1. The Foot
Chapter 17

2. Foot Anatomy 26 Bones 7 Tarsal 5 Metatarsal 14 Phalanges 38 Joints
4 Arches

3. Bones of the Foot

4. Bones of the Foot

5. Bones of the Foot

6. Tarsal Bones Talus Calcaneus Navicular Cuboid Cuniforms Medial
Intermediate
Lateral

7. Metatarsals & Phalanges

8. Sesamoid Bones 2 (medial and lateral) Under great toe
Functionpulley, increase leverage of tendons that control great toe

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

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

11. Regions of Foot Forefoot Midfoot Hindfoot Metatarsals Phalanges
Navicular
Cuboid
3 Cuniforms
Hindfoot
Calcaneus
Talus

12. Regions of the Foot

13. 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

14. Foot Arches Functions Support body weigh in an economical fashion
Absorb the shock of weight bearing
Provide a space on the plantar aspect of foot for blood vessels, nerves, and muscles

15. 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

16. Lateral Longitudinal Arch
Lower and flatter
Calcaneus, Talus, Cuboid, 4th & 5th metatarsals
Supports—
Ligaments:
Short plantar ligament
Plantar fascia
Tendons:
Peroneus longus

17. Transverse Arch
Cuniforms, Cuboid, & 5th metatarsal

19. 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

20. Gait

21. Pulse Posterior Tibial Artery Medial Malleolous Dorsalis Pedis artery
Extensor Tendon Great Toe

23. Foot Movements Dorsiflexion Plantar Flexion Pronation Inversion
Eversion
Supination
Pronation: combo of PF, eversion, & forefoot abduction
Supination: combo of DF, inversion, & adduction

24. 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

25. Muscles of the Foot

26. Muscles of the Foot

27. Muscles of the Foot

28. Common Injuries of the Foot

29. 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

30. 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

31. 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

32. Plantar Fascia
Wide, non-elastic ligamentous tissue that extends from the anterior portion of calcaneus to heads of metatarsals
Supplies support to longitudinal arch

33. 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)

34. 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

35. Arches

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. Heel Contusion—Treatment
Cold application before activity
Ice & elevation after activity
Absorb shock—
Heel cups
Donut pad

43. 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

44. 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

45. 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

46. Prevention of Foot Injuries
Selecting appropriate footwear
Using shoe orthotic
Foot hygiene

47. Rehabilitation of the Foot
Towel pulls
TheraBand®
Marble pick-up