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Therapeutic Foot Care Certificate Program Part I: Online Home Study Program Program Glossary A • • • • • • • • • • • • • • • a-: Prefix - without, not, lack of, e.g. ataxic muscular coordination AADE: American Association of Diabetes Educators ab-: Prefix - from, away from, e.g. abduction Abduct: Motion of the distal segment away from the midline Abduction: Movement of a body part away from the median plane of the body Abrasion: Irritation or injury of skin tissue that leads to a scraped area of the skin Acceleration: The swinging limb catches up to and passes the torso Accommodative foot orthosis: An orthotic device designed to try to control abnormal function of the foot. They are used to cushion, pad or relieve pressure from a painful or injured area on the bottom of the foot, and can be fabricated from a three-dimensional model of the foot by taking a plaster mold of the foot, having the patient step into a box of compressible foam, or using a mechanical or optical scanner to scan the foot ACE: American College of Endocrinology Achilles tendinitis: Inflammation and degeneration of the achilles tendon, the large tendon located in the back of the leg that inserts into the heel, that may develop following sudden changes in activity level, training on poor surfaces, or wearing inappropriate footwear, especially when participating in activities that involve sudden stops and starts and repetitive jumping (e.g., baseball, basketball, football, tennis, running, dancing). In some cases even prolonged periods of standing can cause symptoms Achilles tendon: Largest tendon in the back of the leg, joining the heel to the calf muscle Active movement: Patient moves a part of the body Active propulsion: The point of time in the gait cycle in which there is heel off of the support limb that ends with heel contact of the swing limb ad-: Prefix - to, toward, near, e.g. adduction -ad: Suffix - to, toward, near, e.g. cephalad 1 • ADA: American Diabetes Association • Adduct: Motion of the distal segment towards the midline • Adduction: Movement of a body part toward the median part of the body • -algia: Suffix - refers to pain, e.g. metatarsalgia • ambi-: Prefix - both, both sides, e.g. ambidextrous • Ambulate, ambulation: Walking about • amphi-: Prefix - on both sides, e.g. amphiarthrosis • Amphiarthrosis: A form of articulation permitting little motion (e.g.: pubic symphysis) • Angle of gait: The angle the longitudinal axis of the foot makes with the line of progression. The average gait angle is 7° toe out per side or 12° to 15° total • Ankle foot orthosis (AFO): A mechanical device used to support and align the ankle and foot, to suppress ankle and foot muscles when overactive, to assist weak and non-functional muscles of the ankle and foot, to prevent or correct ankle and foot deformities, and to improve the functions of the ankle and foot • Ankle gauntlet: Lace-up or velcro fastened ankle brace that helps resist inversion and eversion ankle injuries • Ankle joint: Also known as the talocrural joint (TCJ), this is the joint which connects the proximal end of the talus to the malleoli of the tibia and fibula, forming the “hinged” ankle joint • ankyl/o-: Prefix - refers to a stiff joint, e.g. ankylosis • Antagonist: A muscle whose action is the direct opposite of that of another • Antalgic gait: Walking with a limp to minimize pain on weightbearing structures • anter/o-: Prefix - before, in front of, e.g. anterolateral • Anterior, ventral: The front part of the body • Anterolateral: Away from midsagittal • anti-: Prefix - against, e.g. antifungal • Arch pain: Inflammation and/or burning sensation at the arch of the foot that can be caused by a structural imbalance or an injury to the foot: the most frequently cause is plantar fasciitis • Arch strain: Inflammation and/or burning sensation at the arch of the foot that can be caused by a structural imbalance or an injury to the foot: the most frequently cause is plantar fasciitis • Arch support: Off-the-shelf or custom made orthotics used to support the transverse and longitudinal arches of the pronated foot • Arteries: Blood vessels which transport blood away from the heart 2 • arthr/o-: Prefix - refers to a joint, e.g. diarthrosis • Arthritis, rheumatoid: State characterized by inflammation of joint or joints • Articular cartilage: Cartilage found at the joints • Asymmetric neuropathy: Nerve damage that affects only one side of the body • Autonomic neuropathy: A neuropathy of the autonomic nervous system that affects internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs B • Back strap: A piece of fabric or leather that is located atop the shoe at the upper back used to hold the shoe on the foot • Balance: Equalization or opposing forces • Ball: Width of the sole at the metatarsal heads • Base of gait: The horizontal distance from one heel strike to the next heel strike • BCP: Board for Certification in Pedorthics • Beta cell: The cell type found in the islets of Langerhans in the pancreas, beta cells make insulin and release it into the blood stream • bi-: Prefix - which refers to two, e.g. bilateral • Bilateral: Pertaining to right and left sides • Biomechanical strategies: Methods of addressing physical forces that place wear and tear on the foot during the walking or running gait cycles • Biomechanics: The study of motion in individuals as it relates to internal and external forces that cause or influence movement, i.e. the study of movement and physics of the physical form; the science of locomotion of the human body • Blood glucose: The main sugar that the body makes from food that is ingested. The primary source of glucose is carbohydrates, however, fats and proteins can provide some glucose as well. Glucose is the major source of energy for living cells and is carried to each cell through the bloodstream, and requires the presence insulin in order for the glucose to be uptaken in cells • Blucher: Front-laced shoe in which the quarters are not attached distally to the vamp, giving more allowance at the throat and instep in fitting • Boyd: Amputation at the heel of the foot • Breathability: The ability to allow air exchange to the foot through the material of the shoe 3 • Bubble or balloon patch: A permanent external modification made to the upper of the shoe by adding material to accommodate a bony prominence on the foot • Bunion shield: A device that is placed on the foot and intended to comfort, protect, and moisten painful bunions by molding to the foot, realigning the big toe, and providing immediate relief • Bunion: One of the most commonly occurring foot conditions. Also known as hallux valgus, a bunion is an inflammatory swelling of the bursa over the metatarsophalangeal joint of the great toe, characterized by an abnormal prominence of the inner aspect of the 1st metatarsal head, accompanied by bursal formation, and resulting in a lateral or valgus displacement of the great toe, bunions are painful swollen areas that occur at the hallux, or great toe • Bunionette: Also known as a tailor’s bunion, this is a bunion that occurs at the base of the fifth toe, and is much more common in women than in men, primarily because of wearing high heels • Buttress: A permanent external modification made to the midsole, outsole, and upper of the shoe, intended to bolster the support available through the midfoot C • Cadence: Also known as step rate, cadence refers to the steps per minute as an individual walks. The average cadence is between 101 to 122 steps per minute, and is directly related to an individual’s height • Calcaneal apophysitis: Also known as Sever’s Disease, this is an inflammation of the cartilaginous gap in the calcaneus that occurs in children between the ages of 8-12 • Calcaneal heel spur: Calcaneal exostosis formation secondary to a break in the periosteum of the calcaneus due to tensile forces in the foot. Tends to be associated with plantar fasciitis due to chronic irritation at the calcaneal tuberosity • Calcaneus: The largest of the tarsal bones; the calcaneus forms the heel and articulates with the cuboid anteriorly and the talus • Calluses: Thick areas of skin that form in response to repeated pressure and friction that are intended to protect the skin and the structures beneath it from injury • Cancellous or Spongy Bone: Soft bone texture primarily present in the heads of bone and near the marrow cavity • Capillaries: Small vessel connections between arteries and veins which provide nutrition to tissues and remove waste products 4 • Caudal: Situated beneath or on the underside or inferior side of the body; toward the tail • Cavus (Pes Cavus): Hollow foot, an exaggeration of the normal arch • Cephalad: Toward the head or anterior section of the body • Charcot foot: A foot complication associated with diabetic neuropathy that results in destruction of joints and soft tissue. Also called "charcot's joint" and "neuropathic arthropathy" • Chopart: Amputation of the foot, with the calcaneus, talus, and other parts of the tarsus being retained • chrondr/o-: Prefix - refers to cartilage, e.g. chondromalacia • Chukka: Three-quarter Blucher boot with two or three eyelets or velcro closure • circum-: Prefix - around, e.g. circumduct • Clawtoe: A condition in which there is a high arched foot and toes hyperextended at the metatarsophalangeal joint and flexed at the distal joints • Clogs: Shoes with no back (contour) • Compact or dense bone: Highly vascularized bone tissue found in the diaphysis of the bone • Compartment syndrome: A condition that arises when there is increased pressure within a small space, or compartment, that leads to a decrease in circulation and function of all tissues which are within that space • Composition: Various materials, which are pulverized, compressed and held with a binder to form a sheet material for insoles, midsoles and heel bases, and other components • Compression force: A force that pushes along both ends of a structure and causes compression of the object • Conform: Ability of a material to be molded to the shape of the foot • Contralateral: Located on the opposite side of the body • Contusion: More commonly known as a bruise, a contusion results from an impact to the body that crushes underlying muscle fibers and connective tissue with no breaks to the skin • Cookie: Longitudinal arch pad • Corn pad: Mechanical barrier product that limits friction between toes and shoes. Pads are sometimes medicated to wear away excess skin • Corns: Thickened areas of skin that form in response to excessive pressure and friction, as the result of the body's attempt to protect the skin and the structures beneath it 5 • Counter: A stiff piece of leather or heavy material, placed around the heel of a shoe between the lining and the outside of the shoe, that is intended to strengthen the back of the shoe and keep its shape • Cranial: Toward the head • Crossover toe: A condition in which there is joint instability of the second toe leading to misalignment and drift • Cuboid: On lateral side of foot, articulates proximally with calcaneus and distally with bases of fourth and fifth metatarsal shafts • Cuneiforms: Three wedge-shaped bones located between distal aspect of navicular and bases of three medial metatarsal shafts • Custom foot orthosis: An internal foot device manufactured through the use of a 3-D foot image, intended to accommodate bony deformities, and/or modify movement patterns of the foot and lower extremity • Custom-molded shoe: Shoe molded from a full-dimensional cast of a patient’s foot • cutane/o: Prefix - refers to skin, e.g. subcutaneous D • -dactyl/o: Suffix - term that refers to a finger or toe digit, e.g. syndactyly • Deceleration: Forward movement of the limb is slowed down to position the foot for heel strike • Deep: Located internal to the surface of the body, e.g. muscle, arteries • derm/a: Prefix - refers to the skin, e.g. dermatology • -desis: Suffix - to bind or stabilize, e.g. arthrodesis • Diabetes mellitus: A metabolic disease that occurs when the body is not able to use glucose for energy and growth. Insulin is either absent or not well utilized in the body, which leads to the inability of cells to take in glucose for use • Diabetic retinopathy: Damage to the retina of the eye, caused by damage to the retinal blood vessels resulting from diabetes. Retinopathy is a leading cause of blindness • Diaphysis: The elongated cylindrical portion (the shaft) of a long bone, between the ends or extremities, which are usually articular and wider than the shaft • Diarthrosis: A movable joint (e.g.: synovial joints) • Digital fracture: Contact fracture of the phalanges of the foot, most commonly located at the fifth toe, but also found at the third and fourth toes • Dispersion pad: Pads that evenly redistribute weight in the foot 6 • Distal interphalangeal joint (DIP): Forefoot joint located between the middle phalanx and the distal phalanx of each toe • Distal neuropathy: Nerve damage that affects the hands and/or the feet • Distal: Some part of the body that lies away from the central portion, or trunk, of the body; further away from the point of insertion • dors/o-: Prefix - term that refers to the back or top of the foot, e.g. dorsolateral • Dorsal: Top of the foot • Dorsiflexion: Movement of the foot whereby the foot or toes move upward toward the shin, e.g. Foot off of gas • Dorsum: Top aspect of the foot • Double support phase: Both limbs are in contact with the ground simultaneously • Double support: The phase of gait that encompasses the period of time when both feet are on the ground, and occurs twice in the gait cycle. Consists of initial double support and terminal double support • Doubler: An interlining, cemented in place to the upper part of a shoe and located between the toe lining and the vamp, is used to provide additional padding to the forepart of the shoe, and to maintain the shape of the shoe • Drop foot: A condition that results in excessive ankle plantarflexion in the terminal swing as a result of insufficient dorsiflexors • dys-: Prefix - refers to a bad, painful, or difficult condition, e.g. dysfunction • Dysesthesia: impaired or painful touch sensation E • Edema: Accumulation of fluid in the tissues • Elevation: Material added to the plantar aspect of the shoe for limblength discrepancies • endo-: Prefix - refers to an inner location, within something, e.g. endoscopy • epi-: Prefix – refers to an area upon or surrounding, e.g. epidermis • Epiphysis: The end of a long bone, usually wider than the shaft, and either entirely cartilaginous or separated from the shaft by a cartilaginous disk • eryth-: Prefix – refers to something red in color, e.g. erythematous, erythrocyte • -esthesia: Suffix -term which denotes feeling or sensation, e.g. anesthesia 7 • Eversion: Turning away from the midline of the body • Evert: Motion away from the midline • Exostosis: Another name for a spur, an exostosis is a growth or projection that arises off the surface of the bone due to chronic irritation of the site • Extension: Movement of a joint in the body so that the angle between the bones of the limb and at the joint is increased • Extensor digitorum longus: Runs along anterior surface of tibia along dorsal aspect of foot and extends to four toes; function is to extend toes and dorsiflex the ankle • Extensor hallucis longus: Runs along anterior surface of fibula and crosses anterior to the ankle joint into dorsal surface of distal phalanx of hallux; function is to dorsiflex the hallux and ankle joint • Extensor: Muscle that straightens a joint and moves a limb farther from the body • Extrinsic muscle: A muscle which originates outside of the part of the body where it is found or upon which it acts F • Fascia: Tough fibrous membrane which covers muscles and other soft structures of the body, and can serve to join bones or separate muscle • Fibula: Located on lateral aspect of leg and is a more slender bone – distal end is the lateral malleolus, part of the ankle joint • Fixator: An accessory muscle that serves to steady a part • Flange: A projected edge • Flare: Widened heel or sole base; permanent external modification made to the shoe, especially at the midsole and outsole, intended to widen the base of support on the medial or lateral portions of the shoe • Flexion: Bending a joint in the body so that the angle between the bones of the limb and at the joint is decreased • Flexor digitorum longus: Located at the middle of the posterior tibial surface, leads to tendon that runs behind medial malleolus along plantar surface of foot and inserts into distal phalange of lesser toes; function is gripping of the lesser toes, and assist in plantarflexion of the ankle joint • Flexor hallucis longus: Location begins at lower two-thirds of posterior surface of fibula and runs along plantar of surface foot inserting into base of hallux; function is to flex the hallux and assist in plantarflexion of the ankle joint • Flexor: A muscle that bends a joint and brings a limb closer to the body 8 • Foot care: Active participation in taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses, which can all lead to amputation. Good care includes daily examination of the feet, toes, and toenails and wearing properly fitted shoes and socks or stockings • Foot flat: The moment in time during the stance phase when the foot is flat on the ground • Fracture: A split or a break of a bone, due to a contact or pressure in excess of that which the bone can withstand • Functional foot orthosis: An orthotic device used to correct abnormal foot function as well as correct for abnormal lower extremity function. There are various types and some may also attempt to accommodate painful areas on the plantum of the foot. These are generally made of flexible, semi-rigid, or rigid materials fabricated from a three-dimensional model of the foot by taking a plaster mold of the foot, having the patient step into a box of compressible foam, or using a mechanical or optical scanner to scan the foot • Functional shoe: Shoe designed to change the biomechanics of a person’s gait G • Gait cycle: The activity that occurs between heel strike of one limb, the reference limb, and the subsequent heel strike of that same limb • Gait stride: The distance from initial contact of one foot to the following initial contact of the same foot • Gait: The rhythmic alternating movements of the two lower extremities, which result in the forward movement of the body. Simply stated, it is the manner in which we walk • Gastrocnemius: Has two heads, medial, and lateral, and runs along posterior surface of calf into the achilles tendon; function is to assist the soleus in flexing the ankle joint • Gastroparesis: A form of neuropathy that affects the gastrointestinal tract, which keeps food from being digested properly and from moving through the GI tract in a normal way, resulting in vomiting, nausea, or bloating and interfering with diabetes management • Genu valgum: Also known as ‘knock-knee’, genu valgum is a valgus knee deformity in which the lower legs distal to the knees point away from the midline, the knees are abnormally close together, and the space between the ankles is increased • Genu varum: Also known as ‘bow-leg’ genu varum is a varus knee deformity in which the lower legs distal to the knees point toward the 9 • • • • • midline, the knees are abnormally separated, and limbs of the lower extremity are bowed inward Geriatric: Older people in the physiologic and pathologic aspects Girth: Circumferential dimension measured around the last Glucose tolerance test: A test given to an individual to measure his/her ability to process glucose. The test is given in a lab or doctor's office in the morning before the person has eaten. A first sample of blood is taken from the person. Then the person drinks a liquid that has glucose in it. After one hour, a second blood sample is drawn, and, after another hour, a third sample is taken. The object is to see how well the body deals with the glucose in the blood over time Great (Big) toe interphalangeal joint: The joint between the two phalanges of the big or great toe Ground reaction force (GRF): The force generated when the foot contacts the ground, and is equal but opposite to the force the foot applies to the ground H • Haglund’s disease: A common condition in which there is an increase or thickening of the lateral side of calcaneus, which causes it to become more prominent; can result in abrasion, inflammation, and/or bursitis to the area • Hallux rigidus: The great toe, a condition in which walking is painful • Hallux valgus: A deviation of the great toe toward the outer or lateral side of the foot • Hallux: Great or big toe • Hammer toe shield: A mechanical barrier product that limits friction between toes and shoes • Hammer toe: A hammertoe is a toe hyperextended at the distal interphalangeal and metatarso-phalangeal joints. The proximal interphalangeal joint is flexed • Heel cup: Cup-like device that is used to relieve pain and reduce stress on the achilles tendon. The heel cushion and gel product absorbs heel strikes and helps relieve pain • Heel elevation: Material added to the heel only to accommodate equines position or leg length discrepancy • Heel pain: A common condition in which weight bearing on the heel causes extreme discomfort caused generally by either over-use repetitive stress or plantar fasciitis 10 • Heel spur: A bony growth on the plantar side of the foot where the plantar fascia connects to the calcaneus; an abnormal growth or protuberance of the heel bone formed by calcium deposits left when the plantar fascia pulls away from the heel area • Heel wedge: Wedge designed to help align the calcaneous during ambulation to limit excessive pronation or supination • Heel, Thomas: Heel with anteriorly extended medial border • Heel-off: A point during the stance phase when the heel leaves the ground • Heloma durums: Also known as hard corns, these corns develop on the tops and tips of the toes and along the sides of the feet • Heloma molles: Also known as soft corns, these corns develop between the toes and are sometimes referred to as "kissing corns" • hem/o: Prefix - refers to blood, e.g. hemoglobin • hemi-: Prefix - half or partial, e.g. hemidysesthesia • hidr/o: Prefix - refers to sweat, e.g. hyperhidrosis • Hindfoot: The tarsus region or back part of the foot • homo-: Prefix - same, e.g. homolateral • hydr/o: Prefix - refers to water, e.g. anhydrosis • hyper-: Prefix - over, above, or excessive, e.g. hyperextend • Hyperglycemia: Blood glucose levels higher than normal. Hyperglycemia can result from a lack of insulin in the body, or when the body cannot use the insulin it does have to turn glucose into energy. • hypo-: Prefix - under, below, or beneath, e.g. hypoglycemic • Hypoglycemia: Blood glucose levels lower than normal. In diabetic patients this can occur when they have injected too much insulin, eaten too little food, or have exercised without extra food. Symptoms of hypoglycemia include feeling nervous, shaky, weak, or sweaty, accompanied by a headache, blurred vision, and hunger 11 I • Impaired glucose tolerance (IGT): Blood glucose levels higher than normal but under the threshold for diagnosis of diabetes. People with IGT may or may not develop diabetes • Incidence: A statistical term that refers to the number of new cases of a disease in a specified period of time • Inferior: Lower section of the body; below • Inflare: Last or shoe whose distal region provides more medial than lateral surface area • infra-: Prefix - below, beneath, inferior, e.g. infrapatellar • Ingrown toenail: The edge of the toenail grows into the skin of the toe. Most common in the great toe, ingrown toenails can occur in any toe, and usually result from curved toenails, poorly fitting shoes, toenails that are trimmed improperly, or a toe injury • Initial contact: The stage of gait when the foot strikes the ground and represents the beginning of the stance phase • Initial swing: The stage of gait in which the thigh begins to advance; the knee continues to flex and the foot clears the ground • Inlay: Material or device inserted into the shoe • Inner sole: Material conforming to the size and shape of the last bottom upon which the foot rests; an insole • Insensitive: Not appreciable by the senses; insensate • Insertion: The end of the muscle that is attached to a bone or ligament that moves upon muscle contraction • Insole: Also known as the inner sole, this is the part of the shoe that is in direct contact with the plantar surface of the foot. It lies between the midsole or outsole and the sole of the foot, is generally removable, allowing it to be replaced with orthotics • Instep: Portion of the upper over the midfoot • Insulin resistance: Inability of the body to use glucose in the presence of insulin. This is common in individuals who are overweight, and in individuals with high serum lipid levels and hypertension • Insulin-dependent diabetes mellitus (IDDM): Also known as type I diabetes, this is a chronic condition in which the pancreas makes little or no insulin because the pancreatic beta cells have been destroyed. The body cannot use glucose for energy: the use of insulin is required • inter-: Prefix - located between, e.g. interosseous • Internal: Inner part of a structure, e.g. the inside of a shoe • intra-: Prefix - located in, within, e.g. intra-articular 12 • Intractable Plantar Keratosis (IPK): Type of callus on the ball of the foot having a deep core known as a nucleation. This particular type of callus can be especially painful to pressure • Inversion Ankle Sprain (See also Sprain): The most common foot injury, an inversion ankle sprain is an injury to the ligaments located at the lateral side of the foot at the ankle, characterized by pain, swelling, and black and blue marks on the lateral side of the foot at the ankle. The lateral ligament complex of the ankle consists of the following ligaments: anterior talofibular ligament, posterior talofibular ligament and calcaneofibular ligament, which work together to stabilize the ankle. Inversion injuries constitute about 85% of all ankle sprains with approximately 65% resulting in a tear of the anterior talofibular ligament, and 20% in a tear of both the anterior talofibular ligament and calcaneofibular ligament o Grade I: mild swelling secondary to stretching the ligament o Grade II: moderate swelling and an incomplete tear to the ligaments o Grade III: severe swelling in the presence of a complete ligament rupture • Inversion: A motion in which the foot is rotated or turned inwardly • Invert: Motion towards the midline • Ipsilateral: Located on the same side of the body • -itis: Suffix - refers to inflammation, e.g. sesamoiditis J • Joint capsule: A structure in which the diarthrostic or synovial joint is encased. Composed of fibrous and synovial membranes, the joint capsule attaches the ends of the articulations together • Joint cavity: The enclosed, fluid-filled space inside the joint capsule that allows the two bones of the joint to move against each other with little or no friction, due to the presence of synovial fluid within the cavity K • kerat/o: Prefix - horn-like substance, e.g. keratosis • kines/o - kinesis: Prefix/Suffix - refers to movement, e.g. kinesiology, hyperkinesis L 13 • Lactic acidosis: The buildup of lactic acid in the body. Lactic acid is produced by the use of glucose for energy. Lactic acidosis may be associated with diabetic ketoacidosis or liver or kidney disease • Last: o In shoemaking, the last is the solid form (like a cast) that is used to mold a shoe, and determines the fit of the shoe based on the design, shape, and volume of the last; The solid form around which the shoe is molded, approximating the shape and size of the foot, over which a shoe is made; usually made of wood or plastic, or plaster o The combination of the insole, midsole, and outsole components of the sole of the shoe are also occasionally referred to as a last • Lasting: Shaping or molding of the upper of the shoe to conform to the contours of the last • Lateral counter: extended to the fifth metatarsal region • Lateral: Pertaining to the side or outside; away from the midline or median of the body • Levy mold: Full-length inlay that conforms to contour of the plantar foot • Ligament: A band or sheet of tough, fibrous connective tissue which attaches two or more bones, cartilages, or other structures as well as providing support for fasciae or muscles • Ligament: Fibrous tissue that connects bones to other bones and helps stabilize joints • Limb Length Discrepancy: A difference in length between the two limbs in either the upper or lower extremity • Linings: Shoe lining materials used today are leather, cotton, and manufactured synthetics such as tricot and vinyl. Linings absorb foot moisture and can be bacteriostatic • Lis Franc: A division of the foot between the tarsus and metatarsus; an amputation region • Loading response: In gait, refers to the initial double support stance period • Long counter: Extended distally • Long medial counter: A long medial counter provides support and stability for high arched pes cavus foot • Longitudinal arch: Arc of hindfoot and midfoot from mid-calcaneus extending proximal to the first metatarsal head • Longitudinal: Lengthwise; parallel to the long axis of the body or a part of the body 14 M • Macro: Prefix - large, e.g. macromelia • Macrovascular disease: Disease of the large blood vessels common in individuals with diabetes of long duration, macrovascular disease includes coronary artery disease, cerebrovascular disease, and peripheral vascular disease • mal-: Prefix - bad, or poor, e.g. misalignment • Malleolus/i: Malleolus means hammer in Latin, and is used to describe the bony projection found at the distal end of the fibula and the tibia, that forms the ankle joint in combination with the talus • medi-: Prefix - located in the middle of, e.g. medial • Medial counter: extended to the first metatarsal region • Medial post: A medial post provides stability and shores the midfoot during the gait cycle • Medial: Inside; toward the midline of the body; pertaining to the middle • Medullary cavity : Pertaining to the marrow of the bone • meta-: Prefix - located after, beyond, or behind, e.g. metatarsal • Metatarsal bar (external): Permanent modification to the shoe wherein a bar of some material is added to the midsole beneath the ball of the foot intended to change the flex point of the shoe • Metatarsal bar: Rubber, leather, or synthetic bar applied transversely to the sole of the shoe with the apex immediately behind the metatarsal heads • Metatarsal cuneiform exostosis: Also known as a saddle bone deformity, this refers to the formation of a spur on the dorsum of the foot due to enlargement of the metatarsal cuneiform joint • Metatarsal disarticulation: Amputation of the foot at the metatarsal and phalangeal joint • Metatarsal head: The end of the metatarsals which articulate with the joints of the adjacent bones – generally used to describe the distal metatarsal head • Metatarsal pad: Permanent internal modification to the shoe via the addition of material added to the area of the shoe proximal to the metatarsal heads at the ball of the foot intended to support the transverse arch of the foot to relieve pressure and redistribute weight • Metatarsal phalangeal joint (MTP): Forefoot joint located between the metatarsal and the proximal phalanx of the adjacent toe • Metatarsal: Relating to the metatarsus or to one of the metatarsal bones • Metatarsalgia: A general term used to describe a painful foot condition that occurs in the metatarsal region of the foot 15 • Microvascular disease: Disease of the smallest blood vessels; common in individuals with diabetes of long duration. The walls of the vessels become abnormally thick but weak, then bleed, leak protein, and slow the flow of blood through the small vessels of the body, which leads to a decrease in perfusion to some tissues, leading to damage • Mid stance: Foot is flat on the ground and the weight of the body is directly over the supporting limb • Midsole: The midpart of the last of the sole of the shoe placed between the outsole and insole. The midsole provides cushioning and stability to the foot • Midstance phase: The stage of gait in which the body progresses over the foot in a controlled manner and the contralateral swing limb provides the motion • Mid-swing: The part of the swing stage of gait in which the thigh continues to advance as the knee begins to extend and foot clearance is maintained • Midtarsal joint: A combination joint comprised of the calcaneocuboid joint located on the lateral side of the foot, and the talonavicular joint located on the medial side of the foot • Mononeuropathy: Nerve damage that affects only one nerve • Morton’s Neuroma (Morton, T.G. (1835-1903). Surgeon. Philadelphia, PA): An inflammation or enlarging of the interdigital nerve trunk generally between the third and fourth MP joint, which is characterized by thickening or swelling of a nerve near the toes; typically more common in women than men • Morton’s Syndrome (Morton, Dudley J., Anatomist): This is characterized by a short first metatarsal bone causing excessive weight to be borne by the second metatarsal head. It is usually a hereditary condition and will result in callus formation under the second and third metatarsals. • Morton’s toe: A common forefoot disorder in which the first metatarsal is shorter than the others, leading to the appearance of a longer second toe • Muscle (Skeletal): A tough, elastic tissue that is attached at either end to a fixed location and moves or stabilizes a body part via contraction • Muscle action: The movement of the body produced by the muscle • my/o: Prefix - refers to muscle tissue, e.g. myofascitis • myc/o: Prefix - refers to fungus or fungal, e.g. mycodermatitis • myel/o: Prefix - refers to either the bone marrow or the spinal cord, e.g. poliomyelitis, myeloma • Myositis: Chronic, persistent muscle inflammation 16 N • Navicular: Boat shaped bone (Proximal portion is concave and distal portion is convex) that articulates with head of talus proximally and cuneiforms distally. Functions: Transmits forces hindfoot to forefoot • Nephropathy: Disease of the kidneys caused by damage to the small blood vessels or to the units in the kidneys that clean the blood. People who have had diabetes for a long time may have kidney damage • Nerve: Cordlike fibrous bundles of neurons that transmit sensory and motor impulses between the central nervous system (CNS) and other parts of the body • neur/o: Prefix - refers to a nerve, e,g. neuron, neuralgia • Neuropathy: A disease of the nervous system in which neurons of the body are damaged. Neuropathy, especially peripheral neuropathy, is common in individuals with diabetes. The three major forms of neuropathy are: peripheral neuropathy, autonomic neuropathy, and mononeuropathy • Noninsulin-dependent diabetes mellitus (NIDDM): Also known as type II diabetes mellitus, this is the most common form of diabetes mellitus. Unlike type 1 diabetes, in which the pancreas makes no insulin, people with type 2 diabetes produce some insulin, sometimes even large amounts. However, either their bodies do not produce enough insulin or their body cells are resistant to the action of insulin O • -o/genesis: Suffix - refers to a beginning or formation, e.g. erythrogenesis • onych/o: Prefix - a finger or toe nail, e.g. onychogryphosis curvature • Origin: The initial point of attachment of a muscle; the origin does not move when the muscle contracts • orth/o: Prefix - straight, upright, or correction, e.g. orthograde walk • Orthoses: Supportive device for the body • oste/o: Prefix - bone, e.g. osteomyelitis • Osteoarthritis: The most common type of arthritis, osteoarthritis is characterized by the wearing away of cartilage around the joints. It is also known as “wear and tear” arthritis, and is a non-inflammatory degenerative joint disease that is accompanied by pain and stiffness in the joints • Outflare: Last or shoe whose distal region provides more lateral than medial surface area 17 • Outsole: The bottom part of the sole of a shoe that is exposed to external wear, thus comprised of extremely durable materials to withstand wear • Oxford: Low-quarter, laced shoe P • -paresis: Suffix - a slight paralysis, or loss of sensation, e.g. hemiparesis • Paresthesia: Burning, prickling, itching, or tingling sensation, with no apparent physical cause • Passive movement: Practitioner moves a part of the patient’s body • Passive propulsion: The point of time in the gait cycle which begins with heel contact of the swing limb and ends with toe-off of the support limb • -pathy: Suffix - disease, e.g. neuropathy • ped-, pod-: Prefix - refers to the foot, e.g. pedorthics, podiatric • Pedal: Related to the foot, e.g. Pedal pulse, Ped, Pod, Pes • Pedorthics: Allied foot health profession concerned with the design, manufacture, fit, and modification of footwear and related appliances • Periosteum: A specialized connective tissue covering all bones of the body, and possessing bone-forming potentialities • Periostitis: An inflammation of the periosteum, or covering of the bone • Peripheral neuropathy: Damage to the peripheral nerves , which usually affects the feet and legs leading to pain, numbness, or tingling. Peripheral neuropathy is also known as "somatic neuropathy" and/or "distal sensory polyneuropathy" • Peripheral vascular disease (PVD): A type of macrovascular damage, which affects the large blood vessels of the arms, legs, and feet, and is common in individuals with long-standing diabetes. Results from lack of blood flow to the limbs secondary to blockages in arms, legs, and feet. The symptoms and signs of PVD include aching pains in the arms, legs, and feet (especially when walking) as well as slowly healing sores. Preventative measures include good foot care, cessation of smoking, and controlling hypertension and blood glucose levels • Peroneus brevis (PB): Muscle that begins at distal two-thirds of lateral surface of fibula and leads into peroneus brevis tendon, which runs along lateral surface of calcaneus and attaches to styloid process at base fifth metatarsal shaft; function is evert the foot and assist the PL in ankle plantarflexion • Peroneus longus (PL): Muscle that begins at upper part of fibula, continues downwards and behind lateral malleolus, runs diagonally across plantar surface of foot and attaches to base of first metatarsal and 18 • • • • • • • • • • • • • • • • • • • • medial cuneiform; function is to evert the foot and to plantarflex the ankle joint Pes cavus: Also known as ‘high arch’, is a condition that describes an excessively elevated toe-to-heel arch of the foot Pes planus: Also known as “flat foot,” this is a condition in which the arch or instep of the foot collapses and comes in contact with the ground, although in some individuals, this arch never develops PFA: Pedorthic Footwear Association phleb/o: Prefix - refers to a vein, e.g. phlebitis Pirogoff: Amputation of the foot at the ankle, part of the calcaneus being left in the lower end of the stump Plantar aponeurosis: Also known as the plantar fascia, the aponeurosis is the band of connective tissue that crosses the foot at the arch from the calcaneus to the toes Plantar fascia: The thick, ligament-like tissue that fans out over the sole of the foot from its origin at the calcaneus to its insertion into the tendons of the toes Plantar fasciitis: Non-specific inflammatory change in the plantar fascia, resulting in pain beneath the heel; Inflammation of the plantar fascia or plantar aponeurosis, is especially prominent in the medial plantar side of the heel. Often associated with heel spurs Plantar warts: Painful epidermal tumors that occur on the plantar surface of the foot, caused by human papilloma virus Plantar: Bottom aspect of the foot Plantarflexion: Movement of the foot whereby the foot or toes move downward toward the sole, e.g. Foot on gas Planus, pes planus: Refers to the presence of a flat foot Platform: Elevated sole -plegia: Suffix - complete paralysis, e.g. quadriplegia Point of maximum tenderness (PMT): The time of greatest pain upon physical examination and subsequent palpation of the foot Polyneuropathy: Nerve damage that affects several nerves of the body Posterior tibial tendinitis (PTT): Inflammation and swelling of the posterior tibial tendon which runs from the inside of the ankle to the arch of the foot Posterior, dorsal: The back part of the body; the back portion of the shoe or foot Postprandial blood glucose: Blood level measured within 1-2 hours after eating to see the amount of glucose. Normal is <140 mg/dL Post-tibial tendon dysfunction: Tendinitis that results from a strain placed on the posterior tibial tendon, leading to an inability of the tendon 19 • • • • • • • • • • • • • to hold up the arch resulting in flat feet, which can lead to heel pain, arch pain, plantar fasciitis and/or heel spurs pre-: Prefix - referring to something before or in front of, e.g. prematurity Pre-swing: The stage of gait in which the foot remains on the floor while the knee rapidly flexes and weight is shifted to the other limb Prevalence: A statistical term that refers to the number of individuals in a given group or population who are reported to have a disease Prime mover: The muscle that acts directly to bring about the desired movement primi-: Prefix - first, e.g. primivarus Pronation/Pronate: Tri-plane motion of the foot consisting of eversion, dorsiflexion, and abduction Proteinuria: The presence of protein in the urine Proximal interphalangeal joint (PIP): Forefoot joint located between the proximal phalanx and the middle phalanx of each toe Proximal: Closer to the trunk of the body; Closer to the point of insertion pseudo-: Prefix - false, e.g. pseudopodia Pump bump: Also known as Haglund’s deformity, this condition is characterized by a pronounced bony prominence located at the back of the calcaneus. While it is often hereditary, this condition often arises as a result of the constant friction associated with a tightly fitted shoe rubbing against the heel of the foot Push-off: In gait, this is the period of time in which there is advancement of the limb into swing phase -pyorrhea: Suffix - discharge of pus, e.g. dermopyorrhea R • Range of motion (ROM): The extent to which a particular joint can be moved • Ray: The metatarsals and phalanges combined form a ray, i.e., the first ray is the first metatarsal and the hallux (big toe) • retro-: Prefix - after or located behind, e.g. retrocalcaneal • Retrocalcaneal bursitis: Inflammation of the bursa located in the achilles tendon • Rocker bar: Sole bar with the apex beneath the metatarsal shafts, causing rocking instead of flexing action • Rocker bottom: A modified sole apexed at various positions to assist the gait cycle and relieve or transfer pressure from the designated areas of the foot 20 • Rocker sole: A permanent external modification of the shoe, applied to the midsole and outsole. Material is added to the shoe, modifying the shoe’s flex point in order to improve function or protection of the foot and ankle; These shoe soles are used to control motion in the ankle joint, and the metatarsalphalangeal joints. They also help reduce ground-reactive forces to the metatarsal heads, the toes, and any area of the foot over which the body propels S • semi-: Prefix - which refers to half or partial, e.g. semipermeable • Sesamoiditis: Irritation and inflammation of the tissues surrounding the sesamoid bones, under the first metatarsophalangeal joint, usually due to repetitive, excessive pressure on the forefoot • Shank: Firm, stiff, inflexible part of the shoe between the heel breast and ball; the part of the sole of the shoe that is located between the heel and the ball, and reinforced with rigid materials intended to support • Shear force: A force that acts parallel to a plane; the planes remain parallel, but the angles change • Shin splint: A term that refers to pain in the tibial or shin area of the lower leg. It can develop as a number of conditions, including periostitis, myositis, stress fracture, or compartment syndrome • Shoe heel: The solid back part of the shoe that covers the foot to the sole of the shoe • Short bones: Small bones that are generally cuboidal in structure, found primarily in the hands and feet • Short shoes: Improperly fitted shoes that provide inadequate space in the toe box • Single support: The point in the gait cycle which consists of mid-stance and terminal stance phases, and begins with toe-off of the opposite limb and ends with heel contact of the same limb • Skin: The largest organ, the skin covers the entire body as a protective membrane comprised of the dermis and epidermis, which also provides touch sensation to the CNS • Sole bar: A full-length bar made of steel or another rigid material that is applied to the sole of the shoe in order to eliminate dorsiflexion of the foot • Sole: The sole of the shoe is a combination region that is comprised of the insole, midsole, and outsole • Soleus: Located at posterior surface of fibula shaft and leads to achilles tendon; function is to assist the gastrocnemius in flexing the ankle joint 21 • Splay foot: Typically a flat foot causing toes to spread apart from each other • Sprain (Also see Inversion Ankle Sprain): Injury to a ligament; generally divided into three grades: o Grade I: mild swelling secondary to stretching the ligament o Grade II: moderate swelling and an incomplete tear to the ligaments o Grade III: severe swelling in the presence of a complete ligament rupture • Spur: Another name for an exostosis, a spur is a growth or projection that arises off the surface of the bone due to chronic irritation of the site; a dull spine or projection from a bone • Stance phase: In gait, the period of time during which the foot is in contact with the ground. This is the weightbearing phase of gait • Step length: Measured from the heel contact of one limb to the heel contact of the opposite limb. Each stride length will consist of two steps, usually of equal length • Stress fracture: A slight fracture of a bone in the foot that is related to overuse and weakening or fatigue of the muscles, not due to impact • Stride length: The distance between two consecutive contacts of the same foot, measured from the heel contact to one limb to the next heel contact of the same limb. The average stride length is 4.5 feet, and men have a 14% longer stride length then women • sub-: Prefix - referring to something under, beneath, or below, e.g. subluxation • Subtalar joint (STJ): The joint which joins the calcaneus to the talus, and enables the foot to rotate at the ankle • Sulcus: Long, narrow groove or furrow on the plantar surface of the foot proximal to the phalanges • Superficial: Located on or near the surface of the body, e.g. Skin, Vein • Superior: Upper section of the body; above • Supination/supinate: A tri-plane motion consisting of the simultaneous movement of the calcaneus and the foot in the direction of adduction, inversion, and plantarflexion • supra-: Prefix - referring to something above, e.g. supraorbital ridge • Sustentaculum tali: Projection on medial side of heel that helps support the talus of calcaneus • Swing phase: In gait, the period of time in which the foot is off the ground and swinging forward; the unsupported phase that begins when the foot is no longer in contact with the ground. The limb is free to move • sym-: Prefix - meaning in union with, together, e.g. symphysis pubis • Syme: Amputation of the foot at the ankle joint with removal of both malleoli 22 • Symmetric neuropathy: Nerve damage that affects both sides of the body • Synarthrosis: An immovable articulation in which the bony elements are united by continuous intervening fibrous tissue (e.g.: joints between the teeth and jaw bones) • Syndrome X: Also known as metabolic syndrome, this relates to a combination of health conditions that place a person at high risk for heart disease: type 2 diabetes, high blood pressure, hyperinsulinemia, and hyperlipidemia • Synergist: A muscle that contributes to the action of the principle muscle T • Talipes equinovarus deformity: A complex deformity, actually a form of clubfoot, involving many bones, articulations, and soft-tissue structures in which the heel is elevated and turned outward from the midline of the body • Talocrural joint (TCJ): The joint which connects the proximal end of the talus to the malleoli of the tibia and fibula, forming the “hinged” ankle joint • Talus: Key bone of the foot in contact with tibia and fibula, calcaneus and navicular. Movements of hindfoot and midfoot are tied to this bone • Tarsus: The seven bones that form the hind portion of the foot • Tendinitis: Inflammation of a tendon • Tendon: A tough flexible connective tissue that attaches muscle to the periosteum of the bones; fibrous tissue that connect muscles to bone • Tensile force: A stretching force or tension that pulls at both ends of a component or structure along its length • Terminal stance: The stage of gait that takes place from the time the heel rises until the other limb makes contact with the floor, and the body progresses past the forefoot • Terminal swing: During the swing stage of gait, the moment when the leg reaches out to achieve step length • Thermoplastic: Synthetic material that can be repeatedly softened by heat and hardened by cooling • Tibia: Located medially, is larger of two bones of the leg – distal end is the medial malleolus, which forms parts of the ankle joint • Tibialis anterior: Located at anterior of tibia, in front of ankle joint lateral to medial malleolus and attaches to medial cuneiform and base of first metatarsal bone; function is to dorsiflex ankle • Tibialis posterior (TP): Location begins from top of fibula and tibia on posterior surface, ending in posterior tibialis tendon that extends below 23 • • • • • • • • • • • medial malleolus and inserts into the navicular; function is to invert the foot and assist in plantarflexion of the ankle joint Toe box: The toe box of the shoe, intended to cover and protect the toes, promoting the shoe’s durability by stiffening the shoe, is the semi-circular area of the shoe that envelops the toes; Reinforcement used to retain the original contour of the toe and guard the foot against trauma or abrasion Toe cap: A device made of a thin flexible fabric that is used to protect the toe from rubbing against the top of the shoe as well as comfort pain caused by friction, blisters, corns, ingrown toenails, and calluses Toe crest: An elastic or gel device worn between the ball of the foot and the toes that is used to hold the toe(s) in a relaxed position, relieve pressure, and help relieve pain caused by painful toe conditions including hammer, claw, or mallet toes Toe separator/comb: A soft cushioning device used to provide toe separation to keep toes from overlapping, and to provide relief from corns and friction Toe sleeve: Aligns the big toe to reduce aggravation of bunions and absorb pressure and friction to relieve toe irritations, including blisters, corns, and calluses. Toe spring: Elevation of the undersurface of the sole at the toe, works to give a slight rocker effect to the shoe, is built into the last, and is dependent on the shoe style, thickness, and heel height Toe-off: Only the big toe of the forward / reference limb in contact with the ground; when terminal contact is made with the toe Transmetatarsal: Amputation of the foot at the metatarsal midline Transverse arch: The arch formed by the metatarsal bones, 1-5 Transverse: Placed crosswise, situated at right angles to the long axis of the body or of a part Triglyceride: A type of lipid that is directly related to consumed fats. The body needs insulin to remove this type of fat from the blood, therefore, an individual’s diabetes is under control and a person's weight is what it should be, the triglyceride level should be <150 mg/dL U • Ulcer, trophic: A lesion on the surface of the skin or a mucous surface caused by superficial disintegration and loss of wound with superficial loss of tissue from trauma; is not primarily an ulcer, but may turn into one if healing stops or infection occurs • Ulcer: A break in the skin; a deep sore. Diabetes patients often form ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the ill-fitting shoes; A local sore most commonly found on the 24 surface of a toe or foot area, produced by the sloughing of inflammatory necrotic tissue • uni-: Prefix - referring to one, e.g. unilateral • University of California Biomechanics Laboratory at Berkley (UCBL): A foot orthosis used to stabilize a flexible foot deformity, usually a flexible flat foot. This product differs from other foot orthoses because it encompasses the heel with a molded heel cup which in turn holds the heel, in a neutral, vertical position, and controls the inside arch of the foot and the outside border of the forefoot • Upper: All of the parts that comprise the upper parts of the shoe, including the outside, counter, toe box, tongue and laces, and lining, that will be put together with the last and the bottom of the shoe V • Valgus: Angular deformity in which the limb distal to the deformity is angulated away from the midline; eversion away from the midline • Vamp: Forepart of the shoe upper over the metatarsal shafts; the upper part of a boot or shoe covering the instep and sometimes extending over the toe; i.e., the complete front part of the upper of a shoe, including the area where the shoe laces are located • Varus: Angular deformity in which the limb distal to the deformity is moved closer to the midline of the body; inversion towards the midline • Veins: Blood vessels which transport blood toward the heart • ven/o: Prefix - vein, e.g. venopuncture W • Wedge: Tapered leather, rubber, or other material used to elevate one side of the sole and/or heel; also known as heel wedge; A device incorporated into a shoes construction or inserted in the shoe sole to provide elevation to compensate for biomechanical instability • Windlass mechanism: A ‘windlass’ is a tightening of a rope or cable. In this instance it is a foot mechanism in which the plantar fascia winds around the metatarsal head when the toes dorsiflex and the heel rises off the ground; leads to elevation of the arch and a shortens the distance between the calcaneus and the metatarsal heads 25