قــالــوا سُبحَانَكَ لا عِلمَ لَنَا إِلا مَا عَلَّمتَنَا إِنَّك أَنتَ العَلِيمُ الحَكِيمُ

The foot The foot bones The foot joints Foot movements 1- ankle motion 2- tarsal joints motion 3- phalangeal motion

Normal foot characteristics Pain free Centralized tendon Achilles No stiffness or limited ROM No contractures or ms. imbalance Three or seven wt. bearing points Normal arches

Difference between the hand and foot The hand bone arrange for wide ROM, manipulation, arches, bone rows,.. The foot wt. bearing, propelling, nerves– ms protection

The foot arches Factors maintain arches Functions of the arches

The foot injuries Terminology (talipes- heel and foot together, pes- forefoot alone ) Equinus – vertical position of tarsus in a horse’s foot Calcaneus – calcaneum assumed more vertical position than normal

Painful heel Flat foot Metatarsalgia Hammer toe drop foot Hallux rigidus and valgus

Operative TTT Arthroplasty Arthrodesis Tendon transfer Tenoplasty Physical Therapy – TTT Passive movement Active movement Ms re-education splints

Ankle sprains Ankle sprains are the most common injury in sports (especially soccer, volleyball, basketball) 1/ people/day 55% do not seek medical attention 40% will develop chronic symptoms of pain or recurrent injury Gender, foot type and general laxity not risk factors, previous sprain definitely a risk factor

Management Initial management: RICE ? Immobilization for severe sprains (brace or taping) Diminish pain and swelling Increase ROM Strengthening Proprioception Brace for return to sport (especially if laxity) Surgery: if widening of the mortice or chronic instability

The ankle that doesn’t get better Innapropriate rehab Missed fractures Osteochondral lesions Recurrent instability Impingement Tendinopathies or tendon tears (esp. Peroneals, can also sublux) Sinus tarsi syndrome

Sinus tarsi

Prevention What’s the evidence? Previous sprain: proprioceptive training reduces rate of re-sprain in soccer players (relative risk of injury 0.13 compared to placebo) Prophylaxis: bracing decreases rate of sprains in volleyball players

Air Cast Walker

Ankle braces

Achilles tendonitis Causes – related to too rapid increase in frequency, duration and intensity of running TTT Modification of running program Use NSAID if indicated Cryotherapy and cryokinetics Iontophoresis No cortisone injection

Foot wear correction ( firm close fitted, wide heel base, mm of heel wedge) Restore normal limb alignment Correct overpronation with orthoses

FOOT PAIN 1.You have any persistent pain following a foot injury. 2. You have a bunion that is so painful that it interferes with your walking. 3. You have a painful corn or callus or a fungal infection of your feet and you have diabetes or poor circulation. 4. You have an infected ingrown toenail. 5. You notice a sudden painful swelling and redness of any of your joints, especially the big toe.

ANKLE PAIN 1.You have severe ankle swelling and pain following a sudden injury. 2. You are unable to walk comfortably or have any numbness or tingling in your foot several hours after an injury. 3. You gradually develop pain, redness, or swelling in your ankle that persists for more than two days, even without an injury.

. SHIN SPILNTS FOOT TYPES SELECTING PROPER FOOTWEAR

Plantar fasciitis No causation link between calcaneal spurs and plantar fasciitis Risk factors: pes cavus or planus, running, non-supportive footwear, reduced ankle dorsiflexion, obesity RICE, stretching, strengthening, heel pad/orthotics, taping, night splint, shock wave therapy, cortisone injection (risk of plantar fascia rupture), surgery

Splints

Hallux valgus (bunions) Primary deformity is matatarsus primus varus Most common causes are constricting footwear and overpronation therefore treatment is orthotics and wider shoes, surgery if severe

Hallux Valgus