Bones of the Foot (1)

26 bones Phalanges = 14

Numbered 1-5 (big toe = Hallux = #1) distal Interphalangeal joint (DIP) proximal interphalangeal joint (PIP) Metatarsal phalangeal joint (MP)

Metatarsals (numbered 1-5)

Bone of the foot (2)

Tarsals- Fig 12-2 Calcaneous (heel bone) Talus (main weight bearing) Navicular- medial 3 cuneiforms Cuboid-lateral

The arches Fig 12-10

Function to support and distribute body weight

Three arches: Fig 12-10 Medial longitudinal (higher)

supported by calcaneal-navicular ligament (spring)

Lateral longitudinal Transverse

Plantar Fascia Supports longitudinal arch

The Ankle Fig 12-1/12-3

Ankle joint = talocrural joint Three bones

Tibia (medial malleolus)-major weight bearing Fibula (lateral malleolus) Talus

Hinge joint Dorsi-Flexion Plantar Flexion

Subtalar Joint

The joint between the talus and the calcaneous

Shifts during weight bearing (WB) Supination/inversion Pronation/eversion

Tibiofibular Joint -Fig 12-3

Composed of Tibia and Fibula Ligaments/Membrane

Anterior Tibofibular Lig Posterior Tibofibular Lig Interosseious membrane- connects the

tibia and fibula; runs the entire diaphysis of both bones

Ankle ligaments (1) – Fig 12-3

Medial Deltoid ligament -4 parts Triangular shape (very strong)

Lateral Anterior talofibular (ATF) Calcaneofibular (CF) Posterior talofibular (PTF)

Ankle and foot are composed of numerous ligaments; where ever two bones meet

Muscles of the Lower Leg Thick sheaths of fascia divide muscles into 4

compartments Anterior Compartment

Dorsiflexion (DF), Toe Extension (EXT), Inversion (INV)

Lateral Compartment Eversion (EV)

Deep Posterior Compartment Toe Flexion (flex), Inversion (INV)

Superficial Posterior (Plantar flexion (PF))

Nerves and Blood Supply

Nerves Sciatic nerve branches into the peroneal

(ant/lat) and tibial nerves (post) Blood Supply

Femoral Artery →Popliteal artery → Anterior and Posterior Tibial artery

Anterior Tibial becomes the dorsalis pedis artery →dorsal pedal on the dorsum of foot

Posterior Tibial is located behind medial malleolus.

ROM

DF-tibialis anterior, extensor digitorum PF- gastroc and soleus INV- tibialis anterior and posteror EV- peroneals Toe Ext.-extensor digitorum and hallucis Toe Flexion flexor digitorum and hallucis

Review

http://www.csuchico.edu/~sbarker/shock/Anklequiz.html

http://www.rad.washington.edu/atlas2/ http://www.medicalmultimediagroup.com/pate

d/foot/achilles/achilles.html

Prevention of Injury

Stretch achilles tendon tight achilles increases risk of plantar fasciitis,

achilles tendonitis, and ankle sprains Strengthen anterior leg muscles

important for shin splints Strengthen lateral/medial leg muscles Strengthen intrinsic foot muscles Good shoes; change shoes, correct type of

shoes for playing surface

Injury information

Precursors = something that may predispose an athlete to that injury

All injuries should be treated for symptoms thus RICE. This will not be listed with each injury but should be remembered

HOPS includes information typically seen or heard during the HOPS assessment. Most injuries include swelling, discoloration etc in area, this is not included in slides

Lateral Ankle Sprain

MOI: PF and/or Inv More common than medial ankle sprains due

to (make up about 90% of ankle sprains): differing length of malleoli (lateral is longer) Stronger deltoid ligament

Precursors: tight achilles, improper shoes, previous ankle injury

HOPS and Tx See field strategy 12.2

Medial Ankle Sprain

Less common then lateral ankle sprains MOI: eversion Sometimes accompanied by a fracture HOPS

point tenderness over deltoid and anterior/ posterior joint line

Swelling not as obvious Takes almost twice as long to recover in some

cases

Achilles tendonitis

Precursors: achilles tendon tightness, change in shoes, running surfaces, workout changes

HOPS chronic injury pn during and after activity Thickening of the tendon Crepitation Pn with Resistive PF, Passive DF

Tx: stretch achilles, heel lift, tape, ultrasound

Achilles Tendon rupture

Precursors: athletes between 30 and 40, power sports (BB); recreational athletes

HOPT MOI: push off with knee extending sharp pain, feels snap or pop “kicked in the back of the leg” visible defect/palpable defect positive Thompson test Excessive passive DF

Tx: refer to physician

Medial Tibial Stress Syndrome (1)

“shin splints” Precursors: achilles tendon tightness, change

in shoes, running surfaces, workout changes, arch problems

HOPS sometimes bilateral; pn along distal 1/3 of

medial tibial border initially: pn at start of activity that decreases

with activity, then recurring after activity Later: pain before during and after activity

Medial Tibial Stress Syndrome (2)

HOPS (cont) Pn increased with AROM PF, INV Usually responds well to treatment

Tx Cryotherapy stretching of achilles strengthen deep posterior muscle strengthen anterior muscles

Plantar Fasciitis

Precursors: obesity, achilles tendon tightness, overuse, shoes

HOPT chronic injury pn first thing in the morning point tenderness over the medial calcaneal

tubercle Pn with toe extension and ankle DF TX- Hot and Cold Modalities, stretching, rest,

orthodics, change in shoes, heel lift, tape, roll foot over soda can

Compartment Syndrome (1)“Volkman's Ischemic Contracture”

Two types: Exertional (MOI:previous injury in leg, chronic

onset); Read; **Exertional CS can lead to Acute CS

Acute (MOI: blow to front of the leg) Acute-HOPT

Increasing pain in the front of the leg firm tight skin in front of shin loss of sensation between 1st and 2nd toes

Compartment Syn (2)

diminished pulse at dorsalis pedis artery Inability to DF ankle, or extend toes

(progressive) The 5 Ps (ie, pain, pallor, paresthesias,

paralysis, pulselessness) Tx

Ice and Immobilize Get to physician (MEDICAL EMERGENCY) Abnormalities can occur within 30 minutes;

irreversible damage can occur within 12-24 hrs

“Turf” Toe

Precursors: hard surfaces, lightweight, flexible shoes, artificial turf

HOPT MOI-jamming of hallux, hyperextension of toe sport position requiring hyperextension Pn, point tnederness over 1st MP joint Push off phase of running is painful Pn with passive extension of the great toe

Treatment (TX) taping, metatarsal pad, stiff soled shoes,

manage symptoms

Ingrown toenail

Precursors improper cutting of toenails, too small shoes,

contant sliding of foot in shoes HOPT

nail grown into the surrounding skin signs of infection around the nail bed

Tx See field strategy 12.5

Motron’s Neuroma

Precursors: tight fitting shoes, HOPT

pn on the plantar side of the foot, usually between the 3rd and 4th metatarsal

Pn and numbness radiates to the 3rd & 4th toes Pain relieved by Non weight bearing (NWB) Pn caused by squeezing the foot

Treatment (TX) taping, metatarsal pad, wider shoes, cortisone

shots, surgery

Stress Fractures Precursors: female athletes with menstrual

irregularities (amenorrhea) increase in training regimen, old shoes

common sides: tibia, fibula, neck of 2nd metatarsal

HOPS pn on WB, relieved by NWB localized pn (often unilateral)

Tx: complete rest 4-12 weeks, referral for bone scan

Jones Fracture

Avulsion fracture of the peroneus brevis tendon where it attaches to the base of the 5th metatarsal

Common with severe inversion ankle injuries HOPS:

pn over base of 5th metatarsal MOI: severe, forceful inversion

Bunions- Hallux Valgus

Medial aspect of 1st MP joint HOPT

C/S- Shoes, congenital, lig. laxity, prolonged pronation of foot

Angular deformity of the great toe Pain around the first MP joint (inflammation)

Treatment (TX) taping, wider shoes, surgery last option

Tests

ROM- good/bad; active/passive; perform bilaterally; award a %

Strength-good/bad; perform bilaterally; award a %

Special Test Thompson Test

achilles tendon rupture Anterior Drawer

ATF ligament Talar Tilt

CF ligament Deltoid ligament

Fracture Test- FS 12.6

Test

Functional Test (p.235-236)- heel raises, walking, balancing, squatting, running, jumping, (progression is the key)

Specialized Rehab

Towel crunches Theraband Exercises all ROM Picking up objects (marbles) BAPS (wobble board) Stability Trainers http://www.promedproducts.com/Merchant2/

merchant.mv?Screen=CTGY&Store_Code=PP&Category_Code=BB

Achilles Stretch straight = gastroc bent = soleus