1. THE FOOT
Chapter 18

2. Introduction
The traditional sports activities in which athletes compete at the high school, college and professional level all involve some elements of running, jumping and changing directions. The function of the foot is critical. One instant the foot must be a mobile adapter to absorb shock, and the next minute it must become a rigid lever to propel the body forward. Injury is common.

3. Foot Anatomy
Muscles and Movements: the movements of the foot are produced by numerous muscles
Bones: the foot consists of 26 bones: 14 phalangeal, 5 metatarsal, and 7 tarsal

6. Foot Anatomy
Articulations: five regions-inter-phalangeal, meta-tarsophalangeal, inter-metatarsal, tarsometatarsal, sub-talar, and mid-tarsal
Stabilizing Ligaments: midtarsal joint is given added strength in its plantar aspect by the long plantar ligaments

7. Foot Anatomy Arches of the Foot
Lateral longitudinal arch- outer aspect
Anterior metatarsal arch- shaped by the distal heads of the metatarsals
Transverse arch- extends across the transverse tarsal bones; it gives protection to soft tissue and increases the foot’s mobility

9. Ligaments

10. Ligaments

11. Foot Anatomy
Nerve Supply: the Tibial nerve, largest division of the sciatic nerve, supplies the muscles of the back of the leg and the plantar aspect of the foot
Blood Supply: major portion of the blood is supplied to the foot by the anterior and posterior Tibial arteries

13. Foot Biomechanics Pronation and Supination
Excessive Pronation: major cause in stress injury/prolonged into the propulsive phase of running
Excessive Pronation: compensatory movement at the subtalar joint will not allow the midtarsal joint to unlock, which causes the foot to remain excessively rigid

15. Assessing Foot Conditions
History:
Is this the first time this condition has occurred?
How did the injury occur?
What type of pain is there?
Is there any alteration in sensation?
On what type of surface has the athlete been training on?
etc…………

16. Assessing Foot Conditions
Observation:
Is the athlete favoring the foot, walking with a limp, or unable to bear weight?
Is the injured part deformed, swollen, or discolored?
Is there pes planus (a flatfoot) or pes cavus (a high arch)?
Is the foor well aligned? Does it maintain its shape on weight bearing?

17. Assessing Foot Conditions
Palpation: besides determining pain sites, swelling, and deformities, palpation is used to determine and evaluate circulation.

18. Assessing Foot Conditions
Special Tests:
Movement- both, ex- and intrinsic foot muscles should be assessed for pain and range of motion during active, passive, and resistive isometric movement
Tinel’s Sign- taping over posterior tibial nerve produces tingling distal to area. Numbness, tingling and paresthesia may indicate the presence of tarsal tunnel syndrome.
cont…

19. Assessing Foot Conditions
Special Tests: (continued)…
Morton’s Test- with foot in a supine position, transverse pressure is applied to heads of the metatarsals, causing a sharp pain in the forefoot.
Neurological Assessment- Reflexes and cutaneous distribution needs testing, skin sensation should be noted for any alteration

21. Recognition & Management Specific Injuries & Conditions
Injuries to the Tarsal Region
Etiology: occur laterally from severe inversion/dorsi-flexion force or medially from inversion and plantar flexion
Symptoms and Signs: repeated trauma to the ankle; feels pain on weight bearing and complains of catching and snapping/swelling
Management: X-ray/Protective immobilization/Rehabilitation; if it still contains then surgery is accountable

22. Recognition & Management Specific Injuries & Conditions
Injuries to the Tarsal Region
Etiology: fracture of talus; occur laterally from a severe inversion
Symptoms and Signs: history of repeated trauma to the ankle/complains on weight bearing and of catching and snapping along with swelling
Management: X-Ray; protective immobilization with non-weight bearing progressing to full weight bearing depending on symptoms

23. Recognition & Management Specific Injuries & Conditions
Injuries to the Calcaneous
Etiology: from landing after a jump or fall from a height
Symptoms and Signs: immediate swelling and pain and an inability to bear weight
Management: RICE; early range of motion exercises are suggested

24. Recognition & Management Specific Injuries & Conditions
Arches
Pes Planus
Etiology: medial longitudinal arch appears to be flat and is sometimes said to be fallen
Signs and Symptoms: pain and feeling of weakness or fatigue in the medial longitudinal arch; calcaneal eversion
Management: if it’s not causing athlete any pain, then absolutely nothing should be done, if done then may content in causing unnecessary problems

25. Recognition & Management Specific Injuries & Conditions
Arches
Pes Cavus Foot
Etiology: an arch that is higher than normal (aka) “claw foot” or “hollow foot”
Signs and Symptoms: general foot pain, metetarsalgia, and clawed or hammer toes
Management: no attempt should be made to correct the problem, may cause deformity

26. Foot Rehabilitation
General: Rehab techniques for managing injuries to lower extremity & the foot, often require athlete to be non-weight bearing
Weight Bearing: if athlete is unable to walk without a limp, non-weight bearing or limited weight-bearing crutch walking might be employed
Flexibility: important to restore full range of motion following various injuries to the phalanges

27. Foot Rehabilitation Joint Mobilization
Anterior/posterior calcaneocuboid glides are used for increasing adduction and abduction. (The calcaneus should be stabilized while the cuboid is mobilized)
Anterior/posterior tarsometatarsal glides decrease hypomobility of the metatarsals
Anterior/posterior talonavicular glides also increase adduction and abduction. (One hand stabilizes the talus while the other mobilizes the navicular bone)

28. Foot Rehabilitation
Neuromuscular: involves a highly integrativem dynamic process involving multiple neurological pathways.
Flexibility: important to restore full range of motion following various injuries to the phalanges

29. Foot Rehabilitation Foot Orthotics
Pads and soft flexible felt supports.
Semirigrid orthotics made of flexible thermoplastics, rubber, or leather.
Functional or rigid orthotics are made from hard plastic and also require neutral casting.
Neuromuscular: involves a highly integrativem dynamic process involving multiple neurological pathways.

30. Summary The function of the foot is critical to athletic performance.
Evaluation and recognition of injuries and conditions can present a challenge to the athletic trainer.
Many chronic conditions of the lower extremity can be related to foot mechanics.
Management, rehabilitation, and prevention of foot conditions is essential.