Foot Injuries

© 2011 McGraw-Hill Higher Education. All rights reserved. Normal Gait Two phases: Stance or support phase which starts at initial heel strike and ends at toe-off Swing or recovery which represents time from toe-off to heel strike Figure 18-10 © 2011 McGraw-Hill Higher Education. All rights reserved.

© 2011 McGraw-Hill Higher Education. All rights reserved. Stance Phase Accounts for 60% of gait cycle Involves weight bearing in closed kinetic chain Five periods Initial contact (double limb support) Loading response (double limb support) Mid stance (single limb support) Terminal stance (single limb support) Pre swing Swing Phase Period of non-weight bearing Three periods Initial swing Mid swing Terminal swing Figure 18-11 © 2011 McGraw-Hill Higher Education. All rights reserved.

© 2011 McGraw-Hill Higher Education. All rights reserved. Running and walking gait have same components During running gait Loading and mid-stance = more rapid After toe off – period of no ground contact Stance phase = 33% of gait cycle © 2011 McGraw-Hill Higher Education. All rights reserved.

Three phases of gait: heel strike, mid-support, toe off

CALLUSES develop from friction excess skin on the ball/heel of the foot problems- can develop blisters underneath Care make sure shoes fit correctly shave off excess skin (pumice stone, file or callus shaver) stop at the pink layer

BLISTERS Caused by rubbing of top (epidermis) and bottom (dermis) layers H2O gets between the two layers Prevention: 2 layers of socks shoes that fit correctly vaseline smooth feet develop easier band aid/moleskin

Care 1) don’t pop unless you need to dry-no wet-yes 2) small incision with sterile object 3) drain fluid 4) antibiotic into blister 5) cover with band aid/donut 6) (optional) uncover at home to dry out

INGROWN TOENAILS Caused by: the toe nail growing into the tissue cutting the nail to short shoes that are to small Prevent cut toenails straight across Care cotton under nail V notch scrape down the center of the nail

HEEL BRUISE Care: RICE tape job crutches heel cup contusion to the fat pad under the calcaneous Care: RICE tape job crutches heel cup

TURF TOE results from playing on artificial surfaces and flexible footwear toe is snagged and hyper extended Care RICE Tape Crutches/splint Steel insole or hard soled shoes

JONES FX Fracture at the base of the 5th metatarsal Mechanism inversion w/ plantar flexion Assessed as a sprain, won’t heal, x-ray taken and then found

STRESS FX Usually seen in the metatarsals easily prevented Prevention: Rest Decrease mileage Shoes Change Surfaces Care Refer for X-ray

PES PLANUS flat feet, fallen arch Care Arch supports Orthotics Shoes

PES CAVUS High arch Cause Tight achillies, posterior musculature Care: Stretch posterior calf Deep-tissue massage Heel lifts

FALLEN TRANSVERSE ARCH Metatarsal heads fall Cause: surface shoes posture genetics Care: Orthotics RICE Refer if necessary for x-rays

BUNIONS ‘Hallux Valgus’ 1st metatarsal/phalange joint swells and forms callus, this causes the toe to be pushed laterally Cause: Shoes Genetics

BUNIONETTE Bunion on 5th metatarsal Care: tape exercise wedge surgery

METATARSALGIA General pain in ball of foot Cause: Surface Shoes Socks Genetics Injury Care: RICE Crutches Splint/Boot Change in surface/sport

MORTONS NEUROMA Nerve protrusion between MP joints Care: Donut RICE Don’t play with it!

Hyperflexion of PIP joint with hyperextension of DIP HAMMER TOES Hyperflexion of PIP joint with hyperextension of DIP Usually happens on 2nd and 3rd digits Cause: shoes (short/long) Care: Change shoes Tape Surgery

CLAW TOES One toe or all toes Contraction of the flexor tendons Toes end up constantly flexed Cause: Injury Shoes Care: Surgery to fix extensor tendon

HEEL BURSITIS calcaneal bursitis Also called; Haglund’s deformity and “pump bump” Care: RICE Donut Surgery-complications?

EXOSTOSES bone spurs Cause: Rubbing from shoes Injury Tendonitis Care: Donut-Stop rubbing Shoes Surgery-Complications?

PLANTAR FASCITIS Caused from tight posterior muscles Care: RICE Splints (day and night) Massage (posterior calf and foot) Shoes