Managing Common Foot Problems

Managing Common Foot Problems John J. Kasik MS ATC CPed Foot Types • Planus or Flat • Normal • Cavus or High Arched Planus or Flat Foot • Rigid/Mobile/Hyper-Mobile • Symptomatic/Asymptomatic/Functional • Forefoot Varus can be common “Normal” Foot • Mobile/Hyper-Mobile • May actually be the least common type Cavus or High Arched Foot • Mobile • Rigid/Arthritic – Lateral ankle sprains can be common – Metatarsalgia – Claw toes, Hammer Toes – Plantar flexed first ray is common Foot Sections • Rearfoot • Midfoot • Forefoot/toes Common Foot Conditions/Problems • Rear Foot – – – – – – Heel Pain/Spurs Inferior Calcaneal Bursitis Fat Pad Inflammation Achilles Tendonitis Plantar Fasciitis/Spring Ligament Sever’s Disease: Calcaneal Apophysitis/Retrocalcaneal Bursitis/Haglunds Deformity/Pump Bump Heel Pain/Spurs/Fat Pad Inferior Calcaneal Bursitis • Hard heel cup • Heel spur pad or donut • Gel heel cup • Accommodative orthotic with heel spur pad – Point tender area can be marked in cast or tray Achilles Tendonitis • Felt or Foam Heel Lift • Achilles Accommodation Pad • Decrease Calcaneal motion, inversion/eversion with Lodi taping or orthotic with extrinsic posting. Plantar Fasciitis/Spring Ligament • Regimented Calf Stretching Program • Lodi or Longitudinal Arch Taping • Rule out bone spur • Heel Lift • Full contact custom semi-rigid/rigid orthotic • Groove to accommodate tight PF or FHL Calcaneal Apophysitis/Sever’s Disease Retrocalcaneal Bursitis Haglunds Deformity/Pump Bump • Check shoe size with a Brannock device • Achilles stretching • Up to 3/8” heel lift, should be bilateral • Casting or walking cast in slight plantar flexion • Felt or Foam accommodation • Accommodate affecting shoe Common Foot Conditions/Problems • Midfoot – Cuboid Syndrome – subluxing cuboid – Os Trigonum contusion – Peroneal Tendonitis/Subluxation/Strain – Posterior Tibial Tendonitis/Strain – Flexor Hallucis/Digitorum Tendonitis – Tarsal Tunnel Syndrome Cuboid Syndrome • Manipulation/mobilization with foot whip or supine traction • Longitudinal arch taping • Felt padding to decrease frequency of subluxation • Arch support: custom or OTS Os Trigonum Contusion • Test with passive forced plantar flexion • Tape in dorsiflexion or dorsiflexion assist • Reverse heel lift/forefoot lift • Reduce forced plantar flexion • Often mistaken for retrocalcaneal bursitis Peroneal Tendonitis/Subluxation/Strain • Lateral heel wedge • Felt “j” pad applied to peroneal area in conjunction with lateral heel wedge • Lateral forefoot posting may relieve peroneal longus discomfort Posterior Tibialis Tendonitis/Strain Flexor Hallucis/Digitorum Tendonitis • Medial heel wedge or posting to relieve tension on the affected muscles • Bilateral heel lift to decrease fulcrum and relieve tension • Full contact arch support to support navicular Tarsal Tunnel Syndrome • Similar to carpal tunnel syndrome as an impingement etiology • Custom or OTS arch supports to increase spacing in the tarsal tunnel for over pronators • Shock absorbing insoles or supports for cavus arches Common Foot Conditions/Problems • Forefoot/Phalanges – Lis Franc Sprains – Jones & Stress Fractures – Bunion/Bunionette – Sesamoid conditions – Neuroma’s – 1st MP Joint conditions (Turf Toe) – Hammer Toes/Claw Toes/ Mallet Toes – Skin conditions: Corns, Calluses, Warts Lis Franc Sprains Jones & Stress Fractures • Surgical intervention • Walking cast/Cam walker – Temporary rigid orthotic • Custom Orthotic rigid enough to control – motion • Steel or Carbon fiber shank Bunion/Bunionette Sesamoid Conditions • Toe Spacers • First or Fifth ray cut • • out Rigid Forefoot Plate Control over pronation/reduce Compensated FF varus • Sesamoid • • • accommodations Rigid Forefoot Plate Toe Spacers 1st MP joint padding Neuroma’s • Check shoe width • Felt or Foam Metrise or Met bar • Permanent accommodation in orthotic • Refer to physician Turf Toe • Determine Etiology • Rigid plate for ROM limitation • First ray cut out • Sesamoid relief for plantar pain • Soft 1st ray plug with plate • Toe spacer in conjunction with above Hammer Toes/Claw Toes/Mallet Toes • Met bar • Toe Crest pad • Larger toe box in shoe • Callus pads Corns, Calluses, Warts • Determine etiology for calluses – Alleviate reason for friction • Felt accommodations on corns • Relief or depressions for warts calluses • Medicated pads • Reduction of affected areas Miscellaneous • Get a Brannock device • Use felt pads diagnostically • Moleskin for incremental posting • Harris mat • Foot biomechanics refers to other areas and vice versa Thank You