Chapter 4 The Foot and Toes continued

Range of Motion Testing  Focus on MTP joints (flexion & extension)  Bilateral comparison  Box 4-4 Foot Goniometry, page 113

 Active ROM (first MTP)  Extension  Flexion  Compensatory motion  Passive ROM  Figures 4-22 & 4-23, page 114  Resisted ROM  Box 4-5, page 115

Ligamentous and Capsular Testing  MTP and IP Joints  MCL, LCL, joint capsule  Overpressure  Box 4-6, page 116  Intermetatarsal Joints  Deep transverse ligament and interosseous ligaments  Gliding  Box 4-7, page 117

Ligamentous and Capsular Testing  Tarsometatarsal Joints  Dorsal and Plantar glide  Box 4-8, page 118  Midtarsal Joints  Dorsal and Plantar glide of cuneiforms  Box 4-9, page 119

Neurologic Examination  L4 – S2 nerve roots  Neurologic symptoms  Box 1-5, Chapter 1  Tarsal Tunnel Syndrome/Interdigital neuroma (Figure 4-24, page 117)

Pathologies and Related Special Tests  Improper biomechanics or result of compensation by foot for biomechanical deficits elsewhere in lower extremity

Arch Pathologies  Most commonly occur congenitally  Increasing or decreasing height of arch  Arch height (Figure 4-25, page 120)  Navicular drop indicates change in height from non-weight-bearing to weight- bearing

Pes Planus  Figure 4-26, page 120  Congenital origin, biomechanical changes, or acute trauma  Affects function of subtalar and calcaneocuboid joints  Acute – trauma to supporting structures  Accessory navicular (Fig. 4-27, pg 121)  Mechanical Factors

 Rigid (structural) vs. flexible (supple)  Box 4-10, page 122  Navicular drop test (Box 4-11, page 123)  Should not be left untreated

Pes Cavus  Figure 4-28, page 124  Congenital, neurologic, disease  Associated with stiffness and impaired ability to absorb ground contact forces  Dorsal pads under calcaneus and MT heads appear smaller than normal  Claw toes, calluses over PIP joints  Treatment options

Transverse Metatarsal Arch Pathology  Only slightly visible  Deficiency can produce pain under heads of second through fifth MTs  Intertarsal neuroma  Inspect, palpate plantar surface

Plantar Fasciitis  Table 4-7, page 125  Causes of the inflammation  Trauma to plantar fascia can lead to many problems  Signs and symptoms  Accompanied by other dysfunctions  Treatment options

Heel Spur  Exostosis of medial calcaneal tubercle  Relationship with plantar fascia  Similar signs, symptoms and treatments to plantar fasciitis

Plantar Fascia Rupture  Dorsiflexion of foot combined with extension of toes  Risk of rupture  Signs and symptoms

Tarsal Coalition  Bony, fibrous or cartilaginous union between two or more tarsal bones  Hereditary condition; calcaneonavicular, talonavicualr, talocalcaneal joints  Signs and symptoms  Treatment  Figure 4-29, page 126

Tarsal Tunnel Syndrome  Entrapment of posterior tibial nerve as it passes through tibial tunnel  Tunnel formed anteriorly by tibia and talus and laterally by calcaneus  Flexor retinaculum = fibrous roof (Fig 4-30, pg 127)  Acute, predisposing conditions, anatomical factors, biomechanics  Patient complaints  Evaluation/Treatment  Table 4-8, page 127  Figure 4-31, page 128

Metatarsal Fractures  Direct trauma or overuse  Base of fifth (Figure 4-32, page 128)  Jones’ fracture (Figure 4-33, page 129)  Stress fractures  March fractures  Signs and symptoms (Figure 4-34, page 129)  Management  Table 4-9, page 130

Phalangeal Fractures  Longitudinal force or crushing force  Figure 4-35, page 130  Signs and symptoms  Treatment

Intermetatarsal Neuroma  Entrapment of nerve between two MT heads  Morton’s Neuroma  Causes/predisposing factors  Signs and symptoms  Treatment  Figure 4-36, page 131

Hallux Rigidus  Progressive degeneration of first MTP joint  Hallux limitus/ankylosis  Causes  Signs and symptoms  Treatment  Figure 4-37, page 132

First Metatarsophalangeal Joint Sprains  Mechanism of injury  “Turf Toe”  Signs and symptoms  Management

On-Field Evaluation of Foot Injuries  Equipment considerations  On-field history  On-field inspection  On-field palpation  On-field ROM tests

On-Field Management of Foot Injuries  Plantar fascia ruptures  Fractures and Dislocations