{"id":1163,"date":"2022-09-19T11:41:57","date_gmt":"2022-09-19T15:41:57","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/legs-feet-and-related-joints\/"},"modified":"2024-05-03T15:34:53","modified_gmt":"2024-05-03T19:34:53","slug":"legs-feet-and-related-joints","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/legs-feet-and-related-joints\/","title":{"raw":"Legs, Feet, and Related Joints","rendered":"Legs, Feet, and Related Joints"},"content":{"raw":"<span style=\"color: #000000\">Assessment of the legs and feet progresses from the upper leg to the toes; related joints include the hips, knees, ankles, and toes. This assessment involves inspection, palpation, range of motion, and muscle testing. Most of it is completed with the client in a supine position with their head on the pillow and their arms relaxed at their side.<\/span>\r\n\r\n<span style=\"color: #000000\">Use a trauma-informed approach: tell the client you need to inspect their legs, including their hips, and provide them with a drape. Only expose the areas that you are assessing, particularly the hips, because clients may feel a sense of discomfort exposing this area.<\/span>\r\n<h2><span style=\"color: #000000\"><strong>Inspection<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">Steps for inspecting the legs and feet:<\/span>\r\n<ol>\r\n \t<li><span style=\"color: #000000\"><strong>Inspect<\/strong> for <strong>colour, swelling, masses, <\/strong>and <strong>deformities<\/strong> with a focus on the muscles, bones, and joints. This involves inspecting from the hips\/upper leg to the toes on the anterior, lateral, and posterior sides of the legs. To inspect the posterior side, you can either ask the client to lift their leg into the air or to reposition on their lateral side. Then, you should expose the full area of the hip ensuring the client is draped. Inspect all of the joints (hip, knee, ankles, and toes).\u00a0<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, there will be no discolouration, swelling, masses, or deformities. <\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Describe the appearance and location of any discolouration, swelling, masses, and deformities.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000;text-align: initial;font-size: 1em\"><strong>Inspect for symmetry in terms of leg size <\/strong>and<strong> length<\/strong>. This can be done by just looking at the legs: compare the thigh size and the calf size from one limb to the other and from the hips to the feet. You can evaluate with a tape measure for accuracy if upon inspection you notice a potential discrepancy, or the client has indicated a concern. For circumference, measure at the largest point around the thigh and the calf. For leg length, place the tape measure at the anterior-superior point of the iliac crest to the inferior point of the bony prominence of the medial malleolus and repeat again. Some begin at the umbilicus as opposed to the iliac crest. Because many factors can affect accuracy, it is best to measure twice and take an average of the two measurements (Applebaum et al., 2021).\u00a0<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">The legs are usually of equal length and circumference.\u00a0<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Describe any asymmetry that is greater than 10 mm (1 cm).<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000;text-align: initial;font-size: 1em\">Note the <strong>findings<\/strong>:<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cThigh and calf circumference and leg length are equal bilaterally. No discolouration, swelling, masses, and deformities noted on hips, legs, knees, ankles, or toes.\u201d<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cSwelling and purple-blue discolouration over lateral side of left knee. No deformities noted. Client reported they were \u2018side tackled\u2019 during rugby.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<h2>Palpation<\/h2>\r\n<span style=\"color: #000000\">Steps for palpating the legs and feet:<\/span>\r\n<ol>\r\n \t<li><span style=\"color: #000000\"><strong>Palpate for temperature<\/strong> from the hips\/upper legs to the toes bilaterally. Palpate around each of the joints as you move down the client\u2019s legs.<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Temperature is normally warm to touch and equal bilaterally. Temperature may get slightly cooler toward the feet.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings include increased temperature over a joint and sometimes a muscle. Describe the characteristics and the location.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000\"><strong>Palpate for pain, masses, swelling, deformities, <\/strong>and<strong> palpable fluid<\/strong> from hips to toes. Palpate the whole leg and foot including the full joint. If the client reports pain prior to assessment, assess that area last.<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, there will be no pain, masses, swelling deformities or palpable fluid.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">If present, describe the characteristics and the location.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cClient\u2019s hips, legs, knees, ankles, and toes are warm to touch and cooler at toes, equal bilaterally with no swelling, masses, deformities, pain, or palpable fluid noted.\u201d<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cClient\u2019s left ankle to toes are cool to touch in comparison to right ankle. Swelling around the base of the ankle. Client reported discomfort as a 4\/10 upon palpation. Client reported \u2018twisting ankle\u2019 stepping off a ladder.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<h2><span style=\"color: #000000\"><strong>Range of Motion<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">ROM of the legs and feet is focused on the hips, knees, ankles, and toes (see <strong>Table 7<\/strong> for normal ranges). While performing this assessment, observe the ROM and also listen for crepitus and ask the client about the presence of pain. Start with the unaffected leg first, and then move to the affected leg for comparisons.<\/span>\r\n\r\n<span style=\"color: #000000\">The assessment begins with the client in a supine position with the legs straight \u2013 this is considered: neutral position. All assessments are completed in supine position except hip extension.<\/span>\r\n\r\n<span style=\"color: #000000\">Steps for assessing ROM of the legs and feet:<\/span>\r\n<ol>\r\n \t<li><span style=\"color: #000000\">To perform <strong>hip flexion with straight leg<\/strong> and <strong>hip flexion with knee flexion<\/strong>, ask the client to lie with their hips\/pelvis still. Ask the client to lift one leg up (with leg straight) while bending it at the hip and moving it as close to the upper body as they can, then return to a neutral position (this is hip flexion with straight leg). Next, ask the client to lift the leg up as high as they can while bending it at the hip and the knee (hip flexion with knee flexion). Perform on the other leg.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">To perform <strong>hip extension<\/strong>, ask the client to stand and move one straight leg back while keeping their body facing forward and upright. This is normally done at the end of the exam when the client stands up for you to assess their spine. If the client cannot stand, you may assess in the prone position. NOTE: this ROM can be performed toward the end of the assessment when asking the client to stand to assess the spine.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">To perform <strong>hip abduction<\/strong> and <strong>adduction<\/strong>, ask the client to lie in a neutral position. For hip abduction, ask the client to move their leg out (keeping leg straight) toward the side (moving off the bed) and back to neutral. Repeat on the opposite leg. Next, for hip adduction, place one hand proximal to the ankle and one proximal to the knee on the underside of the leg and lift the client\u2019s legs up enough so that the client can slide their other leg underneath. Next, ask the client to slide the opposite leg underneath the leg that you are holding up. Return to a neutral position and repeat on the opposite leg.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">To perform <strong>hip internal rotation<\/strong> (also called medial rotation) and <strong>external rotation<\/strong> (also called lateral rotation), first ensure the client does not engage the spine with any sort of spinal rotation. For hip internal rotation, ask the client to bend one leg up at the knee, keeping their foot flat on the table with the knee pointing to the ceiling, then tip their knee inward (medially) and keeping their heel fixed to the table and their hips still (flat on table). Then, return the leg so that the knee is pointing to the ceiling. For external rotation, ask the client to tip their knee outward (laterally) while keeping the heel fixed to the surface and keeping their hips still (flat on table). Then, return to the leg to a neutral position with both legs straight. Repeat on the opposite leg. Note, both of these ROM can also be done in sitting position, which is commonly seen in practice.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">To perform<strong> knee flexion<\/strong> and <strong>extension<\/strong>, ask the client to bend their leg at the knee by sliding their foot\/heel toward their buttocks (knee flexion), and then back to a neutral position (extension). Repeat on the opposite leg.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">To perform <strong>dorsiflexion<\/strong> and <strong>plantar flexion<\/strong>, ask the client to point and move their toes on both feet toward their shin or head (dorsiflexion), and then back to a neutral position. Next, ask the client to point and move their toes away from the body with the soles of the feet facing down (plantar flexion), and then return to a neutral position.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">To perform <strong>ankle inversion<\/strong> and <strong>eversion<\/strong>, place one hand on the client\u2019s lower leg to stabilize their tibia and ask the client to tilt\/move the sole\/bottom of the feet inward (medially) facing each other (inversion), and then back to a neutral position. Next, for ankle eversion, ask the client to move the sole\/bottom of the feet outward (away from each other), and then return to a neutral position.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">To perform <strong>toe flexion<\/strong> and <strong>extension<\/strong>, ask the client to curl their toes toward the bottom of the foot, and then ask the client to uncurl their toes and point the tips of their toes up as much as possible, and then back to a neutral position.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cFull range of motion, no crepitation, and pain of hip, knees, ankles, and toes bilaterally, smooth and symmetrical movements of joints with no obvious misalignments.\u201d<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cRight knee flexion is 110 degrees and extension 10 degrees, no crepitation. Reported muscle tightness on movement.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">NOTE: See<strong> Video 15<\/strong>\u00a0for ROM of hips, <strong>Video 16<\/strong>\u00a0for ROM of the knees, <strong>Video 17<\/strong>\u00a0for ROM of the ankles, and <strong>Video 18 <\/strong>for ROM of the toes.<\/span>\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/LOT3XZPzUTs[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 16<\/strong>: ROM of the hips [1:59]<\/span>\r\n\r\n&nbsp;\r\n\r\nhttps:\/\/youtu.be\/epoxeEQ2mjU\r\n\r\n<span style=\"color: #000000\"><strong>Video 17<\/strong>: ROM of the knees [0:29]<\/span>\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/IPzXr4m68iY[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 18<\/strong>: ROM of the ankles [0:37]<\/span>\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/Qne0DVClwL8[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 19<\/strong>: ROM of toes [0:21]<\/span>\r\n\r\n&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Table 7<\/strong>: Normal ROM of hips, knees, ankles, and toes (adapted from American Academy of Orthopaedic Surgeons, 1965; Luttgens &amp; Hamilton, 1997)<\/span>\r\n<table class=\"grid landscape\" style=\"border-collapse: collapse;width: 100%;height: 135px\" border=\"0\">\r\n<tbody>\r\n<tr class=\"shaded\" style=\"height: 30px\">\r\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Joint<\/strong><\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Range of motion<\/strong><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Hips: Flexion with straight leg and bent leg<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">100 and 120 degrees<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Hips: Extension<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">30 degrees<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 60px\">\r\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Hips: Abduction and adduction<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Abduction: 40-45 degrees<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Adduction: 20-30 degrees<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 60px\">\r\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Hips: External\/lateral and internal\/medial rotation<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">External\/lateral rotation: 45\u201350 degrees<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Internal\/medial rotation: 40\u201345 degrees<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Knee: Flexion<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">150 degrees<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 60px\">\r\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Ankle: Dorsiflexion and plantarflexion<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Dorsiflexion: 20\u201330 degrees<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Plantarflexion: 20\u201350 degrees<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 60px\">\r\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Ankle: Inversion and eversion<\/span><\/p>\r\n<\/td>\r\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Inversion: 35 degrees<\/span><\/p>\r\n<p class=\"no-indent\"><span style=\"color: #000000\">Eversion: 15 degrees<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h2><span style=\"color: #000000\"><strong>Manual Muscle Testing (MMT)<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">Perform\u00a0 MMT after you assess ROM. Explain the procedure before applying force. Perform MMT on each joint bilaterally. Grade the resistance according to the institution\u2019s grading scale (e.g., MRC) or just describe it and note whether it is equal bilaterally.<\/span>\r\n\r\n<span style=\"color: #000000\">This testing generally begins with the client in a supine position with the legs straight (neutral position).<\/span>\r\n\r\n<span style=\"color: #000000\">Steps for MMT:<\/span>\r\n<ol>\r\n \t<li><span style=\"color: #000000\">To perform <strong>hip flexion with straight leg<\/strong>, place one hand proximal to the ankle and the other proximal to the knee. Ask the client to bend\/flex their leg at the hip as if they were going to lift their leg up (keeping leg straight) while you apply force and they resist it. Return to a neutral position and then repeat the procedure on the opposite side.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">To perform <strong>hip extension<\/strong>, ask the client to raise their\u00a0 straight leg up (hip flexion with leg straight), place one hand proximal to the ankle and the other proximal to the knee (both on the underside of the leg), and then ask the client to move their leg back down to the table while you apply force and they resist it. Return to a neutral position and repeat on the opposite leg.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">To perform <strong>hip abduction and adduction<\/strong>, place one hand proximal to the knee and the other proximal to the ankle on the lateral side of the leg. Ask the client to move their leg out toward the side (moving off the bed) while you apply force and they resist it. Return to a neutral position and repeat on the opposite leg. Next, ask the client to move their leg out\/abduct toward the edge of the bed (about 15 degrees). Place one hand proximal to the knee and the other proximal to the ankle on the medial side of leg. Ask the client to move their leg in toward the centre (moving their leg toward the other leg) while you apply force and they resist it.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">To perform <strong>knee extension and flexion<\/strong>, ask the client to bend their leg\/knee keeping their foot flat on the table (about 90 degrees) with the other leg remaining straight in neutral position. Place one hand proximal to the knee for support and the other proximal to the ankle so that you can apply force. Ask the client to extend their leg by moving their foot off the bed (like a kicking action) while you apply force and they resist it. Return to the 90-degree position with the foot flat on the table. Next, for flexion, place one hand proximal to the knee for support and the other proximal to the ankle to apply force on the posterior side of the leg. Ask the client to move their foot off the table so that their lower leg is parallel to the table and knee at about 90 degrees, and then bend their knee and bring the heel of their foot back down to the table while you apply force and they resist it. Repeat on the opposite leg.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">To perform <strong>ankle dorsiflexion and plantarflexion<\/strong>, place your hand on the top (dorsal) side of one foot. Ask the client to point and move their toes toward their shin or head while you apply force and they resist it. Repeat on the other foot. For plantar flexion, place your hand on the bottom (plantar) side of the foot. Ask the client to point and move their toes away from the body, with the sole of the foot facing down, while you apply force and they resist it. Repeat on the other foot.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Note the findings:<\/span><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normal findings might be documented as: \"\u201cfull resistance equal bilaterally on all lower limb ROM with no pain.\u201d<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings might be documented as: \"partial resistance with left hip ROM with mild pain.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">NOTE: see <strong>Video 20<\/strong>\u00a0for MMT of hips, <strong>Video 21<\/strong>\u00a0for MMT of knees, <strong>Video 22<\/strong>\u00a0for MMT of ankles.<\/span>\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/3gmUWblf5P4[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 20<\/strong>: MMT of hips [3:08]\u00a0<\/span>\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/CpE7EJpxvu0[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 21<\/strong>: MMT of knees [1:47]<\/span>\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/uZ2s-ta69Sc[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 22<\/strong>: MMT of ankles [1:11]<\/span>\r\n\r\n&nbsp;\r\n<div class=\"textbox shaded\">\r\n<h2 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">Clients may require a leg or arm amputation and may choose to wear a prosthetic to replace the amputated limb. Prosthetics can be expensive and require replacing from use or damage; the cost and resources available vary by province or territory. Aesthetics and functionality of prosthetics have evolved over time (Franzino, 2020) from uncomfortable wooden limbs to functional life-like or artistic structures. Clients often choose a prosthetic that is closest to their skin tone (Hussain, 2011) or may choose an alternative style for sports or fashion (Burton, &amp; Melkumova-Reynolds, 2019). As a nurse, you should advocate for clients\u2019 needs and preferences as they may encounter unconscious bias and barriers during the process. Another issue is that while the prosthetic assists with mobility and function, it also becomes a part of their body, or an extension of their body, and part of their self-identity. Always ask permission to touch when assessing the client\u2019s prosthetic. A trauma-informed approach will help foster a safe environment for the client to share their thoughts and feelings about the amputation and their prosthetic limb. Focusing on the client\u2019s needs fosters collaboration and a client-centred decision-making process.<\/span>\r\n\r\n<\/div>\r\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\r\n[h5p id=\"87\"]<code><\/code>\r\n<h2><strong>References<\/strong><\/h2>\r\n<span style=\"color: #000000\">Applebaum, A., Nessim, A., &amp; Cho, W. (2021). Overview and spinal implications of leg length discrepancy: Narrative review. Clinics in Orthopedic Surgery, 13(2), 127-134.<\/span> <a href=\"https:\/\/doi.org\/10.4055\/cios20224\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.4055\/cios20224<\/a>\r\n\r\n<span style=\"color: #000000\">American Academy of Orthopaedic Surgeons. Joint Motion: Method of Measuring and Recording. Chicago: AAOS; 1965.<\/span>\r\n\r\n<span style=\"color: #000000\">Burton, &amp; Melkumova-Reynolds, J. (2019). \u201cMy Leg is a Giant Stiletto Heel\u201d: Fashioning the Prosthetised Body. Fashion Theory, 23(2), 195\u2013218.<\/span> <a href=\"https:\/\/doi.org\/10.1080\/1362704X.2019.1567061\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1080\/1362704X.2019.1567061<\/a>\r\n\r\n<span style=\"color: #000000\">Franzino, J. (2020). \u201cHarmonies of form and color\u201d: Race and the prosthetic body in civil war America. Literature and Medicine, 38(1), 51\u201387.<\/span> <a href=\"https:\/\/doi.org\/10.1353\/lm.2020.0003\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1353\/lm.2020.0003<\/a>\r\n\r\n<span style=\"color: #000000\">Hussain. (2011). Toes That Look Like Toes: Cambodian Children\u2019s Perspectives on Prosthetic Legs. Qualitative Health Research, 21(10), 1427\u20131440.<\/span> <a href=\"https:\/\/doi.org\/10.1177\/1049732311411058\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1177\/1049732311411058<\/a>\r\n\r\n<span style=\"color: #000000\">Luttgens, K. &amp; Hamilton, N. (1997). Kinesiology: Scientific Basis of Human Motion, 9th Ed., Madison, WI: Brown &amp; Benchmark<\/span>","rendered":"<p><span style=\"color: #000000\">Assessment of the legs and feet progresses from the upper leg to the toes; related joints include the hips, knees, ankles, and toes. This assessment involves inspection, palpation, range of motion, and muscle testing. Most of it is completed with the client in a supine position with their head on the pillow and their arms relaxed at their side.<\/span><\/p>\n<p><span style=\"color: #000000\">Use a trauma-informed approach: tell the client you need to inspect their legs, including their hips, and provide them with a drape. Only expose the areas that you are assessing, particularly the hips, because clients may feel a sense of discomfort exposing this area.<\/span><\/p>\n<h2><span style=\"color: #000000\"><strong>Inspection<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">Steps for inspecting the legs and feet:<\/span><\/p>\n<ol>\n<li><span style=\"color: #000000\"><strong>Inspect<\/strong> for <strong>colour, swelling, masses, <\/strong>and <strong>deformities<\/strong> with a focus on the muscles, bones, and joints. This involves inspecting from the hips\/upper leg to the toes on the anterior, lateral, and posterior sides of the legs. To inspect the posterior side, you can either ask the client to lift their leg into the air or to reposition on their lateral side. Then, you should expose the full area of the hip ensuring the client is draped. Inspect all of the joints (hip, knee, ankles, and toes).\u00a0<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, there will be no discolouration, swelling, masses, or deformities. <\/span><\/li>\n<li><span style=\"color: #000000\">Describe the appearance and location of any discolouration, swelling, masses, and deformities.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000;text-align: initial;font-size: 1em\"><strong>Inspect for symmetry in terms of leg size <\/strong>and<strong> length<\/strong>. This can be done by just looking at the legs: compare the thigh size and the calf size from one limb to the other and from the hips to the feet. You can evaluate with a tape measure for accuracy if upon inspection you notice a potential discrepancy, or the client has indicated a concern. For circumference, measure at the largest point around the thigh and the calf. For leg length, place the tape measure at the anterior-superior point of the iliac crest to the inferior point of the bony prominence of the medial malleolus and repeat again. Some begin at the umbilicus as opposed to the iliac crest. Because many factors can affect accuracy, it is best to measure twice and take an average of the two measurements (Applebaum et al., 2021).\u00a0<\/span>\n<ul>\n<li><span style=\"color: #000000\">The legs are usually of equal length and circumference.\u00a0<\/span><\/li>\n<li><span style=\"color: #000000\">Describe any asymmetry that is greater than 10 mm (1 cm).<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000;text-align: initial;font-size: 1em\">Note the <strong>findings<\/strong>:<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cThigh and calf circumference and leg length are equal bilaterally. No discolouration, swelling, masses, and deformities noted on hips, legs, knees, ankles, or toes.\u201d<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cSwelling and purple-blue discolouration over lateral side of left knee. No deformities noted. Client reported they were \u2018side tackled\u2019 during rugby.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<h2>Palpation<\/h2>\n<p><span style=\"color: #000000\">Steps for palpating the legs and feet:<\/span><\/p>\n<ol>\n<li><span style=\"color: #000000\"><strong>Palpate for temperature<\/strong> from the hips\/upper legs to the toes bilaterally. Palpate around each of the joints as you move down the client\u2019s legs.<\/span>\n<ul>\n<li><span style=\"color: #000000\">Temperature is normally warm to touch and equal bilaterally. Temperature may get slightly cooler toward the feet.<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings include increased temperature over a joint and sometimes a muscle. Describe the characteristics and the location.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000\"><strong>Palpate for pain, masses, swelling, deformities, <\/strong>and<strong> palpable fluid<\/strong> from hips to toes. Palpate the whole leg and foot including the full joint. If the client reports pain prior to assessment, assess that area last.<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, there will be no pain, masses, swelling deformities or palpable fluid.<\/span><\/li>\n<li><span style=\"color: #000000\">If present, describe the characteristics and the location.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cClient\u2019s hips, legs, knees, ankles, and toes are warm to touch and cooler at toes, equal bilaterally with no swelling, masses, deformities, pain, or palpable fluid noted.\u201d<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cClient\u2019s left ankle to toes are cool to touch in comparison to right ankle. Swelling around the base of the ankle. Client reported discomfort as a 4\/10 upon palpation. Client reported \u2018twisting ankle\u2019 stepping off a ladder.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<h2><span style=\"color: #000000\"><strong>Range of Motion<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">ROM of the legs and feet is focused on the hips, knees, ankles, and toes (see <strong>Table 7<\/strong> for normal ranges). While performing this assessment, observe the ROM and also listen for crepitus and ask the client about the presence of pain. Start with the unaffected leg first, and then move to the affected leg for comparisons.<\/span><\/p>\n<p><span style=\"color: #000000\">The assessment begins with the client in a supine position with the legs straight \u2013 this is considered: neutral position. All assessments are completed in supine position except hip extension.<\/span><\/p>\n<p><span style=\"color: #000000\">Steps for assessing ROM of the legs and feet:<\/span><\/p>\n<ol>\n<li><span style=\"color: #000000\">To perform <strong>hip flexion with straight leg<\/strong> and <strong>hip flexion with knee flexion<\/strong>, ask the client to lie with their hips\/pelvis still. Ask the client to lift one leg up (with leg straight) while bending it at the hip and moving it as close to the upper body as they can, then return to a neutral position (this is hip flexion with straight leg). Next, ask the client to lift the leg up as high as they can while bending it at the hip and the knee (hip flexion with knee flexion). Perform on the other leg.<\/span><\/li>\n<li><span style=\"color: #000000\">To perform <strong>hip extension<\/strong>, ask the client to stand and move one straight leg back while keeping their body facing forward and upright. This is normally done at the end of the exam when the client stands up for you to assess their spine. If the client cannot stand, you may assess in the prone position. NOTE: this ROM can be performed toward the end of the assessment when asking the client to stand to assess the spine.<\/span><\/li>\n<li><span style=\"color: #000000\">To perform <strong>hip abduction<\/strong> and <strong>adduction<\/strong>, ask the client to lie in a neutral position. For hip abduction, ask the client to move their leg out (keeping leg straight) toward the side (moving off the bed) and back to neutral. Repeat on the opposite leg. Next, for hip adduction, place one hand proximal to the ankle and one proximal to the knee on the underside of the leg and lift the client\u2019s legs up enough so that the client can slide their other leg underneath. Next, ask the client to slide the opposite leg underneath the leg that you are holding up. Return to a neutral position and repeat on the opposite leg.<\/span><\/li>\n<li><span style=\"color: #000000\">To perform <strong>hip internal rotation<\/strong> (also called medial rotation) and <strong>external rotation<\/strong> (also called lateral rotation), first ensure the client does not engage the spine with any sort of spinal rotation. For hip internal rotation, ask the client to bend one leg up at the knee, keeping their foot flat on the table with the knee pointing to the ceiling, then tip their knee inward (medially) and keeping their heel fixed to the table and their hips still (flat on table). Then, return the leg so that the knee is pointing to the ceiling. For external rotation, ask the client to tip their knee outward (laterally) while keeping the heel fixed to the surface and keeping their hips still (flat on table). Then, return to the leg to a neutral position with both legs straight. Repeat on the opposite leg. Note, both of these ROM can also be done in sitting position, which is commonly seen in practice.<\/span><\/li>\n<li><span style=\"color: #000000\">To perform<strong> knee flexion<\/strong> and <strong>extension<\/strong>, ask the client to bend their leg at the knee by sliding their foot\/heel toward their buttocks (knee flexion), and then back to a neutral position (extension). Repeat on the opposite leg.<\/span><\/li>\n<li><span style=\"color: #000000\">To perform <strong>dorsiflexion<\/strong> and <strong>plantar flexion<\/strong>, ask the client to point and move their toes on both feet toward their shin or head (dorsiflexion), and then back to a neutral position. Next, ask the client to point and move their toes away from the body with the soles of the feet facing down (plantar flexion), and then return to a neutral position.<\/span><\/li>\n<li><span style=\"color: #000000\">To perform <strong>ankle inversion<\/strong> and <strong>eversion<\/strong>, place one hand on the client\u2019s lower leg to stabilize their tibia and ask the client to tilt\/move the sole\/bottom of the feet inward (medially) facing each other (inversion), and then back to a neutral position. Next, for ankle eversion, ask the client to move the sole\/bottom of the feet outward (away from each other), and then return to a neutral position.<\/span><\/li>\n<li><span style=\"color: #000000\">To perform <strong>toe flexion<\/strong> and <strong>extension<\/strong>, ask the client to curl their toes toward the bottom of the foot, and then ask the client to uncurl their toes and point the tips of their toes up as much as possible, and then back to a neutral position.<\/span><\/li>\n<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cFull range of motion, no crepitation, and pain of hip, knees, ankles, and toes bilaterally, smooth and symmetrical movements of joints with no obvious misalignments.\u201d<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cRight knee flexion is 110 degrees and extension 10 degrees, no crepitation. Reported muscle tightness on movement.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #000000\">NOTE: See<strong> Video 15<\/strong>\u00a0for ROM of hips, <strong>Video 16<\/strong>\u00a0for ROM of the knees, <strong>Video 17<\/strong>\u00a0for ROM of the ankles, and <strong>Video 18 <\/strong>for ROM of the toes.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Range of Motion (Hips) - MSK Chapter\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/LOT3XZPzUTs?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 16<\/strong>: ROM of the hips [1:59]<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-7\" title=\"Range of Motion (Knees) - MSK Chapter\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/epoxeEQ2mjU?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 17<\/strong>: ROM of the knees [0:29]<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"Range of Motion (Ankles) - MSK Chapter\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/IPzXr4m68iY?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 18<\/strong>: ROM of the ankles [0:37]<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-3\" title=\"Range of Motion (Toes) - MSK Chapter\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/Qne0DVClwL8?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 19<\/strong>: ROM of toes [0:21]<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Table 7<\/strong>: Normal ROM of hips, knees, ankles, and toes (adapted from American Academy of Orthopaedic Surgeons, 1965; Luttgens &amp; Hamilton, 1997)<\/span><\/p>\n<table class=\"grid landscape\" style=\"border-collapse: collapse;width: 100%;height: 135px\">\n<tbody>\n<tr class=\"shaded\" style=\"height: 30px\">\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Joint<\/strong><\/span><\/p>\n<\/td>\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\"><strong>Range of motion<\/strong><\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Hips: Flexion with straight leg and bent leg<\/span><\/p>\n<\/td>\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">100 and 120 degrees<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Hips: Extension<\/span><\/p>\n<\/td>\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">30 degrees<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 60px\">\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Hips: Abduction and adduction<\/span><\/p>\n<\/td>\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Abduction: 40-45 degrees<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Adduction: 20-30 degrees<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 60px\">\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Hips: External\/lateral and internal\/medial rotation<\/span><\/p>\n<\/td>\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">External\/lateral rotation: 45\u201350 degrees<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Internal\/medial rotation: 40\u201345 degrees<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Knee: Flexion<\/span><\/p>\n<\/td>\n<td style=\"width: 50%;vertical-align: top;height: 30px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">150 degrees<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 60px\">\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Ankle: Dorsiflexion and plantarflexion<\/span><\/p>\n<\/td>\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Dorsiflexion: 20\u201330 degrees<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Plantarflexion: 20\u201350 degrees<\/span><\/p>\n<\/td>\n<\/tr>\n<tr style=\"height: 60px\">\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Ankle: Inversion and eversion<\/span><\/p>\n<\/td>\n<td style=\"width: 50%;vertical-align: top;height: 60px\">&nbsp;<\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Inversion: 35 degrees<\/span><\/p>\n<p class=\"no-indent\"><span style=\"color: #000000\">Eversion: 15 degrees<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><span style=\"color: #000000\"><strong>Manual Muscle Testing (MMT)<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">Perform\u00a0 MMT after you assess ROM. Explain the procedure before applying force. Perform MMT on each joint bilaterally. Grade the resistance according to the institution\u2019s grading scale (e.g., MRC) or just describe it and note whether it is equal bilaterally.<\/span><\/p>\n<p><span style=\"color: #000000\">This testing generally begins with the client in a supine position with the legs straight (neutral position).<\/span><\/p>\n<p><span style=\"color: #000000\">Steps for MMT:<\/span><\/p>\n<ol>\n<li><span style=\"color: #000000\">To perform <strong>hip flexion with straight leg<\/strong>, place one hand proximal to the ankle and the other proximal to the knee. Ask the client to bend\/flex their leg at the hip as if they were going to lift their leg up (keeping leg straight) while you apply force and they resist it. Return to a neutral position and then repeat the procedure on the opposite side.<\/span><\/li>\n<li><span style=\"color: #000000\">To perform <strong>hip extension<\/strong>, ask the client to raise their\u00a0 straight leg up (hip flexion with leg straight), place one hand proximal to the ankle and the other proximal to the knee (both on the underside of the leg), and then ask the client to move their leg back down to the table while you apply force and they resist it. Return to a neutral position and repeat on the opposite leg.<\/span><\/li>\n<li><span style=\"color: #000000\">To perform <strong>hip abduction and adduction<\/strong>, place one hand proximal to the knee and the other proximal to the ankle on the lateral side of the leg. Ask the client to move their leg out toward the side (moving off the bed) while you apply force and they resist it. Return to a neutral position and repeat on the opposite leg. Next, ask the client to move their leg out\/abduct toward the edge of the bed (about 15 degrees). Place one hand proximal to the knee and the other proximal to the ankle on the medial side of leg. Ask the client to move their leg in toward the centre (moving their leg toward the other leg) while you apply force and they resist it.<\/span><\/li>\n<li><span style=\"color: #000000\">To perform <strong>knee extension and flexion<\/strong>, ask the client to bend their leg\/knee keeping their foot flat on the table (about 90 degrees) with the other leg remaining straight in neutral position. Place one hand proximal to the knee for support and the other proximal to the ankle so that you can apply force. Ask the client to extend their leg by moving their foot off the bed (like a kicking action) while you apply force and they resist it. Return to the 90-degree position with the foot flat on the table. Next, for flexion, place one hand proximal to the knee for support and the other proximal to the ankle to apply force on the posterior side of the leg. Ask the client to move their foot off the table so that their lower leg is parallel to the table and knee at about 90 degrees, and then bend their knee and bring the heel of their foot back down to the table while you apply force and they resist it. Repeat on the opposite leg.<\/span><\/li>\n<li><span style=\"color: #000000\">To perform <strong>ankle dorsiflexion and plantarflexion<\/strong>, place your hand on the top (dorsal) side of one foot. Ask the client to point and move their toes toward their shin or head while you apply force and they resist it. Repeat on the other foot. For plantar flexion, place your hand on the bottom (plantar) side of the foot. Ask the client to point and move their toes away from the body, with the sole of the foot facing down, while you apply force and they resist it. Repeat on the other foot.<\/span><\/li>\n<li><span style=\"color: #000000\">Note the findings:<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\">Normal findings might be documented as: &#8220;\u201cfull resistance equal bilaterally on all lower limb ROM with no pain.\u201d<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings might be documented as: &#8220;partial resistance with left hip ROM with mild pain.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #000000\">NOTE: see <strong>Video 20<\/strong>\u00a0for MMT of hips, <strong>Video 21<\/strong>\u00a0for MMT of knees, <strong>Video 22<\/strong>\u00a0for MMT of ankles.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-4\" title=\"Manual Muscle Testing (Hips) - MSK Chapter\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/3gmUWblf5P4?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 20<\/strong>: MMT of hips [3:08]\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-5\" title=\"Manual Muscle Testing (Knees)\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/CpE7EJpxvu0?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 21<\/strong>: MMT of knees [1:47]<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-6\" title=\"Manual Muscle Testing (Ankles)\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/uZ2s-ta69Sc?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 22<\/strong>: MMT of ankles [1:11]<\/span><\/p>\n<p>&nbsp;<\/p>\n<div class=\"textbox shaded\">\n<h2 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">Clients may require a leg or arm amputation and may choose to wear a prosthetic to replace the amputated limb. Prosthetics can be expensive and require replacing from use or damage; the cost and resources available vary by province or territory. Aesthetics and functionality of prosthetics have evolved over time (Franzino, 2020) from uncomfortable wooden limbs to functional life-like or artistic structures. Clients often choose a prosthetic that is closest to their skin tone (Hussain, 2011) or may choose an alternative style for sports or fashion (Burton, &amp; Melkumova-Reynolds, 2019). As a nurse, you should advocate for clients\u2019 needs and preferences as they may encounter unconscious bias and barriers during the process. Another issue is that while the prosthetic assists with mobility and function, it also becomes a part of their body, or an extension of their body, and part of their self-identity. Always ask permission to touch when assessing the client\u2019s prosthetic. A trauma-informed approach will help foster a safe environment for the client to share their thoughts and feelings about the amputation and their prosthetic limb. Focusing on the client\u2019s needs fosters collaboration and a client-centred decision-making process.<\/span><\/p>\n<\/div>\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\n<div id=\"h5p-87\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-87\" class=\"h5p-iframe\" data-content-id=\"87\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"MSK: Legs, Feet and Related Joints\"><\/iframe><\/div>\n<\/div>\n<p><code><\/code><\/p>\n<h2><strong>References<\/strong><\/h2>\n<p><span style=\"color: #000000\">Applebaum, A., Nessim, A., &amp; Cho, W. (2021). Overview and spinal implications of leg length discrepancy: Narrative review. Clinics in Orthopedic Surgery, 13(2), 127-134.<\/span> <a href=\"https:\/\/doi.org\/10.4055\/cios20224\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.4055\/cios20224<\/a><\/p>\n<p><span style=\"color: #000000\">American Academy of Orthopaedic Surgeons. Joint Motion: Method of Measuring and Recording. Chicago: AAOS; 1965.<\/span><\/p>\n<p><span style=\"color: #000000\">Burton, &amp; Melkumova-Reynolds, J. (2019). \u201cMy Leg is a Giant Stiletto Heel\u201d: Fashioning the Prosthetised Body. Fashion Theory, 23(2), 195\u2013218.<\/span> <a href=\"https:\/\/doi.org\/10.1080\/1362704X.2019.1567061\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1080\/1362704X.2019.1567061<\/a><\/p>\n<p><span style=\"color: #000000\">Franzino, J. (2020). \u201cHarmonies of form and color\u201d: Race and the prosthetic body in civil war America. Literature and Medicine, 38(1), 51\u201387.<\/span> <a href=\"https:\/\/doi.org\/10.1353\/lm.2020.0003\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1353\/lm.2020.0003<\/a><\/p>\n<p><span style=\"color: #000000\">Hussain. (2011). Toes That Look Like Toes: Cambodian Children\u2019s Perspectives on Prosthetic Legs. Qualitative Health Research, 21(10), 1427\u20131440.<\/span> <a href=\"https:\/\/doi.org\/10.1177\/1049732311411058\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1177\/1049732311411058<\/a><\/p>\n<p><span style=\"color: #000000\">Luttgens, K. &amp; Hamilton, N. (1997). Kinesiology: Scientific Basis of Human Motion, 9th Ed., Madison, WI: Brown &amp; Benchmark<\/span><\/p>\n","protected":false},"author":34,"menu_order":9,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[],"contributor":[85],"license":[56],"class_list":["post-1163","chapter","type-chapter","status-publish","hentry","contributor-january-2023","license-cc-by-nc"],"part":1139,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1163","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":2,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1163\/revisions"}],"predecessor-version":[{"id":1563,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1163\/revisions\/1563"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/1139"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1163\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=1163"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=1163"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=1163"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=1163"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}