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The Foot
Matt Weidenbach
By: Ben Hoffmann
Taylor Westbrook
Foot Anatomy
The foot consists of 26 bones: 14
phalangeal, 5 metatarsal, and 7 tarsal.
Toes are used to balance and propel the
body.
Metatarsal Bones gives elasticity to the
foot in weight bearing.
Tarsal Bones located between the bones
of the lower leg and the metatarsals are
extremely important for support and
locomotion.
Arches of the foot
Foot arches assist the foot in
supporting the body weight; in
absorbing shock of weight bearing;
and in providing a space on the
plantar aspect of the foot for the
blood vessels, nerves, and muscles.
There are 4 arches: The metatarsal,
transverse arch, medial longitudinal
arch, lateral longitudinal arch.
Articulations
Interphalangeal Joint: located at the distal
extremities of the proximal and middle
phalanges. Designed for flexion and extension.
Metatarsophalangeal Joint: Permits flexion,
extension, adduction, and abduction.
Intermetatarsal Joint: Permits slight gliding
movements.
Tarsometatarsal Joint: allows some gliding and
restriction of flexion, extension adduction and
abduction.
Midtarsal Joint: Provides shock absorption.
Inversion, Abduction and Supination
Produce medial movements of the
foot.
These muscles pass behind and in
front of the medial malleolus.
Eversion, Abduction, and Pronation
Produce lateral movements of the
foot.
Muscles passing behind the lateral
malleolus are the fibularis longus and
the fibularis brevis.
Nerve and Blood Supply
Nerve Supply: The medial and lateral
plantar nerves which are branches of
the tibial nerve, supply all of the
intrinsic muscles on the plantar
surface of the foot. The deep
peroneal nerve supplies the extensor.
Blood Supply: The primary blood
supply for the foot comes from the
anterior tibial artery and posterior
tibial arteries.
Structural Deformities
Forefoot varus, forefoot valgus and
rearfoot varus produce excessive
pronation or supination.
The deformities will make the foot
more difficult to act like a shock
absorber.
The compensation usually causes
overuse injuries.
Prevention of Foot Injuries
Appropriate Footwear; selecting an
appropriate shoe is a critical consideration in
preventing a foot problem.
Shoe Orthotics; an orthotic device can be
used to correct biomechanical problems that
exist in the foot and that can cause injury.
Proper foot hygiene; simple tasks such as
keeping toenails trimmed, shaving down
calluses, keeping feet clean and dry can
reduce a number of problems.
Foot Assessment
To correctly assess the foot trainers must
understand that the foot is part of a kinetic
chain that includes both the ankle and the
lower leg.
History of the patients foot must also be
assessed.
Observations such as if the patient is favoring
the foot, walking with a limp or unable to bear
weight should be assessed.
Structural Deformities should also be
observed.
Recognition and Management of
specific Injuries
Fracture of the Talus
Symptoms: Patient often has a history
of repeated trauma to the ankle. Sharp
pain during weight bearing and
complains of catching and snapping
along with swelling
Management: X-ray is essential.
Nonsurgical management. Protective
immobilization, and no weight bearing.
Fracture of the
Calcaneus
Symptoms and signs: occurs mostly from
landing or falling from a high place. There is
usually immediate swelling and pain and an
inability to bear weight.
Management: RICE must be used
immediately to minimize pain and swelling
before referring the athlete to an X-ray. With
non displacement fractures immobilization
and early range of motion exercises are
recommended as soon as pain and swelling
go down or is tolerated.
Calcaneal stress fracture
Occurs with repetitive impact during heel strike
and is most commonly found in distance runners.
Symptoms and signs: weight bearing and
complaints of pain tend to continue after an
exercise stops. May not come up on X-rays so a
bone scan may be the best option.
Management: for the first 2 or 3 weeks rest is
important with little as possible weight bearing on
the foot. Active range of motion exercises of the
foot and ankle during rest. After 2 or 3 weeks,
gradually work the athlete back into it with
cushioning shoes.
Apophysitis of the
Calcaneus
Occurs in the young and physically
active.
Symptoms and Signs: Pain occurs at
the posterior heel below the
attachment of the Achilles tendon
insertion of the child or adolescent
athlete.
Management: Best treated with rest,
ice, stretching and antiinflamatory
medications.
Retrocalcaneal Bursitis
Caused by inflammation of the bursa
that lies between the Achilles tendon
and the calcaneal.
Symptoms and Signs: Swelling on
both sides of the heel cord.
Management: RICE and NSAIDs. The
use of ultrasound can reduce
inflammation.
Heel Contusion
Seen mostly in sports that have a sudden
stop and go response or a sudden change
from horizontal to vertical movement.
Symptoms and Signs: Severe pain in the
heel, unable to withstand the stress of
weight bearing.
Management: No bearing weight on heel
for 24 hours, RICE, and wear shock
absorbent footwear.
Cuboid Subluxation
Pronation and trauma have been
reported to be prominent causes of
cuboid subluxation.
Symptoms and Signs: Pain in the 4th
and 5th metatarsals as well as over
the cuboid. Often pain in the heel
area as well.
Management: Cuboid manipulation is
done to restore the cuboid to the
natural position. Orthotic helps
Tarsal Tunnel Syndrome
Symptoms and Signs: Complaints of
pain and paresthesia are typical,
along the medial and plantar aspects
of the foot.
Management: Antiinflamatory
modalities.
Pes Planus Foot
Pes planus is associated with excessive foot
pronation and may be caused by a number
of factors, including a structural forefoot
varus deformity, shoes that are too tight or
trauma that weakens supportive structures.
Symptoms and Signs: Pain or a feeling of
weakness or fatigue in the medial
longitudinal arch.
Management: Arch support with an
orthotic.
Pes Cavus Foot (High Arch Foot)
Etiology: Pes Cavus refers to a foot that has an
arch that is higher than normal.
Symptoms/Signs: Shock absorption is poor, thus
problems include general foot pain, metatarsalgia,
& hammertoes.
Management: If problems occur, orthotic should
be constructed using lateral wedge. Stretching of
the Achilles tendon and the plantar fascia is
helpful
Second Metatarsal Stress Fracture
(Mortons Toe)
Etiology: Abnormally short first metatarsal, thus
the second toe appears to be longer than the
great toe. Weight bearing becomes uneven, with
more weight now on the second metatarsal. Not
an injury but can develop into one.
Symptoms/Signs: Symptoms are those of stress
fractures in general.
Management: If there are no problems, nothing
should be done. If problems occur, an orthotic
with a medial wedge would be helpful.
Longitudinal Arch Strain
Etiology: Caused by subjecting the musculature of
the foot to stress produced by repetitive contact
with hard surfaces. There is a flattening or strain
to the longitudinal arch.
Symptoms/Signs: Pain is experienced only during
running or jumping. The pain usually appears just
below the posterior tibialis tendon.
Management: RICE followed by therapy and
reduction of weight bearing.
Plantar Fasciitis
Used to describe pain in the proximal arch and heel.
The function of the plantar fascia is to assist in
maintaining the stability of the foot and in securing the
longitudinal arch
Etiology: Tension develops in the plantar fascia during
the extension of the toes and during depression of the
longitudinal arch as a result of weight bearing
Symptoms/Signs: pain in the medial heel, and
eventually moves to central portion of plantar fascia.
Management: Extended period of treatment. Orthotic
therapy useful. Taping may reduce symptoms. Should
engage in Achilles tendon stretching, and stretch the
plantar fascia.
Jones Fracture
Etiology: Can be caused by inversion and plantar
flexion of the foot, by direct force, or repetitive
stress. Most common acute fracture to the
diaphysis at the base of the fifth metatarsal.
Symptoms/Signs: Immediate swelling and pain
over the fifth metatarsal. Healing is slow. Injury
has a high nonunion rate. Nonunion fractures heal
with cartilage between the bone fracture.
Management: Use of crutches with no
immobilization, progressing to full weight bearing
as pain subsides.
Metatarsal Stress Fractures
Etiology: Most common metatarsal stress
fractures involve the shaft of the second
metatarsal.
Symptoms/Signs: Over 2-3 week period, dull pain
begins to occur during exercise, then progresses
to pain at rest. Usually occurs when patients
increase the intensity or duration of their exercise.
Management: Partial weight bearing and 2 weeks
of rest. Return to running should be very gradual.
Bunions (Hallux Valgus
Deformities) & Bunionettes
(Tailors Bunions)
Etiology: Bunion occurs at the head of the first metatarsal. Often
caused by shoes. Bunionette the toe angulates toward the fourth
toe, causing an enlarged metatarsal head.
In all bunions, both the flexor and extensor tendons are malaligned,
creating more angular stress on the joint.
Symptoms/Signs: During formation there is tenderness, swelling,