Ms. Bowman

26 bones Phalanges-toes; proximal, middle, and distal Metatarsals-5; between phalanges and tarsals Tarsals-calcaneus, talus, navicular, cuboid, 3 cuneiforms Divided into 3 sections Rearfoot-formed by the calcaneus and talus; provides stability and shock absorption during the initial stance phase of gait and serves as a lever arm for the Achilles tendon during plantarflexion Midfoot-composed of the navicular, three cuneiforms, and cuboid; shock absorbing section of the foot Forefoot and toes-formed by the 5 metatarsals and 14 phalanges; act as a lever during the preswing phase of gait

Subtalar Joint-articulation of the calcaneus and talus Midfoot- midtarsal joint formed by the articulations of the tarsal bones Plantar calcaneonavicular ligament (spring liegament) Forefoot- Tarsometatarsal joints-junction between the midfoot and forefoot Intermetatarsal joints-proximal and distal joints Metatarsophalangeal joints Interphalangeal joints Medial Ligaments Deltoid ligament-composed of 4 ligaments Posterior tibiotalar ligament Tibiocalcaneal ligament Anterior tibiotalar ligament Tibionavicular ligament Lateral Ligaments Anterior talofibular ligament Calcaneofibular ligament Posterior talofibular ligament

There are many muscles that act on the foot. Those that originate and insert in the foot are called intrinsic foot muscles. These directly influence the foot and toes. Those that originate in the lower leg are called extrinsic foot muscles. These influence motion at the ankle and knee as well as the foot and toes. If the muscle name begins with extensor, then the muscle’s primary function is extension. If the muscle name begins with flexor, then the muscle’s primary function is flexion.

Location of p!-trauma to intrinsic structures or secondary to compensation for improper lower leg biomechanics Metatarsal p!-p! that worsens over time can indicate stress fx; p! between the MTs possibly a result of nerve impingement Great toe p!-localized p! to plantar surface can be indicative of sesamoid fx; p! with flexion or extension can be an indicator for turf toe Onset and Mechanism of injury Acute onset- can occur from trauma (fx, ligament sprain, muscle strain) Insidious onset-result of overuse injuries; may be the result of playing surface, distance and duration of exercise, shoes

Analyze gait Look for Gross deformity Edema Redness Calluses and blisters (indicates improperly fitting shoes, poor mechanics, or underlying bony or soft tissue dysfunction) Observe Alignment of the toes Toenail integrity (ingrown toenails, subungual hematoma) Arches Achilles Calcaneus Plantar surface of the foot

When palpating, check for deformity, alignment, edema, crepitus, and pain Medial Structures 1 st Phalange, 1 st MT, 1 st Cuneiform, Navicular, Talar head Spring Ligament, Calcaneus Lateral Structures 5 th phalange, 5 th MT, Cuboid, Peroneal tubercle, Calcaneus Dorsal Structures Rays, Cuneiforms, Navicular, Dome of Talus, Musculature Plantar Structures Plantar fascia, MT heads, sesamoid bones of great toe

ROM should be measured with a goniometer AROM, PROM, and RROM should be assessed as necessary Goniometry measurements Fulcrum-placed over joint Stationary arm-placed over the proximal (non-moving part of body) Movement arm-placed over the distal (moving part of body)

Valgus and Varus stress tests should be used to test the integrity of the MTP and IP joints Metatarsal gilde test can be used to tests for the integrity of the ligaments connecting the MT Midtarsal joint glide test can be used to test the integrity of the intertarsal ligaments

Foot and toes are supplied by L4 and S2 nerve roots Can be assessed by doing a lower quarter screen

Navicular drop test Tinel’s sign Long bone compression test Pencil test