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The Foot Chapter 17 Foot Anatomy 26 Bones 7 Tarsal 5 Metatarsal 14 Phalanges 38 Joints 4 Arches Bones of the Foot Bones of the Foot Bones of the Foot Tarsal Bones Talus Calcaneus Navicular Cuboid Cuniforms Medial Intermediate Lateral Metatarsals & Phalanges Sesamoid Bones 2 (medial and lateral) Under great toe Functionpulley, increase leverage of tendons that control great toe Joints of the Foot Tibiotalar Talocrural Subtalar Talonavicular Calcaneocubiod Metarsocunieform Joints of the Foot Metatarsophalangeal Joint Proximal Interphalangeal Joint Distal Interphalangeal Joint Regions of Foot Forefoot Metatarsals Phalanges Midfoot Navicular Cuboid 3 Cuniforms Hindfoot Calcaneus Talus Regions of the Foot Plantar Fascia • Thick white band of fibrous tissue originating from the medial tuberosity of the calcaneus and ending at the proximal heads of the metatarsals • Work with ligaments to support arches during weigh bearing and downward forces Foot Arches Functions 1. Support body weigh in an economical fashion 2. Absorb the shock of weight bearing 3. Provide a space on the plantar aspect of foot for blood vessels, nerves, and muscles Medial Longitudinal Arch • Highest of 3 arches of foot • Calcaneus, Talus, Navicular, Cuniforms & 1st three metatarsals • Supports— – Ligaments: • Spring ligament • Plantar fascia – Tendons: • Tibialis posterior • Tibialis anterior Lateral Longitudinal Arch • Lower and flatter • Calcaneus, Talus, Cuboid, 4th & 5th metatarsals • Supports— – Ligaments: • Short plantar ligament • Plantar fascia – Tendons: • Peroneus longus Transverse Arch • Cuniforms, Cuboid, & 5th metatarsal Shoe Wear Patterns • Excessive Pronation – Wear out front of shoe under 2nd metatarsal • Excessive Supination – Wear out lateral border of shoe • Common Misconception – Wearing out the back lateral corner of the shoe means you pronate – This is normal wear pattern Gait Pulse • • • • Posterior Tibial Artery Medial Malleolous Dorsalis Pedis artery Extensor Tendon Great Toe Foot Movements Dorsiflexion Plantar Flexion Pronation Inversion Eversion Supination Muscles of Foot Intrinsic Muscles • Relate to specific body part or bone • • • • Flexor hallucis longus Flexor hallucis brevis Flexor digitorum longus Extensor digitorum longus • Abductor hallucis • Abductor digiti minimi • Tibialis posterior Extrinsic Muscles • Muscle outside a body part, organ, or bone • Gastrocnemius Muscles of the Foot Muscles of the Foot Muscles of the Foot Common Injuries of the Foot Fractures & Stress Fractures • Impair ability to perform competitively • NWB • More swelling & pain than ligament sprain • Point tenderness present • Obvious deformity often present • Usually occur acutely; result of traumatic episode Jones Fracture • Fracture to the diaphysis at the base of the 5th metatarsal • Repetitive stress, direct force, or inversion and PF of foot • Healing slow; high nonunion rate Retrocalcaneal Bursitis • Swelling of the bursa at the back of the calcaneus under the Achilles tendon • S/sxs: – Pain in heel – Painful to touch – Pain worse when rising on toes – Red, warm skin over back of heel Plantar Fascia • Wide, non-elastic ligamentous tissue that extends from the anterior portion of calcaneus to heads of metatarsals • Supplies support to longitudinal arch Plantar Fasciitis • Strain/irritation of the plantar fascia • Caused by: – – – – Overuse Unsupportive footwear Tight Achilles tendon Running on hard surfaces – Chronic irritation • Pain, tenderness on bottom of foot near heal (especially in am) • Untreated will lead to: – – – – Bone imbalance Heel spurs Muscle strains Shin splints Plantar Fasciitis— Treatment • • • • Correct training errors Ice Massage Evaluate shoes & activity level • Arch support • Heel cup or cushion Arches Pes Planus • Flat foot • Associated with excessive pronation • Multiple causes: – Lack of shoe support – Weak muscles • • • • Pain & weakness in medial longitudinal arch Calcaneal eversion Navicular bulging Flattening of arch Pes Cavus • • • • aka Clawfoot, hollow foot Associated with excessive supination Shock absorption poor General foot pain and metatarsalgia common • Abnormally short Achilles tendon • Calluses ball and heel Arch Sprains • Ligaments stretch, thus fail to hold bones of foot in position • When arch weakened, it cannot absorb shock normally • Causes: – – – – Overuse Overweight Fatigue Training on hard surfaces – Non-supportive shoes – Shoes in poor condition Turf Toe • Great toe strain • Hyperextension of the first MTP joint of the big toe • Treatment: – RICE & Support – Limit movement – Turf toe taping Heel Spur • • • • Bony growth on calcaneus Causes painful inflammation Aggravated by exercise As foot flattens, plantar fascia is stretched & pulled where it attaches to calcaneus calcaneus reacts by forming spur of bony material Heel Contusion • Irritation of the lateral aspect of the heel • Sudden stop-and-go or sudden change in movement Heel Contusion—Treatment • Cold application before activity • Ice & elevation after activity • Absorb shock— – Heel cups – Donut pad Sever’s Disease • Traction injury at the apophysis of the calcaneus where the Achilles tendon attaches • Young, physically active athletes – Comparable to Osgood-Shlatter’s disease (at tibial tubercle of knee) • Pain occurs during vigorous activity and does not continue during rest Blisters • Occur on any part of body where there is friction • Most common on feet or heels • Treatment Goals: – Relieve pain – Keep from enlarging – Avoid infection Blisters—Treatment • Wash area thoroughly • Use sterile blade to cut small hole in blister • Squeeze out clear fluid • Do not remove skin • Prevention: – Wear work gloves – Break in new skin – Petroleum jelly/skin lube – Adhesive bandage Prevention of Foot Injuries • Selecting appropriate footwear • Using shoe orthotic • Foot hygiene Rehabilitation of the Foot • Towel pulls • TheraBand® • Marble pick-up
