Chapter 14 - THE FOOT

ANATOMY

ANATOMY – 26 BONES TARSAL BONES – 7 Calcaneus – heel bone Talus – forms the ankle Navicular – medial in respect to the talus Cuboid - lateral Cuneiforms (3)

ANATOMY - BONES METATARSALS – 5 1ST one is medial and 5th one is lateral

ANATOMY - BONES PHALANGES (Toes) – 14 Big toe has two phalanges, the rest of the toes have three Proximal, middle, and distal

ANATOMY - BONES SESAMOIDS Sesamoid bones sit in tendons These are on ball on foot below big toe Helps distribute weight

ANATOMY - ARCHES Support body weight and absorb shock There are four arches: MEDIAL LONGITUDINAL ARCH LATERAL LONGITUDINAL ARCH METATARSAL ARCH TRANSVERSE ARCH

ANATOMY PLANTAR FASCIA Broad, flat tendonous structure that runs on the undersurface of the foot Starts on the calcaneus and inserts onto the heads of the metatarsals Supports the arch of the foot

FOOT - MOTIONS Toes Foot Flexion and Extension Pronation – like fallen arch Supination – high arch

INJURIES

INJURIES PLANTAR FASCITIS Common with athletes who are on toes and/or have high arches Causes: Not enough arch support in shoes, tight calf muscle Signs/Symptoms: Pain occurs in the heel to mid-foot, especially with dorsiflexion Hurts in the morning, feels better as they warm up Treatment: Gentle stretches, roll on tennis ball or frozen can, arch taping or orthodics.

INJURIES RETROCALCANEAL BURSITIS ‘Pump bump’ Cause: Pressure from back of shoe Signs/Symptoms: Swelling where the Achilles attaches to the calcaneus Treatment: RICE, stretching, shoes with wider heel cups, donut pad.

INJURIES FRACTURES DISLOCATIONS SPRAINS STRAINS Toes Metatarsals Interphalangeal Joints SPRAINS STRAINS

INJURIES JONES FRACTURE Fracture of the base of the 5th metatarsal Causes: overuse; inversion; rotational forces S/S: Feels and hears a ‘pop’; pain in the lateral foot Tx: immobilization (cast) 6-8 weeks or longer, often requires surgery

INJURIES BUNIONS (HALLUX VALGUS) Deformity of the head of the 1st metatarsal Cause: extra bone is laid down on head of 1st metatarsal Great toe becomes malaligned S/S: Pain, swelling and deformity of big toe joint Treatment: Proper shoes; doughnut pad over the bunion; surgery?

INJURIES MORTON’S NEUROMA Neuroma is a mass about the nerve sheath S/S: burning, cramping, numb feeling in space between third and fourth toes. Cause: Hyperextension of toes and wearing shoes with narrow toe boxes can increase symptoms Tx: teardrop pad under the metatarsal heads, good shoe selection, possible surgery

INJURIES TURF TOE – page 307 Great Toe sprain Cause: Hyperextension of the big toe at the metatarsal phalangeal joint; kicking something Common on artificial turf b/c turf shoes allow more motion S/S: swelling and pain in the joint Tx: RICE, rigid insoles or toe boxes, taping to prevent hyperextension of toe

INJURIES INGROWN TOENAILS Cause: leading side of toenail grows into skin, usually results in infection and pain May trim nails too short or ill-fitting shoes S/S: Inflammed nail bed, may have drainage/pus Tx: May need to refer to doctor; soak in betadine bath; pack cotton under toenail

BIOMECHANICAL PROBLEMS PRONATION Cause of many, many leg, knee, back problems What does it look like Fallen arch with toes pointed outward Looking at feet from behind, the Achilles will angle outward

QUESTIONS?