Lower Body Evaluation ATC 328 The Foot and Toes Chapter 4

Foot and Toe Anatomy 26 bones –Plus sesamoids Rearfoot Midfoot Forefoot

Rearfoot Anatomy Calcaneus –Sustentaculum tali –Peroneal tubercle Talus

Midfoot Navicular –Posterior tibialis Cuneiforms Cuboid

Forefoot Anatomy 5 metatarsals –MP or MCP 14 phalanges –PIP –DIP –IP

Articulations

Arches Medial longitudinal arch Lateral longitudinal arch –Rarely injured Transverse metatarsal arch –1 st and 5 th metatarsal weight bearing

Medial Longitudinal Arch Calcaneus, talus, navicular, first cuneiform, first metatarsal Supporting structures –Plantar fascia –Plantar calcaneonavicular ligament “spring ligament” –Deltoid ligament –Long plantar ligament

Muscular Anatomy Intrinsic Muscles –Extensor digitorum brevis –Who cares!!! Extrinsic Muscles –Flexor digitorum longus –Flexor hallucis longus –Gastrocnemius/soleus complex –Peroneals –Plantaris –Tibialis posterior/anterior –Extensor digitorum longus –Extensor hallucis longus

Evaluation History –Blah, blah, blah Observation –Edema, effusion, deformity, etc Palpation Special Tests –ROM –MMT –Stability –Etc.

Toe Injuries MP, DIP, PIP, IP sprains 1 st MP joint sprain (turf toe) –Hyperextension mechanism –Rule out fx –Valgus, varus, glide testing –Treatment options

Metatarsal Sprains Intermetatarsal glides Tarsometatarsal glides Midtarsal glides ???

Pes Planus vs. Pes Cavus Most often are congenital abnormalities Other causes –Ligaments –Muscles –Accessory navicular –Tarsal coalition –Plantar fascia Navicular drop test Complications associated with these arch types?

Transverse Metatarsal Arch Most common problem is a loss of this arch. Consequences of fall TMA

Plantar Fasciitis Causes –Acute and chronic Signs and symptoms –Pain at medial calcaneal tubercle –AM pain –Decreased ROM/MMT Treatment Rupture –Acute and steroids

Heel Spurs Related to Plantar Fasciitis? Primary complaint –Pain with heel strike Treatment –Similar to plantar fasciitis –Surgery with chronic cases

Tarsal Coalition Bony, fibrous, or cartilaginous union of tarsal bones Most often affects talus, calcaneus, and/or navicular S/S –Rigid flatfoot –Calcaneal valgus –Forefoot abduction –NWB and WB identical Treatment

Tarsal Coalition

Tarsal Tunnel Syndrome Compression of posterior tibial nerve

Tarsal Tunnel Syndrome Causes –Acute: inversion or eversion –Chronic: structural and biomechanical abnormalities S/S –Plantar/medial foot pain –Positive Tinel sign Treatment

Metatarsal Fractures Stress fractures –Morton’s toe Acute fractures –Avulsion of base of 5 th –Jones’ fracture

Phalangeal Fracture S/S –Pain –Swelling –Positive compression/percussion –Crepitus Treatment –Buddy taping –Stiff insert –Relief pad/bar

Intermetatarsal Neuroma 3 interdigital nerve most common –Morton’s Neuroma Fibrous formation and demyelenization Causes –Thickened/shortened transverse ligament –Fallen transverse arch –Excessive forefoot weight bearing –Excessive pronation –Shoes?

Interdigital Neuroma S/S –Pain and paresthesia –Nodule –Pain with compression –Decreased pain barefoot –Pencil eraser “test” Treatment