Vocabulary

1
Vocabulary

• Hallux Valgus
• Bunionettes
• Hallux Rigidus
• Hammer toes
• Calcaneal apophysitis
• (Severs disease)
• Exostoses
• Metatarsalalgia
• Mortons neuroma
• Pronation
• Plantar fascia
• Stance phase of gait
• Supination
• Swing phase of gait

• Achilles tendon rupture
• Ankle dislocation
• Apophysitis
• Great toe sprain
• Heel spur
• Ingrown toenail
• Osteochondritis dissecans
• Pes cavus
• Pes planus
• Plantar neuroma
• Plantar wart
• Talotibial exostoses
• Tarsal tunnel syndrome

2
Arches of the Foot

• Why do we have arches?
• Supporting body weight
• Absorbs shock
• Providing space for blood vessels, nerves,
  muscles
• Medial longitudinal arch
• Medial border of the calcaneus to distal head of
  1st metatarsal
• Composed of calcaneus, talus, navicular, 1st
  cuneiform/metatarsal
• Main ligament is the spring ligament and
  posterior tibialis muscle for reinforcement
• Lateral longitudinal arch
• Lateral border of the foot
• Composed of calcaneus, cuboid,5th metatarsal

3
Arches of the Foot

• Anterior metatarsal arch
• Distal heads of the metatarsal
• Transverse arch
• cuboid and 3rd cuneiform
• Plantar fascia (plantar Aponeurosis)
• Thick white band of fibrous tissue
• From medial tuberosity of calcaneus to proximal
  heads of metatarsals

4
Articulations

• Interphalangeal articulations
• DIP/PIP joints
• Produces flexion/extension
• Metatarsophalangeal articulations
• condyloid type of a joint
• Flexion, extension, adduction, abduction
• Intermetatarsal articulations
• Sliding joints which permits only gliding motions

5
Articulations

• Tarsometatarsal articulations.
• Saddle shape allows some gliding and limited
  flex/ext., Add/abduction.
• Intertarsal articulations.
• Include the subtalar, midtarsal (transverse
  tarsal), anterior intertarsal (cuneonavicular).
  They are sliding joints.
• Movements include flex/ext, abduction/add,
  inversion/eversion, also pronation/supination.

6
Ligaments of the Foot

• Page 405 fig. 17-5
• Subtalar ligaments
• Articulation between talus and calcaneus
• Talocalcaneal- ant/post, lat/medial
• Major ligament is plantar calcaneonavicular
  Spring lig.
• Midtarsal ligaments
• Dorsal talonavicular, bifurcate, dorsal
  calcaneocuboid
• Anterior tarsal joints
• Cuneinavicular, cuboideonavicular,
  intercuneiform, cuneocuboid ligaments.
• Dorsal and plantar ligaments

7
Muscles and Movements

• Dorsiflexion/plantar flexion
• Plantar- gastrocnemius, soleus, plantaris,
  peroneous longus, peroneus brevis, and tibialis
  posterior
• Dorsiflexion- -tibialis anterior, extensor
  digitorum longus, extensor hallucis longus/
  brevis, and peroneus tertius muscles
• Inversion/adduction/supination
• Tibialis posterior, flexor digitorum longus,
  flexor hallucis longus
• Tibialis anterior and extensor hallucis longus
• Eversion/Abduction/Pronation
• peroneus longus, peroneus brevis
• peroneus tertius, extensor digitorum longus
• Movement of Phalanges

8
Anatomy Continued

• Nerve supply.
• Tibial nerve the largest of the sciatic nerve
  supplies the muscle of the back of the leg and
  plantar surface of the foot.
• Common peroneal nerve smallest of the sciatic
  nerve supplies the muscles of the front of the
  leg and foot.
• Blood supply.
• The major portion of the blood supplied.
• To the foot is by the anterior/posterior tibial
  arteries.

9
Foot Biomechanics

• Stance Phase or support phase
• Starts with initial contact at heel strike and
  ends at toe off
• Foots function at heel strike shock absorber
  and adapts to uneven surfaces
• Heel strike running gait initial contact of the
  foot is lat. aspect of calcaneus
• In running both feet are off the surface at the
  same time
• Heel strike leg ext. rotated and foot supinated
  then the leg int. rotated and foot pronated

10
Foot Biomechanics

• Swing phase or the recovery phase
• Immediately after toe off and the leg is moved
  from behind the body to the front in preparation
  for heel strike.
• In this phase the leg is external rotated and
  foot supinates

11
Evaluation

• Structural concerns
• Most people will at some time in their lives
  develop foot problems
• Genetics and habitual use determines your own
  foot structure
• Look for muscular/tendinous tightness, weakness,
  or hypermobility
• Footwear
• Proper footwear (shoe/socks) are essential in
  injury prevention
• Proper shoes for activity
• Look for wear on shoes and proper arch support

12
Evaluation

• Surface concerns
• Surfaces that are irregular and vary in
  resistance can serve to strengthen the foot over
  time.
• A nonyielding surface can lead to acute/chronic
  injuries
• A too resilient/absorbing surface can lead to
  early fatigue

13
Assessment

• History
• How did it happen? Did it happen suddenly or
  come on slowly?
• What was the mechanism? Type of pain? Is there
  any noises?
• Point to the exact site. When is the pain?
• What type of surface or footwear are you using ?
• Has this ever happened before?

14
Assessment

• Observation
• Are they favoring the foot? Are they limping?
• Is it deformed, swollen, discolored?
• Does it change color by weight bearing or not?
• Is the foot well aligned and whether it maintains
  its shape on weight bearing?
• Look for shoe wear.

15
Palpation - Bony

• Medial
• Medial calcaneus
• Medial malleolus
• Talar head
• Navicular tubercle
• 1st cuneiform
• 1st metatarsal
• 1st MP joint
• 1st phalanx

• Lateral
• Lateral calcaneus
• Lateral malleolus
• Peroneal tubercle
• Cuboid
• Styloid process of 5th metatarsal
• 5th metatarsal
• 5th MP joint
• 5th phalanx

Dorsal 2-4 metatarsal/phalanges, 2-3 cuneiform
16
Palpation Soft Tissue

• Medial/Plantar
• Tibialis posterior
• Deltoid ligament
• Calcaneonavicular lig (spring lig)
• Medial longitudinal arch
• Plantar fascia
• Transverse arch
• Bursal head of 1st metatarsal

• Lateral/Dorsal
• ATF
• PTF
• CF
• Peroneal tendons
• Extensor tendons of toes
• Tibialis anterior tendon

17
Special Tests

• Movements and neurological assessment
• Extrinsic/instrinsic foot muscles should be
  assessed for pain ROM during active, passive,
  resistive isometric movement
• Tinel test posterior tibial nerve
• Tendon reflex Achilles tendon (S1 nerve root)
• Sensation throughout the whole foot

18
Special Tests

• Pulses
• Taken at the posterior tibial and dorsalis pedis
  arteries.
• Posterior tibial is taken inbetween the medial
  mallelous and achilles tendon.
• Dorsalis pedis is taken inbetween externor
  hallicus longus and extensor digitorum longus.

19
Special Test Continued

• Flexibility and rigid flatfeet.
• Check for flexibility put full weight bearing on
  foot then lift foot up.
• Flexible flatfoot is one that the medial
  longitudinal arch is flat then an arch is present
  when weight is removed.
• Care is proper shoes, exercise, arch supports or
  tape.