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Bones of the Foot (1) 26 bones Phalanges = 14 Numbered 1-5 (big toe = Hallux = #1) distal Interphalangeal joint (DIP) proximal interphalangeal joint (PIP)

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Presentation on theme: "Bones of the Foot (1) 26 bones Phalanges = 14 Numbered 1-5 (big toe = Hallux = #1) distal Interphalangeal joint (DIP) proximal interphalangeal joint (PIP)"— Presentation transcript:

1 Bones of the Foot (1) 26 bones Phalanges = 14 Numbered 1-5 (big toe = Hallux = #1) distal Interphalangeal joint (DIP) proximal interphalangeal joint (PIP) Metatarsal phalangeal joint (MP) Metatarsals (numbered 1-5)

2 Bone of the foot (2) Tarsals- Fig 12-2 Calcaneous (heel bone) Talus (main weight bearing) Navicular- medial 3 cuneiforms Cuboid-lateral

3 The arches Fig Function to support and distribute body weight Three arches: Fig Medial longitudinal (higher) supported by calcaneal-navicular ligament (spring) Lateral longitudinal Transverse Plantar Fascia Supports longitudinal arch

4 The Ankle Fig 12-1/12-3 Ankle joint = talocrural joint Three bones Tibia (medial malleolus)-major weight bearing Fibula (lateral malleolus) Talus Hinge joint Dorsi-Flexion Plantar Flexion

5 Subtalar Joint The joint between the talus and the calcaneous Shifts during weight bearing (WB) Supination/inversion Pronation/eversion

6 Tibiofibular Joint -Fig 12-3 Composed of Tibia and Fibula Ligaments/Membrane Anterior Tibofibular Lig Posterior Tibofibular Lig Interosseious membrane- connects the tibia and fibula; runs the entire diaphysis of both bones

7 Ankle ligaments (1) – Fig 12-3 Medial Deltoid ligament -4 parts Triangular shape (very strong) Lateral Anterior talofibular (ATF) Calcaneofibular (CF) Posterior talofibular (PTF) Ankle and foot are composed of numerous ligaments; where ever two bones meet

8 Muscles of the Lower Leg Thick sheaths of fascia divide muscles into 4 compartments Anterior Compartment Dorsiflexion (DF), Toe Extension (EXT), Inversion (INV) Lateral Compartment Eversion (EV) Deep Posterior Compartment Toe Flexion (flex), Inversion (INV) Superficial Posterior (Plantar flexion (PF))

9 Nerves and Blood Supply Nerves Sciatic nerve branches into the peroneal (ant/lat) and tibial nerves (post) Blood Supply Femoral Artery →Popliteal artery → Anterior and Posterior Tibial artery Anterior Tibial becomes the dorsalis pedis artery →dorsal pedal on the dorsum of foot Posterior Tibial is located behind medial malleolus.

10 ROM DF-tibialis anterior, extensor digitorum PF- gastroc and soleus INV- tibialis anterior and posteror EV- peroneals Toe Ext.-extensor digitorum and hallucis Toe Flexion flexor digitorum and hallucis

11 Review Anklequiz.html Anklequiz.html pated/foot/achilles/achilles.html pated/foot/achilles/achilles.html

12 Prevention of Injury Stretch achilles tendon tight achilles increases risk of plantar fasciitis, achilles tendonitis, and ankle sprains Strengthen anterior leg muscles important for shin splints Strengthen lateral/medial leg muscles Strengthen intrinsic foot muscles Good shoes; change shoes, correct type of shoes for playing surface

13 Injury information Precursors = something that may predispose an athlete to that injury All injuries should be treated for symptoms thus RICE. This will not be listed with each injury but should be remembered HOPS includes information typically seen or heard during the HOPS assessment. Most injuries include swelling, discoloration etc in area, this is not included in slides

14 Lateral Ankle Sprain MOI: PF and/or Inv More common than medial ankle sprains due to (make up about 90% of ankle sprains): differing length of malleoli (lateral is longer) Stronger deltoid ligament Precursors: tight achilles, improper shoes, previous ankle injury HOPS and Tx See field strategy 12.2

15 Medial Ankle Sprain Less common then lateral ankle sprains MOI: eversion Sometimes accompanied by a fracture HOPS point tenderness over deltoid and anterior/ posterior joint line Swelling not as obvious Takes almost twice as long to recover in some cases

16 Achilles tendonitis Precursors: achilles tendon tightness, change in shoes, running surfaces, workout changes HOPS chronic injury pn during and after activity Thickening of the tendon Crepitation Pn with Resistive PF, Passive DF Tx: stretch achilles, heel lift, tape, ultrasound

17 Achilles Tendon rupture Precursors: athletes between 30 and 40, power sports (BB); recreational athletes HOPT MOI: push off with knee extending sharp pain, feels snap or pop “kicked in the back of the leg” visible defect/palpable defect positive Thompson test Excessive passive DF Tx: refer to physician

18 Medial Tibial Stress Syndrome (1) “shin splints” Precursors: achilles tendon tightness, change in shoes, running surfaces, workout changes, arch problems HOPS sometimes bilateral; pn along distal 1/3 of medial tibial border initially: pn at start of activity that decreases with activity, then recurring after activity Later: pain before during and after activity

19 Medial Tibial Stress Syndrome (2) HOPS (cont) Pn increased with AROM PF, INV Usually responds well to treatment Tx Cryotherapy stretching of achilles strengthen deep posterior muscle strengthen anterior muscles

20 Plantar Fasciitis Precursors: obesity, achilles tendon tightness, overuse, shoes HOPT chronic injury pn first thing in the morning point tenderness over the medial calcaneal tubercle Pn with toe extension and ankle DF TX- Hot and Cold Modalities, stretching, rest, orthodics, change in shoes, heel lift, tape, roll foot over soda can

21 Compartment Syndrome (1) “Volkman's Ischemic Contracture” Two types: Exertional (MOI:previous injury in leg, chronic onset); Read; **Exertional CS can lead to Acute CS Acute (MOI: blow to front of the leg) Acute-HOPT Increasing pain in the front of the leg firm tight skin in front of shin loss of sensation between 1st and 2nd toes

22 Compartment Syn (2) diminished pulse at dorsalis pedis artery Inability to DF ankle, or extend toes (progressive) The 5 Ps (ie, pain, pallor, paresthesias, paralysis, pulselessness) Tx Ice and Immobilize Get to physician (MEDICAL EMERGENCY) Abnormalities can occur within 30 minutes; irreversible damage can occur within hrs

23 “Turf” Toe Precursors: hard surfaces, lightweight, flexible shoes, artificial turf HOPT MOI-jamming of hallux, hyperextension of toe sport position requiring hyperextension Pn, point tnederness over 1st MP joint Push off phase of running is painful Pn with passive extension of the great toe Treatment (TX) taping, metatarsal pad, stiff soled shoes, manage symptoms

24 Ingrown toenail Precursors improper cutting of toenails, too small shoes, contant sliding of foot in shoes HOPT nail grown into the surrounding skin signs of infection around the nail bed Tx See field strategy 12.5

25 Motron’s Neuroma Precursors: tight fitting shoes, HOPT pn on the plantar side of the foot, usually between the 3rd and 4th metatarsal Pn and numbness radiates to the 3rd & 4th toes Pain relieved by Non weight bearing (NWB) Pn caused by squeezing the foot Treatment (TX) taping, metatarsal pad, wider shoes, cortisone shots, surgery

26 Stress Fractures Precursors: female athletes with menstrual irregularities (amenorrhea) increase in training regimen, old shoes common sides: tibia, fibula, neck of 2nd metatarsal HOPS pn on WB, relieved by NWB localized pn (often unilateral) Tx: complete rest 4-12 weeks, referral for bone scan

27 Jones Fracture Avulsion fracture of the peroneus brevis tendon where it attaches to the base of the 5th metatarsal Common with severe inversion ankle injuries HOPS: pn over base of 5th metatarsal MOI: severe, forceful inversion

28 Bunions- Hallux Valgus Medial aspect of 1st MP joint HOPT C/S- Shoes, congenital, lig. laxity, prolonged pronation of foot Angular deformity of the great toe Pain around the first MP joint (inflammation) Treatment (TX) taping, wider shoes, surgery last option

29 Tests ROM- good/bad; active/passive; perform bilaterally; award a % Strength-good/bad; perform bilaterally; award a % Special Test Thompson Test achilles tendon rupture Anterior Drawer ATF ligament Talar Tilt CF ligament Deltoid ligament Fracture Test- FS 12.6

30 Test Functional Test (p )- heel raises, walking, balancing, squatting, running, jumping, (progression is the key)

31 Specialized Rehab Towel crunches Theraband Exercises all ROM Picking up objects (marbles) BAPS (wobble board) Stability Trainers mv?Screen=CTGY&Store_Code=PP&Category_Code =BB Achilles Stretch straight = gastroc bent = soleus


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