1. The Foot Lecture 9

2. The Foot one of the highest incidence of sport injuries
account for 20 to 25 % of injuries associated with running and jumping sports

3. Anatomy 26 bones - 14 phalangeal, 5 metatarsals & 7 tarsels
toes function to smooth the weight shift and to help maintain stability during weight bearing

4. Arches
function to support and distribute body weight from the talus through the foot , changing weight bearing conditions over varying terrain

6. Longitudinal Arch
from medial border calcaneus to head of 1st metatarsal
arch is higher medially than laterally - medial is usually the point of reference
supported by spring ligament (calcaneonavicular), plantar fascia
tib post. and ant provide dynamic support

8. Plantar Fascia
is a thick interconnected band of fascia that covers the plantar surface of the foot, providing support for the longitudinal arch
it extends from the calcaneus to the proximal phalanx of each toe
during the weight bearing phase of the gait cycle the plantar fascia functions like a spring to store mechanical energy that is release to help the foot push off from the surface

10. Transverse Arch
runs across the anterior tarsal (navicular cuboid and cuneiforms)
supported most by bony structure

11. Joints

12. 1) lnterphalangeal (IP)
PIP& DIP (except 1 st)
hinge joints with support on med and lat collateral , plantar and dorsal surface

13. 2) Metatarsophalangeal (MTP)
condyloid - 2 planes of movement ( flex/ ext, abd/add)
supported by med & lat collat. & plantar and dorsal surfaces

14. 3) Tarsometatarsal attached base of metarsal to tarsal bone
slight gliding in 2 planes (flex/ext , abd/add)
attached by plantar and dorsal lig

15. 4) lntertarsal Gliding joints
these joints allow the foot to adapt to uneven surfaces

16. Foot Mechanics
Pronation
Supination

17. Pronation
a normal amount of pronation is necessary in reducing peak forces sustained during impact
there is a link between excessive pronation and running related injuries
normal pronation 6- 8 degrees

18. Pronation problems.
loose and unlocked
2nd metatarsal #, plantar fasciitis, ant/post tibialis tendinitis, Achilles tendinitis,
tibial stress fractures, PFS ( patella femoral syndrome)

19. Supination Problems
lack of shock absorption
inversion ankle sprains , tibial stress syndrome, peroneal tendinitis, ITB friction syndrome, trochanteric bursitis

20. Dorsiflexion / Plantar Flexion
Motion occurring in the sagittal plane
DF – ankle flexion
PF – ankle extension
Inversion / Eversion
Movements at the subtalar joint
Inversion – medial rotation
Eversion – lateral rotation

21. ROM of Ankle

22. Common Foot Problems and Injuries

23. Hammer and Claw Toes
often congenital - can be caused by improperly fitted shoes - muscle contractures or malalignment of bony structures
hammer toes
involve extension of MTP joint and neutral position of PIP and flexion at the DIP joint

24. claw toes
are a flexion deformities of DIP and PIP joint and hyperextension of the MTP joint
both can lead to painful callus formation on bottom of toe or under MT head
surgery is often only solution to severe cases

26. Turf Toe Sprain of the plantar capsular ligament of the first toe
Results from forced hyperextension of the first toe
related to artificial turf - lightweight shoes that are too flexible and positions that require forced toe hyperextension ( as football linebackers and offensive lineman)

27. pain - tenderness - swelling at MTP joint
push off phase of running particularly painful - as with passive extension of great toe
Rx - ice, protection from excessive motion (taping) - or stiff -soled shoe
decrease activity - particularly running

28. Common Fractures often caused by repeated low magnitude forces
March # - 2nd metatarsal
Jone's # - base of fifth metatarsal -

29. Stress Fractures
Often found in runners especially long distance runners
Females tend to be more susceptible than males
2nd and 3rd more commonly affected , but a stress fracture may develop any where
MOI : overuse , however it can be due to a traumatic event

30. s/s Insidious onset of vague pain Tenderness to palpation
Possible loss of function
Bone scan
Decreased activity weeks
Surgical fixation if necessary

31. Hallux Valgus
bunion - typically found on the medial aspect of the MTP joint of the great toe
on lateral side of foot they are called - bunionettes
pronation of the foot - arthritis, and generalized ligamentous laxity can lead to thickening on the medial side of the first MT head

32. as condition worsens , the great toe may shift laterally and overlap the second toe
this condition is exacerbated by high heels, pointed shoes - thus it is more common in women than men
once deformity has occurred little can be done
tapping in more anatomical position may help – or the use of a toe spacer - otherwise surgery is indicated in severe cases

34. Retrocalcaneal Bursitis
pump bump
external pressure from a heel cup
excessive pronation
poorly padded heel counter
all these lead to swelling, redness of the skin and irritation of the bursa (retrocalcaneal bursa located between the anterior Achilles’ tendon and calcaneus)

35. pain on palpation , active plantar flexion
Rx - gentle stretching , shoe modification - heel lifts
pump bump - large bone spur commonly seen in runners and skaters

37. Morton's Neuroma plantar nerve becomes compressed between the MT heads
due to tight fitting shoes or pronated feet
this leads to irritation of the nerve - pain
Rx - larger shoes - arch supports (MT pads)
local injections

39. Blisters and Calluses
excessive localized pressure or friction between the skin and shoe
caused by shearing forces which cause fluid accumulation to separate the skin layers
fluid is usually clear - sometimes bloody

40. Calluses should be regularly shaved with a callous file or emory board
blood blisters may appear under calluses that are to large and become detached from the underlying skin

42. Preventing Blisters wear properly fitted shoes
break shoes in gradually
lubricants can be applied to susceptible areas (petroleum jelly, skin lube)

43. Athlete's foot (tinea pedis)
a common fungal infection can be spread during casual handling of contaminated socks or picked up in a shower often based on an individual susceptibility and may not affect certain people
characterized by extreme itching, burning and irritation on the sole of the foot and between the toes
Rx with topical antifungal agents and proper foot care

45. Toe Sprains tripping or stubbing
pain , dysfunction, immediate swelling
dislocation - obvious deformities
strap with next toe for a week to two weeks

46. Plantar Fasciitis
excessive tightness of Achilles tendon, excessive pronation , obesity
predisposing factors - training errors, overuse , hyperpronation
pain upon rising in morning - usually subsides with in a short period of time but builds trough out the day
point tenderness over medial calcaneus - increases with forefoot dorsiflexion and toe extension
Rx - taping of arch - foot orthoses
(heel spurs)

49. Ingrown toenail
Preventable with proper care, hygiene and nail care
Toenail should be trimmed straight across to prevent edges from growing under the skin on the side of the nail
Proper fitting shoes should be worn
Problems with shoe size , improper care of nails and sliding of foot in shoe may cause the edge to grow into the lateral nail fold and surrounding skin

50. The nail margin reddens and becomes very painful , may become infected
RX- soak the foot in hot (salty) water
Lift the nail bed and place cotton under the nail to elevate it from the skin fold
Apply antiseptic over the area daily
If infection occurs refer to doctor
Also can try to soak the toe and then cut a V in the centre of the nail
As nail grows it pull the nail away from under the skin
again if infected refer to doctor