; Francis Van Glabbeek, PhD; Geoffroy S Vandeputte, MD; Matthias Vanhees, MD; Matthias Vanhees, MD

Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.

The physical examination of the midfoot is often overlooked in the orthopedic clinic; it is difficult to perform correctly because of the complexity of the bony and ligamentous structures. This video is intended to increase understanding of the anatomy and the different physical examinations of the midfoot. Our goals are to clearly show the anatomical landmarks on the skin, to correctly demonstrate how to perform three different clinical tests during physical examination, and to identify which structures are stressed during physical examination. We used two different human cadaver feet with no history of surgery. The video begins with a systematic visualization of the anatomical landmarks on the skin, including the bones and tarsometatarsal joints, the tibialis anterior and posterior tendons, and the peroneal tendons. Next, three specific tests of the physical examination of the midfoot are demonstrated: the dorsoplantar stability test of the first tarsometatarsal joint, the lateral Lisfranc joint stability test, and the peroneal tendon impingement test. The anatomy and the physical examinations are then repeated with the skin removed and the most important tendons, the Lisfranc joint, and the inferior peroneal retinaculum are discussed in detail. Next, the tarsometatarsal and Lisfranc joints are progressively destabilized by transecting the dorsal and volar ligaments and capsule and eventually the insertion of the peroneus longus. Finally, the physical examination is repeated on the unstable midfoot. During the video, clinical pictures and video fragments help correlate the anatomy and physical examination to clinical pathology. This didactic video gives a brief and clear insight into the anatomy, the most common pathology, and the physical examination of the midfoot. After watching this video, the viewer should be able to comprehend the anatomy and most common pathology of the midfoot and to perform the physical examination correctly.

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