1. © 2007 McGraw-Hill Higher Education. All rights reserved. The Foot PE 236 Amber Giacomazzi, MS, ATC

2. © 2007 McGraw-Hill Higher Education. All rights reserved. The foot is designed basically for: –______________ –____________________

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4. Arches of the Foot

5. © 2007 McGraw-Hill Higher Education. All rights reserved. Plantar Fascia

6. © 2007 McGraw-Hill Higher Education. All rights reserved. Muscle of the Foot and Lower Leg

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8. Prevention of Foot Injuries Highly vulnerable area to variety of injuries Injuries best prevented by selecting __________ _________, correcting __________ __________ _____________ through orthotics Foot will adapt to training surfaces over time –Must be aware of potential difficulties associated with ___________ and ______________ training surfaces

9. © 2007 McGraw-Hill Higher Education. All rights reserved. Recognition and Management of Specific Injuries Foot problems are associated with _______ ________, __________, ____________ ________ __________ or ______________ Sports place exceptional stress on feet ATC’s must be aware of potential problems and be capable of identifying, ameliorating or preventing them

10. © 2007 McGraw-Hill Higher Education. All rights reserved. Foot Assessment Athletes should be referred to qualified personnel for injury evaluation History –Generic history questions –Questions specific to the foot

11. © 2007 McGraw-Hill Higher Education. All rights reserved. Observations –Does athlete ____________, ______, or is _________________________? –Does foot color change w/ weight bearing? –____________________? –shoe? ____________________________?

12. © 2007 McGraw-Hill Higher Education. All rights reserved. Biomechanics of Gait Walking Gait Cycle –____________________ Running Gait Cycle –____________________

13. © 2007 McGraw-Hill Higher Education. All rights reserved. Palpation –Should assess the bony anatomy first Checking for deformities and areas of tenderness –Assessment of soft tissue (muscles and tendons) will allow for detection of _______ __________, _________, ___________or _____________________ –Circulation must also be monitored using the ______________________ Located on ______________________________

14. © 2007 McGraw-Hill Higher Education. All rights reserved. Retrocalcaneal Bursitis (______________) –Cause of Injury The ______________ bursa becomes chronically irritated/inflamed by constant rubbing or pressure from heel contour of shoe causing _____________ –Sign and Symptoms Tenderness, swelling, warmth, redness May progress to palpable and tender bony bump on back of ______________ –Treatment ______________________ Shoe with a different ___________

15. © 2007 McGraw-Hill Higher Education. All rights reserved. Heel Bruise –Cause of Injury Caused by sudden ________, ______ or __________ ____________, ______________________ –Signs and Symptoms _____________in heel and is ______ to withstand stress of __________________ May progress to chronic inflammation of bone covering –Treatment Reduce ____________ for ______, _____ and ________’s Resume activity with heel cup or doughnut pad after pain has subsided (be sure to wear shock absorbent shoes) Applying tape can also be effective in generating a “heel cup”

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17. Plantar Fasciitis –Cause of Condition _____________________________ Change from rigid supportive footwear to flexible footwear Poor running technique ___________________, _______________, __________________, __________________ complex Running on soft surfaces, shoes with _____________ –Sign and Symptoms Pain in ______________ heel, along ____________ _________________ arch Increased pain in _________, loosens after ________ ________, pain with __________________________

18. © 2007 McGraw-Hill Higher Education. All rights reserved. –Treatment Extended treatment (___________) is required __________ therapy is very useful (soft orthotic with deep heel cup) Simple arch taping, use of a ____________to stretch Vigorous ___________stretching and exercises that increase ______________________________ __________and occasionally __________________

19. © 2007 McGraw-Hill Higher Education. All rights reserved. Metatarsal Fractures –Cause of Injury Direct force or by placing torsional/twisting stresses on bone –Signs and Symptoms Difficult to distinguish ________from _________in this case Generally present with ________, ________, ______________ and possible deformity _________ will be necessary to distinguish fx from sprain –Treatment _____________ –RICE for swelling _________________________________________________ _________________________________________

20. © 2007 McGraw-Hill Higher Education. All rights reserved. Jones Fracture –Cause of Injury Fracture of metatarsal caused by ___________ or _____________________________ forces Most common = base of ______________________ –Sign and Symptoms _____________________, pain over 5th metatarsal May feel a “______” High _________________ and course of healing is ____________________ –Treatment Generally requires ______weeks __________________ with _______________if non-displaced If nonunion occurs, ___________________may be required

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22. Metatarsal Stress Fractures –Cause of Injury _____ metatarsal fracture (____________________) Change in ____________, __________, _______, or ______________________ Often the result of ______________________of the foot or ________________(terrain, footwear, surfaces) Often associated with _______________ –Signs and Symptoms Pain and tenderness along second metatarsal Pain with running and walking Continued pain/aching when non-weight bearing

23. © 2007 McGraw-Hill Higher Education. All rights reserved. –Treatment Determine cause of injury Generally good success with ______________ and training modifications (______________, _________ ________) for _____ weeks Return to running should be gradual over a _____ week period with ____________________

24. © 2007 McGraw-Hill Higher Education. All rights reserved. Metatarsal Arch Strain –Cause of Injury ____________ of metatarsals caused by _______in ligaments – results in __________________of foot Will appear to have __________ arch –Signs and Symptoms _______ or ________in metatarsal region Point tenderness (_______________), weakness _________________may form in area of pain –Treatment Pad to elevate metatarsals just behind ball of foot ______________ of foot muscles and _____________ stretching

25. © 2007 McGraw-Hill Higher Education. All rights reserved. Longitudinal Arch Strain –Cause of Injury Result of increased stress on arch of foot Flattening of foot during __________ _______ causing _______on arch (appear suddenly or develop slowly) –Sign and Symptoms Pain with ________and ________, usually below ________________tendon, accompanied by pain and _____________ May also be associated with sprained ______________ ligament and ____________________________strain –Treatment Immediate care, RICE, reduction of weight bearing. Weight bearing must be pain free Arch taping may be used to allow pain free walking

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27. Fractures and Dislocations of the Phalanges –Cause of Injury ____________________, ___________, ______ __________________ –Signs of Injury ___________ and ______________ Swelling and discoloration ________________with dislocation –Care Dislocations should be reduced by a physician _______ may occur with ________or ___________ _______ Buddy taping is generally sufficient Shoe with larger toe box may be necessary

28. © 2007 McGraw-Hill Higher Education. All rights reserved. Bunion (_________________________) –Cause of Injury ___________of ____ metatarsal head; associated with _______________; shoes that are too _______, _______ or _________ ________ becomes inflamed and _________, enlarging joint, and causing _____________________of great toe –Signs and Symptoms Tenderness, swelling, and enlargement of joint initially As inflammation continues, _________________ causing painful ________________

29. © 2007 McGraw-Hill Higher Education. All rights reserved. Care –Wear correct fitting shoes, appropriate orthotics, pad over 1st metatarsal head, tape splint between 1st and 2nd toe –Surgery may be required during later stages of condition

30. © 2007 McGraw-Hill Higher Education. All rights reserved. Morton’s Neuroma –Cause of Condition Thickening of ___________ (_________________) at point where nerve divides into digital branches Commonly occurs between ___ and ____ met heads where ________and _______plantar nerves come together –Signs of Condition Burning ___________ and severe _____________ pain in forefoot Pain relieved with non-weight bearing Toe _____________ ____________symptoms

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32. Care –Teardrop pad can be placed between met heads to increase space, decreasing pressure on neuroma –Shoes with wider toe box would be appropriate

33. © 2007 McGraw-Hill Higher Education. All rights reserved. Turf Toe –Cause of Injury ______________ injury resulting in sprain of ___ ___________________ joint May be the result of single or repetitive trauma –Signs and Symptoms Pain and swelling which increases during _________ in __________, _______, and _________ –Care Increase rigidity of forefoot region in shoe Taping the toe to prevent __________ Rest and discourage activity until pain free –3-4 weeks may be required for pain to subside

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35. Calluses –Cause of Condition Develop from ________– may be painful as fatty layer loses __________ and ____________effect May be vulnerable to _______and ________ and possible __________development underneath –Care Emery callus file may be necessary Massaging with small amounts of lotion may be helpful _________ or __________– care must be exercised Can be prevented –Shoes that ___ ______________are recommended –Wear at least _____ layer of socks –Apply ________________ to reduce ____________

36. © 2007 McGraw-Hill Higher Education. All rights reserved. Blisters –Cause of Injury __________forces on skin – results in development of _____________________ between layers of skin Wearing appropriate footwear (_____ and _____) and applying lubricants may help to reduce friction –Care Take action to reduce friction (apply lubricants, cover with tape/band aid/donut pad) ________________in order to prevent __________ Puncturing may be necessary if ______________ is to great and is causing __________________

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38. Ingrown Toenails –Cause of Condition Leading edge of nail grows into nearby soft tissue –Care Shoes should be appropriate ______ and _______ Correct trimming of nails Nail should be left sufficiently long Should be cut short enough that it is not irritated by shoes or socks Treatment may require ______ and _______ toenail with ______ in order to lift nail away from soft tissue Cutting a _____ notch toward the infected side

39. © 2007 McGraw-Hill Higher Education. All rights reserved. ____________Hematoma –Cause of Injury ___________, ________an object on toe, ____________ another object Repetitive _________ forces on toenail –Signs of Injury Accumulation of blood underneath toenail Likely to produce ____________ and ultimately ______of _____ –Care ______ immediately to reduce pain and swelling Relieve pressure within 12-24 hours (_____ or ___ nail) – must be ________ to prevent ___________

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