• Hallux Valgus • Bunionettes • Hallux Rigidus • Hammer toes • Calcaneal apophysitis

Vocabulary

• Achilles tendon rupture • Ankle dislocation • Apophysitis • Great toe sprain • Heel spur (Sever’s disease) • Exostoses • Ingrown toenail • Metatarsalalgia • Morton’s neuroma • Osteochondritis dissecans • Pes cavus • Pronation • Pes planus • Plantar fascia • Stance phase of gait • Plantar neuroma • Plantar wart • Supination • Swing phase of gait • Talotibial exostoses • Tarsal tunnel syndrome

• • •

Arches

of

the Foot

Why do we have arches?

– Supporting body weight – Absorbs shock – Providing space for blood vessels, nerves, muscles

Medial longitudinal arch

– Medial border of the calcaneus to distal head of 1st metatarsal – Composed of calcaneus, talus, navicular, 1st cuneiform/metatarsal – Main ligament is the spring ligament and posterior tibialis muscle for reinforcement

Lateral longitudinal arch

– Lateral border of the foot – Composed of calcaneus, cuboid,5th metatarsal

Arches of the Foot

• • •

Anterior metatarsal arch

– Distal heads of the metatarsal

Transverse arch

– cuboid and 3rd cuneiform

Plantar fascia (plantar Aponeurosis)

– Thick white band of fibrous tissue – From medial tuberosity of calcaneus to proximal heads of metatarsals

Articulations •

Interphalangeal articulations

– DIP/PIP joints – Produces flexion/extension

•

Metatarsophalangeal articulations

– condyloid type of a joint – Flexion, extension, adduction, abduction

•

Intermetatarsal articulations

– Sliding joints which permits only gliding motions

Articulations

• •

Tarsometatarsal articulations.

• Saddle shape allows some gliding and limited flex/ext., Add/abduction.

Intertarsal articulations.

• Include the subtalar, midtarsal (transverse tarsal), anterior intertarsal (cuneonavicular). They are sliding joints

.

• Movements include flex/ext, abduction/add, inversion/eversion, also pronation/supination.

Ligaments of the Foot

• Page 405 fig. 17-5 •

Subtalar ligaments

• Articulation between talus and calcaneus • Talocalcaneal- ant/post, lat/medial • Major ligament is plantar calcaneonavicular= Spring lig.

•

Midtarsal ligaments

• Dorsal talonavicular, bifurcate, dorsal calcaneocuboid •

Anterior tarsal joints

• Cuneinavicular, cuboideonavicular, intercuneiform, cuneocuboid ligaments.

• Dorsal and plantar ligaments

Muscles and Movements

• Dorsiflexion/plantar flexion • Plantar- gastrocnemius, soleus, plantaris, peroneous longus, peroneus brevis, and tibialis posterior • Dorsiflexion- -tibialis anterior, extensor digitorum longus, extensor hallucis longus/ brevis, and peroneus tertius muscles • Inversion/adduction/supination • Tibialis posterior, flexor digitorum longus, flexor hallucis longus • Tibialis anterior and extensor hallucis longus • Eversion/Abduction/Pronation • peroneus longus, peroneus brevis • peroneus tertius, extensor digitorum longus • Movement of Phalanges

Anatomy Continued

•

Nerve supply.

• Tibial nerve the largest of the sciatic nerve supplies the muscle of the back of the leg and plantar surface of the foot.

• Common peroneal nerve smallest of the sciatic nerve supplies the muscles of the front of the leg and foot.

• Blood supply.

• The major portion of the blood supplied.

• To the foot is by the anterior/posterior tibial arteries.

•

Stance Phase or support phase

• • Starts with initial contact at heel strike and ends at toe off • Foot’s function at heel strike= shock absorber and adapts to uneven surfaces

Heel strike running gait

= initial contact of the foot is lat. aspect of calcaneus • • In running both feet are off the surface at the same time

Heel strike

= leg ext. rotated and foot supinated then the leg int. rotated and foot pronated

•

Swing phase or the recovery phase:

• Immediately after toe off and the leg is moved from behind the body to the front in preparation for heel strike.

• In this phase the leg is external rotated and foot supinates

• Structural concerns:

• Most people will at some time in their lives develop foot problems • Genetics and habitual use determines your own foot structure • Look for muscular/tendinous tightness, weakness, or hypermobility

• Footwear:

• Proper footwear (shoe/socks) are essential in injury prevention • Proper shoes for activity • Look for wear on shoes and proper arch support

•

Surface concerns:

• Surfaces that are irregular and vary in resistance can serve to strengthen the foot over time.

• A nonyielding surface can lead to acute/chronic injuries • A too resilient/absorbing surface can lead to early fatigue

Assessment

• History

• How did it happen? Did it happen suddenly or come on slowly?

• What was the mechanism? Type of pain? Is there any noises?

• Point to the exact site. When is the pain?

• What type of surface or footwear are you using ?

• Has this ever happened before?

Assessment

• Observation

• Are they favoring the foot? Are they limping?

• Is it deformed, swollen, discolored?

• Does it change color by weight bearing or not?

• Is the foot well aligned and whether it maintains its shape on weight bearing?

• Look for shoe wear.

Palpation - Bony

• Medial • Medial calcaneus • Medial malleolus • Talar head • Navicular tubercle • 1 st • 1 st • 1 st • 1 st cuneiform metatarsal MP joint phalanx • Lateral • Lateral calcaneus • Lateral malleolus • Peroneal tubercle • Cuboid • Styloid process of 5 th metatarsal • 5 th metatarsal • 5 th • 5 th MP joint phalanx Dorsal: 2-4 metatarsal/phalanges, 2-3 cuneiform

Palpation – Soft Tissue

• Medial/Plantar • Tibialis posterior • Deltoid ligament • Calcaneonavicular lig (spring lig) • Medial longitudinal arch • Plantar fascia • Transverse arch • Bursal head of 1 st metatarsal • Lateral/Dorsal • ATF • PTF • CF • Peroneal tendons • Extensor tendons of toes • Tibialis anterior tendon

Special Tests • Movements and neurological assessment

• Extrinsic/instrinsic foot muscles should be assessed for pain & ROM during active, passive, & resistive isometric movement • Tinel test= posterior tibial nerve • Tendon reflex: Achilles tendon (S1 nerve root) • Sensation throughout the whole foot

Special Tests • Pulses:

• Taken at the posterior tibial and dorsalis pedis arteries.

• Posterior tibial is taken inbetween the medial mallelous and achilles tendon.

• Dorsalis pedis is taken inbetween externor hallicus longus and extensor digitorum longus.

Special Test Continued

• Flexibility and rigid flatfeet.

• Check for flexibility put full weight bearing on foot then lift foot up.

• Flexible flatfoot is one that the medial longitudinal arch is flat then an arch is present when weight is removed.

• Care is proper shoes, exercise, arch supports or tape.