1. Lower Body Evaluation ATC 328 The Foot and Toes Chapter 4

2. Foot and Toe Anatomy 26 bones –Plus sesamoids Rearfoot Midfoot Forefoot

3. Rearfoot Anatomy Calcaneus –Sustentaculum tali –Peroneal tubercle Talus

4. Midfoot Navicular –Posterior tibialis Cuneiforms Cuboid

5. Forefoot Anatomy 5 metatarsals –MP or MCP 14 phalanges –PIP –DIP –IP

7. Articulations

8. Arches Medial longitudinal arch Lateral longitudinal arch –Rarely injured Transverse metatarsal arch –1 st and 5 th metatarsal weight bearing

9. Medial Longitudinal Arch Calcaneus, talus, navicular, first cuneiform, first metatarsal Supporting structures –Plantar fascia –Plantar calcaneonavicular ligament “spring ligament” –Deltoid ligament –Long plantar ligament

10. Muscular Anatomy Intrinsic Muscles –Extensor digitorum brevis –Who cares!!! Extrinsic Muscles –Flexor digitorum longus –Flexor hallucis longus –Gastrocnemius/soleus complex –Peroneals –Plantaris –Tibialis posterior/anterior –Extensor digitorum longus –Extensor hallucis longus

11. Evaluation History –Blah, blah, blah Observation –Edema, effusion, deformity, etc Palpation Special Tests –ROM –MMT –Stability –Etc.

13. Toe Injuries MP, DIP, PIP, IP sprains 1 st MP joint sprain (turf toe) –Hyperextension mechanism –Rule out fx –Valgus, varus, glide testing –Treatment options

14. Metatarsal Sprains Intermetatarsal glides Tarsometatarsal glides Midtarsal glides ???

15. Pes Planus vs. Pes Cavus Most often are congenital abnormalities Other causes –Ligaments –Muscles –Accessory navicular –Tarsal coalition –Plantar fascia Navicular drop test Complications associated with these arch types?

16. Transverse Metatarsal Arch Most common problem is a loss of this arch. Consequences of fall TMA

17. Plantar Fasciitis Causes –Acute and chronic Signs and symptoms –Pain at medial calcaneal tubercle –AM pain –Decreased ROM/MMT Treatment Rupture –Acute and steroids

18. Heel Spurs Related to Plantar Fasciitis? Primary complaint –Pain with heel strike Treatment –Similar to plantar fasciitis –Surgery with chronic cases

19. Tarsal Coalition Bony, fibrous, or cartilaginous union of tarsal bones Most often affects talus, calcaneus, and/or navicular S/S –Rigid flatfoot –Calcaneal valgus –Forefoot abduction –NWB and WB identical Treatment

20. Tarsal Coalition

21. Tarsal Tunnel Syndrome Compression of posterior tibial nerve

22. Tarsal Tunnel Syndrome Causes –Acute: inversion or eversion –Chronic: structural and biomechanical abnormalities S/S –Plantar/medial foot pain –Positive Tinel sign Treatment

23. Metatarsal Fractures Stress fractures –Morton’s toe Acute fractures –Avulsion of base of 5 th –Jones’ fracture

25. Phalangeal Fracture S/S –Pain –Swelling –Positive compression/percussion –Crepitus Treatment –Buddy taping –Stiff insert –Relief pad/bar

27. Intermetatarsal Neuroma 3 interdigital nerve most common –Morton’s Neuroma Fibrous formation and demyelenization Causes –Thickened/shortened transverse ligament –Fallen transverse arch –Excessive forefoot weight bearing –Excessive pronation –Shoes?

28. Interdigital Neuroma S/S –Pain and paresthesia –Nodule –Pain with compression –Decreased pain barefoot –Pencil eraser “test” Treatment