The Foot www.peakorthopedics.com/book/export/html/45 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 Functionpulley, increase leverage of tendons that control great toe

Joints of the Foot Tibiotalar Talocrural Subtalar Talonavicular Calcaneocubiod Metarsocunieform Tarsometatarsal Joint Subtalar Joint Midtarsal Joint

Joints of the Foot Metatarsophalangeal Joint Proximal Interphalangeal Joint Distal Interphalangeal Joint

Regions of Foot Forefoot Midfoot Hindfoot Metatarsals Phalanges 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 Support body weigh in an economical fashion Absorb the impact of walking, running, jumping or any other weight bearing activity 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 Excessive Supination 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 Pronation: combo of PF, eversion, & forefoot abduction Supination: combo of DF, inversion, & adduction

Muscles of Foot Intrinsic Muscles Extrinsic 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 Muscle outside a body part, organ, or bone Gastrocnemius Gastroc—has long tendons that cross ankle and attach on bones of foot to assist in movement. Talus has no tendon attachment

Muscles of the Foot

Muscles of the Foot

Muscles of the Foot

Warm - Up You will need the following: Scissors Glue 7 colored pencils or markers

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 Continually strained from running and jumping; basketball, volleyball, cross-country (repeated jumping and landing)

Plantar Fasciitis—Treatment Correct training errors Ice Massage Evaluate shoes & activity level Arch support Heel cup or cushion Goal: to reduce shock and shear forces

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 If it ain’t broken don’t fix it! If painful, correct the excessive pronation with orthotic; taping may help; strength training of muscles may help

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 Orthotic with lateral wedge; stretch achilles tendon & plantar fascia

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 Tx: RICE; most arch sprains are to lateral arch or inner longitudinal arch

Turf Toe Great toe strain Hyperextension of the first MTP joint of the big toe Treatment: RICE & Support Limit movement Turf toe taping Great toe important for balance, movement, and speed

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 TX: taping arch or use shoe insert to reduce plantar fascia pull on calcaneus

Heel Contusion Irritation of the lateral aspect of the heel Sudden stop-and-go or sudden change in movement Heel receives, absorbs, and transfers much impact of sports activities (running & jumping) Severe pain in heel; will hurt with WB Calcaneus protected by thick, cornified skin layer and heavy fat pad covering, but even this thick covering cannot always protect against impact of landing or jumping

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 Apophysis-= bone protrusion (bony outgrowth such as a tubercle or tuberosity) Rest, ice, stretching

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

Muscle Movement Foldable Label each flap on of the directional terms Toe Flexion Toe Extension Ankle Eversion Ankle Dorsiflexion Ankle Plantarflexion Glue picture of movement on the under side of the flap. Write the muscle names under the correct flap. Flexor Hallucis Longus Extensor Digitorum Longus Tibialis Posterior Peroneus Longus Extensor Hallucis Longus Flexor Hallucis Brevis Gastrocnemius Peroneus Brevis Soleus Tibialis Anterior Peroneus Tertius Flexor Digitorum Longus

Common Injuries Brochure Include the following: Bones that are found in the foot Draw the anatomy How to prevent foot injuries Basic definition of each foot injury which includes the symptoms they would experience and where Common treatments Rehabilitation Draw a picture of athlete completing rehab