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					The Foot
 Chapter 17
           Foot Anatomy
 26 Bones
    7 Tarsal
    5 Metatarsal
    14 Phalanges
 38 Joints
 4 Arches
Bones of the Foot
Bones of the Foot
Bones of the Foot
                Tarsal Bones

   Talus
   Calcaneus
   Navicular
   Cuboid
   Cuniforms
     Medial
     Intermediate
     Lateral
Metatarsals & Phalanges
         Sesamoid Bones
 2 (medial and lateral)
 Under great toe
 Functionpulley, increase leverage of
  tendons that control
  great toe
          Joints of the Foot
   Tibiotalar
   Talocrural
   Subtalar
   Talonavicular
   Calcaneocubiod
   Metarsocunieform
Joints of the Foot
          Metatarsophalangeal
           Joint
          Proximal
           Interphalangeal Joint
          Distal Interphalangeal
           Joint
             Regions of Foot
 Forefoot
   Metatarsals
   Phalanges
 Midfoot
   Navicular
   Cuboid
   3 Cuniforms
 Hindfoot
   Calcaneus
   Talus
Regions of the Foot
          Plantar Fascia
• Thick white band of fibrous tissue
  originating from the medial tuberosity of
  the calcaneus and ending at the proximal
  heads of the metatarsals
• Work with ligaments to support arches
  during weigh bearing and downward
  forces
                Foot Arches
 Functions
  1. Support body weigh in an economical fashion
  2. Absorb the shock of weight bearing
  3. Provide a space on the plantar aspect of foot for
     blood vessels, nerves, and muscles
  Medial Longitudinal Arch
• Highest of 3 arches of
  foot
• Calcaneus, Talus,
  Navicular, Cuniforms &
  1st three metatarsals
• Supports—
   – Ligaments:
      • Spring ligament
      • Plantar fascia
   – Tendons:
      • Tibialis posterior
      • Tibialis anterior
 Lateral Longitudinal Arch
• Lower and flatter
• Calcaneus, Talus,
  Cuboid, 4th & 5th
  metatarsals
• Supports—
  – Ligaments:
     • Short plantar ligament
     • Plantar fascia
  – Tendons:
     • Peroneus longus
         Transverse Arch
• Cuniforms, Cuboid, &
  5th metatarsal
Shoe Wear Patterns
         • Excessive Pronation
            – Wear out front of shoe
              under 2nd metatarsal
         • Excessive Supination
            – Wear out lateral border of
              shoe
         • Common Misconception
            – Wearing out the back
              lateral corner of the shoe
              means you pronate
            – This is normal wear pattern
Gait
                Pulse
•   Posterior Tibial Artery
•   Medial Malleolous
•   Dorsalis Pedis artery
•   Extensor Tendon
    Great Toe
         Foot Movements
 Dorsiflexion       Inversion
 Plantar Flexion    Eversion
 Pronation          Supination
             Muscles of Foot
Intrinsic Muscles           Extrinsic Muscles
• Relate to specific body   • Muscle outside a body
   part or bone               part, organ, or bone

• Flexor hallucis longus    • Gastrocnemius
• Flexor hallucis brevis
• Flexor digitorum longus
• Extensor digitorum
  longus
• Abductor hallucis
• Abductor digiti minimi
• Tibialis posterior
Muscles of the Foot
Muscles of the Foot
Muscles of the Foot
 Common
 Injuries
of the Foot
 Fractures & Stress Fractures
• Impair ability to perform
  competitively
• NWB
• More swelling & pain than
  ligament sprain
• Point tenderness present
• Obvious deformity often
  present
• Usually occur acutely;
  result of traumatic episode
Jones Fracture
 • Fracture to the
   diaphysis at the base
   of the 5th metatarsal
 • Repetitive stress,
   direct force, or
   inversion and PF of
   foot
 • Healing slow; high
   nonunion rate
   Retrocalcaneal Bursitis
• Swelling of the bursa at the back of the
  calcaneus under the Achilles tendon
• S/sxs:
  – Pain in heel
  – Painful to touch
  – Pain worse when
    rising on toes
  – Red, warm skin over
    back of heel
          Plantar Fascia
• Wide, non-elastic ligamentous tissue that
  extends from the anterior portion of
  calcaneus to heads of metatarsals
• Supplies support to longitudinal
  arch
           Plantar Fasciitis
• Strain/irritation of the   • Pain, tenderness on
  plantar fascia               bottom of foot near
• Caused by:                   heal (especially in
   – Overuse                   am)
   – Unsupportive footwear   • Untreated will lead to:
   – Tight Achilles tendon      –   Bone imbalance
   – Running on hard            –   Heel spurs
     surfaces                   –   Muscle strains
   – Chronic irritation         –   Shin splints
         Plantar Fasciitis—
            Treatment
• Correct training errors
• Ice
• Massage
• Evaluate shoes &
  activity level
• Arch support
• Heel cup or cushion
Arches
                 Pes Planus
• Flat foot
• Associated with excessive
  pronation
• Multiple causes:
    – Lack of shoe support
    – Weak muscles
•   Pain & weakness in medial longitudinal arch
•   Calcaneal eversion
•   Navicular bulging
•   Flattening of arch
              Pes Cavus
• aka Clawfoot, hollow foot
• Associated with excessive supination
• Shock absorption poor
• General foot pain and metatarsalgia
  common
• Abnormally short Achilles tendon
• Calluses ball and heel
              Arch Sprains
• Ligaments stretch,        • Causes:
  thus fail to hold bones     – Overuse
  of foot in position         – Overweight
• When arch                   – Fatigue
  weakened, it cannot         – Training on hard
  absorb shock                  surfaces
  normally                    – Non-supportive shoes
                              – Shoes in poor
                                condition
               Turf Toe
• Great toe strain
• Hyperextension of the first MTP joint of the
  big toe
• Treatment:
  – RICE & Support
  – Limit movement
  – Turf toe taping
                Heel Spur
•   Bony growth on calcaneus
•   Causes painful inflammation
•   Aggravated by exercise
•   As foot flattens, plantar
    fascia is stretched & pulled
    where it attaches to calcaneus
    calcaneus reacts by
     forming spur of bony material
          Heel Contusion
• Irritation of the lateral aspect of the heel
• Sudden stop-and-go or sudden change in
  movement
Heel Contusion—Treatment
• Cold application before activity
• Ice & elevation after activity
• Absorb shock—
  – Heel cups
  – Donut pad
               Sever’s Disease
• Traction injury at the apophysis of the
  calcaneus where the Achilles tendon
  attaches
• Young, physically active athletes
  – Comparable to Osgood-Shlatter’s disease (at
    tibial tubercle of knee)
• Pain occurs during vigorous activity and
  does not continue during rest
                Blisters
• Occur on any part of body where there is
  friction
• Most common on feet or heels
• Treatment Goals:
  – Relieve pain
  – Keep from enlarging
  – Avoid infection
      Blisters—Treatment
• Wash area thoroughly   • Prevention:
• Use sterile blade to     – Wear work gloves
  cut small hole in        – Break in new skin
  blister                  – Petroleum jelly/skin
                             lube
• Squeeze out clear
                           – Adhesive bandage
  fluid
• Do not remove skin
Prevention of Foot Injuries
• Selecting appropriate footwear
• Using shoe orthotic
• Foot hygiene
 Rehabilitation of the Foot
• Towel pulls
• TheraBand®
• Marble pick-up

				
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posted:11/7/2011
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