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 Bones –Phalanges, metatarsls, Tarsal Bones (Calcaneus, talus, navicular, cuboid, 3 cuneiform) Articulations Stabilizing Ligaments

Foot Anatomy Nerve Supply and Blood Supply –Nerve: tibial (back of leg/ plantar surface of foot) * common peroneal (front of leg & dorsal foot) –Blood: anterior and posterior tibial arteries Arches –Longitudinal (medial and lateral) –Anterior metatarsal (runs across distal metatarsal heads; runs medially to laterally) –Transverse metatarsal (across tarsal bones; medially to laterally) Plantar Fascia (medial calcaneus to proximal metatarsal heads)

Muscles and Movements Dorsiflexion: tibialis anterior, EDL, EHL, Peroneus Teritus Plantar flexion: Gastrocnemius, soleus, planatris, peroneus longus and brevis, posterior tibialis, etc Inversion, Adduction, Supination: tibialis posteriror, FDL, FHL, EHL, tibialis anteior Eversion, Abduction, Pronation: peronus longus and brevis, peroneus tertius, EDL Movement of phalanges: FDL, Quadratus plantar, lumbrical, interossei, EDL, EHL, EDB, etc

Foot Biomechanics Normal Gait Patterns Pronation and Supination –Excessive Pronation (internal rotation of the leg); hypermobility at the joint –Excessive Supination (external rotation of the leg) Other Structural Deformities

Prevention of Foot Problems Shoes & Socks –Construction Last: basic form shoe built on Upper: portion controling foot Midsole: affects stbaility Heel counter: control rearfoot motion –Selection For pronated foot: less flexible; good rearfoot control; straight- lasted (forefoot does not curve) Proper Foot Care & Hygiene –Toenails trimmed, shaving calluses, keeping dry, wearing proper devices

Foot Orthotics and Devices Forefoot varus (excessive pronation) –Rigid type and medial wedge under head of 1dt metatarsal Forefoot Valgus (excessive supination) –Semirigid and lateral wedge under 5 th metatarsal Rearfoot Varus –Semirigid and have wedge under medial calcaneus and small wedge under 1 st metatarsal

Assessing Foot Conditions History Observation Palpation Special Tests

Recognition & Management Specific Injuries & Conditions Injuries to the Tarsal Region –Talar Fracture –Calcaneous Fracture / stress fracture –Sever’s Disease –Retrocalcaneal Bursitis –Heel Contusion –Cuboid Subluxation –Tarsal Tunnel Syndrome

Recognition & Management Specific Injuries & Conditions Metatarsal Region –Flat foot (aka?) –High Arch (aka?) –Longitudinal Arch Strain (lateral ) –Plantar Fascitis (braces arch) –Jones Fracture (base of 5 th ) –Metatarsal stress fracture Most common : 2 nd – March Fx –Bunion (hallux valgus; 1 st met.) –Sesamoditis –Metatarsalgia (2 nd, 3 rd met head) –Metatarsal arch strain –Morton’s Neuroma (b/t 3 rd & 4 th ) –

Recognition & Management Specific Injuries & Conditions Toes –Sprain –Turf Toe Hyperextension injury to great toe –Fracture / dislocations (usually dorsal) –Morton’s toe (short 1 st met, WB on 2 nd met) –Hallux Rigidus (DJD, bony spurs dorsal aspect of 1 st met) –Hammer/Claw toes –Overlapping toes

Foot Rehabilitation General body conditioning Weight Bearing (pay attention to kinetic chain) Joint Mobilization maintain/normalize joint motion) Flexibility (especially as impact the phalanges) Neuromuscular (strength & kinetic chain) Foot Orthotics Prevention from Reinjury

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.