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The
Signs |
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Posterior
Crease of the ankle (PC) |
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Normally
the skin of the posterior ankle shows multiple fine creases
- Deeper creases imply more posterior contracture. (Figs.
7 a, b, c). |
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| Fig.
7a |
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Examine
the back of the heel with the foot held gently corrected.
Normally one sees multiple fine creases that do
not change the contour of the heel. They allow the
skin to adjust and stretch as the ankle dorsiflexes.
In this case, the Posterior Crease sign is scored
as 0. |
| 0 |
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| Fig.
7b |
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In
the abnormal foot there are one or two deep creases.
If these deep creases do not appreciably change
the contour of the heel, the Posterior Crease sign
is scored as 0.5. |
| 0.5 |
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| Fig.
7c |
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If
these deep creases appreciably change the contour
of the heel, the Posterior Crease sign is scored
as 1. |
| 1 |
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top |
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| 2 |
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Emptiness
of the Heel (EH) (Figs. 8a, b) |
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This
sign is a measure of posterior contracture. With the talus
fully plantarflexed, the calcaneus is also in equinus
and the posterior aspect of the calcaneus is drawn up
and out of the heel pad. As the talar plantar flexion
corrects, the calcaneus fills the heel pad. Palpating
the heel pad therefore can give an estimation of how plantar
flexed the talus is, and hence, an estimation of residual
posterior contracture. |
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| Fig.
8a |
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The
foot is placed in the gently corrected position,
and the examining finger is placed on the corner
of the heel, the finger bisecting the angle between
the sole of the foot and the back of the calf. Gentle
pressure is applied with the finger. Normally the
tuberosity of the calcaneus is immediately palpable
and the empty heel sign is scored 0. |
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| Fig.
8b |
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The
empty heel sign is scored 0.5 when the heel pad
feels somewhat empty/soft to the examining digit.
The tuberosity however, remains palpable deep within
the heel pad. The empty heel sign is scored 1 when
the heel pad feels empty to the examining digit.
No bony prominences can be appreciated within the
heel pad. |
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