Chapter 14 - THE FOOT

ANATOMY

ANATOMY – 26 BONES

• TARSAL BONES – 7– Calcaneus – heel bone– Talus – forms the ankle– Navicular – medial in

respect to the talus– Cuboid - lateral– Cuneiforms (3)

ANATOMY - BONES• METATARSALS – 5

– 1ST one is medial and 5th one is lateral

ANATOMY - BONES

• PHALANGES (Toes) – 14 – Big toe has two

phalanges, the rest of the toes have three

– Proximal, middle, and distal

ANATOMY - BONES

• SESAMOIDS– Sesamoid bones sit

in tendons– These are on ball on

foot below big toe– Helps distribute

weight

ANATOMY - ARCHES

• Support body weight and absorb shock

• There are four arches:– MEDIAL LONGITUDINAL ARCH– LATERAL LONGITUDINAL ARCH– METATARSAL ARCH– TRANSVERSE ARCH

ANATOMY

• PLANTAR FASCIA – Broad, flat tendonous structure that runs on the

undersurface of the foot– Starts on the calcaneus and inserts onto the

heads of the metatarsals– Supports the arch of the foot

FOOT - MOTIONS

• Toes– Flexion and Extension

• Foot– Pronation – like fallen arch– Supination – high arch

INJURIES

INJURIES

• PLANTAR FASCITIS– Common with athletes who are on toes and/or

have high arches– Causes: Not enough arch support in shoes, tight

calf muscle– Signs/Symptoms: Pain occurs in the heel to mid-

foot, especially with dorsiflexion• Hurts in the morning, feels better as they warm up

– Treatment: Gentle stretches, roll on tennis ball or frozen can, arch taping or orthodics.

INJURIES

• RETROCALCANEAL BURSITIS– ‘Pump bump’– Cause: Pressure from back of shoe– Signs/Symptoms: Swelling where the Achilles

attaches to the calcaneus– Treatment: RICE, stretching, shoes with wider

heel cups, donut pad.

INJURIES

• FRACTURES– Toes– Metatarsals

• DISLOCATIONS– Interphalangeal Joints

• SPRAINS

• STRAINS

INJURIES

• JONES FRACTURE– Fracture of the base of the 5th metatarsal– Causes: overuse; inversion; rotational forces– S/S: Feels and hears a ‘pop’; pain in the lateral

foot– Tx: immobilization (cast) 6-8 weeks or longer,

often requires surgery

INJURIES

• BUNIONS (HALLUX VALGUS)– Deformity of the head of the 1st metatarsal– Cause: extra bone is laid down on head of 1st

metatarsal• Great toe becomes malaligned

– S/S: Pain, swelling and deformity of big toe joint– Treatment: Proper shoes; doughnut pad over the

bunion; surgery?

INJURIES• MORTON’S NEUROMA

– Neuroma is a mass about the nerve sheath– S/S: burning, cramping, numb feeling in space

between third and fourth toes. – Cause: Hyperextension of toes and wearing

shoes with narrow toe boxes can increase symptoms

– Tx: teardrop pad under the metatarsal heads, good shoe selection, possible surgery

INJURIES• TURF TOE – page 307

– Great Toe sprain– Cause: Hyperextension of the big toe at the

metatarsal phalangeal joint; kicking something• Common on artificial turf b/c turf shoes allow more

motion

– S/S: swelling and pain in the joint– Tx: RICE, rigid insoles or toe boxes, taping to

prevent hyperextension of toe

INJURIES

• INGROWN TOENAILS – Cause: leading side of toenail grows into skin,

usually results in infection and pain• May trim nails too short or ill-fitting shoes

– S/S: Inflammed nail bed, may have drainage/pus

– Tx: May need to refer to doctor; soak in betadine bath; pack cotton under toenail

BIOMECHANICAL PROBLEMS• PRONATION

– Cause of many, many leg, knee, back problems

– What does it look like

• Fallen arch with toes pointed outward

• Looking at feet from behind, the Achilles will angle outward

QUESTIONS?