THE FOOT Chapter 18

Introduction The traditional sports activities in which athletes compete at the high school, college and professional level all involve some elements of running, jumping and changing directions. The function of the foot is critical. One instant the foot must be a mobile adapter to absorb shock, and the next minute it must become a rigid lever to propel the body forward. Injury is common.

Foot Anatomy Muscles and Movements: the movements of the foot are produced by numerous muscles Bones: the foot consists of 26 bones: 14 phalangeal, 5 metatarsal, and 7 tarsal

Foot Anatomy Articulations: five regions-inter-phalangeal, meta-tarsophalangeal, inter-metatarsal, tarsometatarsal, sub-talar, and mid-tarsal Stabilizing Ligaments: midtarsal joint is given added strength in its plantar aspect by the long plantar ligaments

Foot Anatomy Arches of the Foot Lateral longitudinal arch- outer aspect Anterior metatarsal arch- shaped by the distal heads of the metatarsals Transverse arch- extends across the transverse tarsal bones; it gives protection to soft tissue and increases the foot’s mobility

Ligaments

Ligaments

Foot Anatomy Nerve Supply: the Tibial nerve, largest division of the sciatic nerve, supplies the muscles of the back of the leg and the plantar aspect of the foot Blood Supply: major portion of the blood is supplied to the foot by the anterior and posterior Tibial arteries

Foot Biomechanics Pronation and Supination Excessive Pronation: major cause in stress injury/prolonged into the propulsive phase of running Excessive Pronation: compensatory movement at the subtalar joint will not allow the midtarsal joint to unlock, which causes the foot to remain excessively rigid

Assessing Foot Conditions History: Is this the first time this condition has occurred? How did the injury occur? What type of pain is there? Is there any alteration in sensation? On what type of surface has the athlete been training on? etc…………

Assessing Foot Conditions Observation: Is the athlete favoring the foot, walking with a limp, or unable to bear weight? Is the injured part deformed, swollen, or discolored? Is there pes planus (a flatfoot) or pes cavus (a high arch)? Is the foor well aligned? Does it maintain its shape on weight bearing?

Assessing Foot Conditions Palpation: besides determining pain sites, swelling, and deformities, palpation is used to determine and evaluate circulation.

Assessing Foot Conditions Special Tests: Movement- both, ex- and intrinsic foot muscles should be assessed for pain and range of motion during active, passive, and resistive isometric movement Tinel’s Sign- taping over posterior tibial nerve produces tingling distal to area. Numbness, tingling and paresthesia may indicate the presence of tarsal tunnel syndrome. cont…

Assessing Foot Conditions Special Tests: (continued)… Morton’s Test- with foot in a supine position, transverse pressure is applied to heads of the metatarsals, causing a sharp pain in the forefoot. Neurological Assessment- Reflexes and cutaneous distribution needs testing, skin sensation should be noted for any alteration

Recognition & Management Specific Injuries & Conditions Injuries to the Tarsal Region Etiology: occur laterally from severe inversion/dorsi-flexion force or medially from inversion and plantar flexion Symptoms and Signs: repeated trauma to the ankle; feels pain on weight bearing and complains of catching and snapping/swelling Management: X-ray/Protective immobilization/Rehabilitation; if it still contains then surgery is accountable

Recognition & Management Specific Injuries & Conditions Injuries to the Tarsal Region Etiology: fracture of talus; occur laterally from a severe inversion Symptoms and Signs: history of repeated trauma to the ankle/complains on weight bearing and of catching and snapping along with swelling Management: X-Ray; protective immobilization with non-weight bearing progressing to full weight bearing depending on symptoms

Recognition & Management Specific Injuries & Conditions Injuries to the Calcaneous Etiology: from landing after a jump or fall from a height Symptoms and Signs: immediate swelling and pain and an inability to bear weight Management: RICE; early range of motion exercises are suggested

Recognition & Management Specific Injuries & Conditions Arches Pes Planus Etiology: medial longitudinal arch appears to be flat and is sometimes said to be fallen Signs and Symptoms: pain and feeling of weakness or fatigue in the medial longitudinal arch; calcaneal eversion Management: if it’s not causing athlete any pain, then absolutely nothing should be done, if done then may content in causing unnecessary problems

Recognition & Management Specific Injuries & Conditions Arches Pes Cavus Foot Etiology: an arch that is higher than normal (aka) “claw foot” or “hollow foot” Signs and Symptoms: general foot pain, metetarsalgia, and clawed or hammer toes Management: no attempt should be made to correct the problem, may cause deformity

Foot Rehabilitation General: Rehab techniques for managing injuries to lower extremity & the foot, often require athlete to be non-weight bearing Weight Bearing: if athlete is unable to walk without a limp, non-weight bearing or limited weight-bearing crutch walking might be employed Flexibility: important to restore full range of motion following various injuries to the phalanges

Foot Rehabilitation Joint Mobilization Anterior/posterior calcaneocuboid glides are used for increasing adduction and abduction. (The calcaneus should be stabilized while the cuboid is mobilized) Anterior/posterior tarsometatarsal glides decrease hypomobility of the metatarsals Anterior/posterior talonavicular glides also increase adduction and abduction. (One hand stabilizes the talus while the other mobilizes the navicular bone)

Foot Rehabilitation Neuromuscular: involves a highly integrativem dynamic process involving multiple neurological pathways. Flexibility: important to restore full range of motion following various injuries to the phalanges

Foot Rehabilitation Foot Orthotics Pads and soft flexible felt supports. Semirigrid orthotics made of flexible thermoplastics, rubber, or leather. Functional or rigid orthotics are made from hard plastic and also require neutral casting. Neuromuscular: involves a highly integrativem dynamic process involving multiple neurological pathways.

Summary The function of the foot is critical to athletic performance. Evaluation and recognition of injuries and conditions can present a challenge to the athletic trainer. Many chronic conditions of the lower extremity can be related to foot mechanics. Management, rehabilitation, and prevention of foot conditions is essential.