1. Athletic Injuries of the Foot ROP SPORTS HEALTH CARE MRS. CAMOU

2. CC #1 Fools wander … Wise people reach their destination

3. CC # 2 It is better to fail while trying than to succeed at doing nothing.

4. Skeletal Anatomy – 26 Bones Tarsal bones (7) –Calcaneous –Talus –Navicular –Cuboid –Cuneiforms Medial Intermediate Lateral Metatarsals (5) –1-5: med  lat Phalanges (14) –Proximal (1-5) –Intermediate (2-5) –Distal (1-5)

5. Skeletal Anatomy Forefoot –Phalanges –Metatarsals Midfoot –Cuneiforms –Navicular –Cuboid Rearfoot –Talus –Calcaneous

6. Skeletal Anatomy - Arches Medial longitudinal Lateral longitudinal Metatarsal Transverse

7. Skeletal Anatomy - Arches

8. Skeletal Anatomy - Joints Meta-tarso-phalangeal (MP or MTP) Subtalar –Talus –Calcaneus

9. Musculotendinous Anatomy Anterior Aspect –Extensors of toes –Extensor digitorum longus –Extensor digitorum brevis –Extensor hallucis longus –Extensor hallucis brevis

10. Musculotendinous Anatomy Posterior Aspect –Flexors of toes –Flexor digitorum longus –Flexor digitorum brevis –Flexor hallucis longus –Flexor hallucis brevis

11. Circulatory Anatomy Distal pulse –Posterior tibial artery –Dorsal pedis artery

12. Circulatory Anatomy Where to palpate the Distal Pulse A. Posterior tibial artery B. Dorsal pedis artery AB

13. Neurological Anatomy Tibial nerve – located in -superficial posterior muscles Peroneal nerve- located in –Superficial – lateral compartment –Deep – anterior compartment Plantar nerve – located in –Medial and lateral – foot

14. Common Foot Injuries STRAINS- muscles and tendons SPRAINS- ligaments FRACTURES- bones DISORDERS- skin, calluses, bunions

15. Plantar Fasciitis Plantar fasciitis (say "PLAN-ter fash-ee-EYE- tus") is the most common cause of heel pain. -The plantar fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. -It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk.

16. Plantar Fascia Biomechanics If you strain your plantar fascia it gets: weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk.

17. Treatment(Tx) for Plantar Fasciitis CAUSES Your feet roll inward too much when you walk (excessive pronation).excessive pronation You have high arches or flat feet. You walk, stand, or run for long periods of time, especially on hard surfaces.(athletes) You are overweight.overweight You wear shoes that don't fit well or are worn out.shoes You have tight Achilles tendons or calf muscles.Achilles tendonscalf Tx : Rest,Ice,Equipment,NSAID (non-steroidal anti- inflammatory drug) Give your feet a rest. Try not to walk or run on hard surfaces. To reduce pain and swelling, try putting ice on your heel. Take an over-the-counter pain reliever like ibuprofen, or anti- inflammatory like naproxen (such as Aleve)ibuprofennaproxenAleve NSAID=Non-steroidal Anti-inflammatory Drugs Do toe stretches, calf stretches several times a day, especially when you first get up in the morning.toe stretchescalf stretches Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts (orthotics ). Use them in both shoes, even if only one foot hurts.orthotics

18. Fractures of the Foot Tarsal bones (rear foot) –Calcaneous M.O.I- (mechanism of injury) Direct contact (fall/jump) Can be complete or stress –Talus M.O.I Forced dorsiflexion Susceptible to avascular necrosis (tissue death due to a lack of blood supply) and osteochondritis dissecans (piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone) –Metatarsals Transverse or spiral Avulsion @ base of 5 th met is a Jones’ fracture Stress fracture or Marcher fracture – usually 2 nd or 3 rd metatarsal Tx: stabilize, splint, send to E.R. for x-rays and cast Minimum 6-8 wks in a cast / surgery may be needed.

19. Metatarsal Fractures

20. Jones Fracture (base of 5 th met) 1 2 3 4 5

21. March Fracture 2 nd or 3 rd met

22. Foot Strains and Sprains Arches –Medial longitudinal arch strain Plantar fasciitis –Heel spur syndrome Phalanges –Great toe MP joint “Turf Toe” Sprain ligaments of big toe

23. Contusions to the Foot Calcaneous –“Heel bruise” –“Stone bruise” Metatarsals –Usually at met heads Treatment: rest, ice, protection Metatarsal heads

24. Structural Conditions Morton’s Toe –Second toe is longer than the Great toe –Can lead to stress fractures and neuroma (nerve tumor) Hallux Valgus –Valgus stress on first ray –Leads to bunions

25. Bunions

26. Structural Conditions Hammer Toes –Buckling of an IP joint –Commonly due to muscle imbalance –Leads to calluses and bunions Pes Planus –Flat feet –Excessive pronation –Shin splints / knee problems Pes Cavus –High arches –Faster runners –Claw feet –Excessive supination

27. Pes Planus (flat feet)

28. Other Foot Injuries Tinea pedis –“athlete’s foot” –Fungal infection of skin Tx: topical ointment, antibiotic Verrucae plantaris –Plantar warts –Viral infection of the sole of the foot Tx: topical ointments

29. Other Foot Injuries Morton’s Neuroma –Inflammation of the nerve typically between the 3 rd and 4 th metatarsals Tx: Rest, protection, injections or surgery Retrocalcaneal bursitis –“pump bumps” –Caused by inflammation of Achilles bursa Tx: Rest, Ice, Protection, NSAID

30. Other Foot Injuries Sever’s Disease –“calcaneal apophysitis” is the most common cause of heel pain in the growing athlete. –It is a Traction injury at insertion of Achilles tendon (growth plate injury) Tx: Rest, Ice, NSAID