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Chapter 18: The Foot
Foot Anatomy: Bones
 Toes
– Phalanges
– Sesamoid Bones
 Metatarsals
 Tarsal Bones
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Calcaneus
Talus
Navicular
Cuboid
Cuneiforms
Foot Anatomy: Arches
 Anterior Metatarsal Arch
– Shaped by heads of 1st-5th metatarsals
 Transverse Arch
– Primarily cuboid & internal cuneiform
 Medial Longitudinal Arch
– Calcaneus, talus, navicular, 1st cunieform, & 1st
metatarsal
– Calcaneonavicular Ligament
 Lateral Longitudinal Arch
– Calcaneus, cuboid, & 5th metatarsal
Foot Anatomy: Plantar Fascia
 Fibrous connective tissue
 Originates at medial tuberosity of
calcaneus
 Inserts at proximal heads of
metatarsals
 Supports foot against downward
forces
Foot Anatomy: Articulations
 Interphalangeal Joints
 Metatarsophalangeal Joints
 Intermetatarsal Joints
 Tarsometatarsal Joints
 Intertarsal Joints
 Subtalar Joint
– Articulation between talus in calcaneous
– Inversion, eversion, pronation, & supination
 Midtarsal Joint
– Consists of two joints: Calcaneocuboid and Talonavicular
– Directly related to position of subtalar joint
Movements
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Dorsiflexion
Plantar Flexion
Inversion
Eversion
Adduction
Abduction
Supination
Pronation
Flexion
Extension
Intrinsic Muscles of Foot
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Extensor Digitorum Brevis
Abductor Hallucis
Flexor Digitorum Brevis
Abductor Digiti Minimi
Quadratus Plantae
Lumbricales
Flexor Hallucis Brevis
Adductor Hallucis
Flexor Digit Minimi Brevis
Plantar Interossei
Dorsal Interossei
Muscle & Action
 Extensor Digitorum brevis (dorsal muscle)
– extends the 2nd-5th toes
 Abductor Hallicus
– abducts the great toe
 Flexor Digitorum Brevis
– flexes the 2nd-5th toes
 Abductor Digiti Minimi
– abducts the small toe
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Muscles & Actions
 Quadratus Plantae
– Aids in flexing the 2nd-5th toes
 Lumbricles
– flexes the 2nd-5th toes
 Flexor Hallucis Brevis
– flexes the great toe
 Adductor Hallicus
– adducts the great toe
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Muscles & Actions
 Flexor Digiti Minimi Brevis
– flexes the small toe
 Plantar interossei
– adducts the toes toward the 2nd toe
 Dorsal interossei
– Abducts the toes from the 2nd toe; moves the
2nd toe medially and laterally
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Nerve & Blood Supply
 Nerve Supply
– Tibial Nerve
 Posterior Leg & Plantar aspects of foot
– Common Peroneal Nerve
 Anterior Leg & Foot
 Blood Supply
– Anterior & Posterior Tibial Arteries
Gait
 Stance Phase
– Initial contact to toe-off
– Five periods
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Initial Contact
Loading Response
Mid Stance
Terminal Stance
Pre-Swing (Toe Off)
 Swing Phase
– Period of non-weight bearing
– Three periods
 Initial Swing
 Mid Swing
 Terminal Swing
Prevention of Foot Injuries
 Selecting Appropriate Footwear
 Using a Shoe Orthotic
 Foot Hygiene
Foot Assessment
 History
– What? When? How? Previous
hx?
 Observation
– Symptoms
– Structural Deformities
– Shoe Wear Patterns
 Palpation
– Bony Palpations
– Soft-Tissue Palpation
– Pulses
 Range of Motion
– AROM (athlete performs ROM)
– PROM (ATC performs ROM)
– RROM (Adds resistance)
 Special Tests
– Tinel’s Sign
– Morton’s Tests
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Squeeze Test
– Fracture Tests (Bump Test)
– Neurological Assessment
Special Tests
 Morton’s test (Neuroma)
– Put the foot in a supine position
– Apply tranverse pressure to the
– heads of the metatarsals
– + test is a sharp p! in the forefoot
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Special Tests
 Tinel’s Sign
– Tapping over the posterior tibial nerve
– Produces tingling distal to that area
– + sign numbness, tingling, and paresthesia
(prickling sensation)
– Indicates possible tarsal tunnel syndrome
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Recognition Of Injuries
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Fractures
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Talus
Calcaneus
Phalanges
5th Metatarsal
 Jones Fx
– 1st or 2nd Metatarsal
 March Fx
– Tarsometatarsal
 Lisfranc Injury
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Bursitis
– Retrocalcaneal
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Apophysitis
– Calcaneus (Sever’s Disease)
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Morton’s Neuroma
Contusions
– Heel
– “Bone Bruise”
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Subluxation/Dislocations
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Cuboid
Phalanges
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Arches
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Pes Planus
Pes Cavus
Longitudinal Strain
Metatarsal Strain
Plantar Fascitis
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Bunions
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Hallux Valgus
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Inflammation
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Sesamoiditis
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Toes
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Sprains
Turf Toe
Hammer, Mallet, or Claw
Overlapping
Subungual Hematoma
Injuries
 Fractures of the Talus
– Etiology: occurs laterally from a severe IV & DF
force or medially from an IV and PF force
– Treatment
 X-ray for accurate diagnosis, immobilization
– S&S
 hx of repeated trauma to the ankle
 p! on weight bearing, complains of catching and
snapping
 intermittent swelling
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 talar dome is tender on palpation
Injuries
 Fracture of the Calcaneus
– Etiology
 occurs from landing after a jump or fall from a height
– S&S
 immediate swelling and p!
 can not bear weight
– Management
 RICE immediately
 X-rays
 Immobilize
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Injuries
 Sever’s Disease
– Etiology
 occurs in young, physically active patients
 injury at the apophysis (bone protrusion) of the
calcaneus where the Achilles tendon attaches
– S&S
 p! occurs at the posterior heel
 p! occurs during vigorous activity
– Management
 Rest, Ice, stretching the Achilles tendon
 Anti-inflammatory medications (IBU, Advil)
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Injuries
 Tarsal Tunnel Syndrome
– Etiology
 tarsal tunnel is behind the medial malleolus
 tibialis posterior, flexor hallucis & flexor digitorum
pass through this tunnel. Any trauma to this area can
compromise these structures
– S&S
 p! and paesthsia along the medial & plantar aspect
 + Tinel’s sign
– Management
 anti-inflammatory medication, orthotics, surgery
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Injuries
 Pes Planus Foot (Flatfoot)
– Etiology
 medial longitudinal arch appears to be flat/fallen
 repeated pounding
– S&S
 P! or fatigue in the medial longitudinal arch
– Management
 no p!=no treatment
 P!= orthotic
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Injuries
 2nd Metatarsal Stress Fracture (Morton’s
Toe)
– Etiology
 the 1st metatarsal is longer than the 2nd
– S&S
 p! both during & after activity
 point tenderness
– Management
 no symptoms= no correction
 medial wedge orthotic
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Injuries
 Plantar Fascitis
– Etiology
 can occur in patients with pes cavus or pes planus
– S&S
 p! in the anterior medial heel
 p! is increased when the patient bears weight in the
morning or after sitting for long periods of time
 p! in dorsiflexion
– Management
 Orthotic
 Arch taping and stretching the plantar fascia
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Foot Rehabilitation
 General Body Conditioning
 Weight Bearing
– Progress from NWB to WB
– Correct Gait
 Joint Mobilization
– Anterior/Posterior Glides
 Flexibility
– Triceps Surae & Plantar Fascia
 Muscular Strength
– Exercises?
 Neuromuscular Control
– Proprioception Exercises
– Closed Kinetic Chain
 Foot Orthotics & Taping