Chapter 4Chapter 4

The Foot and Toes continuedThe Foot and Toes continued

Range of Motion TestingRange of Motion Testing

Focus on MTP joints (flexion & Focus on MTP joints (flexion & extension)extension)

Bilateral comparisonBilateral comparison Box 4-4 Foot Goniometry, page 113Box 4-4 Foot Goniometry, page 113

Active ROM (first MTP)Active ROM (first MTP) Extension 75-85Extension 75-8500

Flexion 35-45Flexion 35-4500

Compensatory motionCompensatory motion Passive ROMPassive ROM

Figures 4-22 & 4-23, page 114Figures 4-22 & 4-23, page 114 Resisted ROMResisted ROM

Box 4-5, page 115Box 4-5, page 115

Ligamentous and Ligamentous and Capsular TestingCapsular Testing

MTP and IP JointsMTP and IP Joints MCL, LCL, joint capsuleMCL, LCL, joint capsule OverpressureOverpressure Box 4-6, page 116Box 4-6, page 116

Intermetatarsal JointsIntermetatarsal Joints Deep transverse ligament and interosseous Deep transverse ligament and interosseous

ligamentsligaments GlidingGliding Box 4-7, page 117Box 4-7, page 117

Ligamentous and Ligamentous and Capsular TestingCapsular Testing

Tarsometatarsal JointsTarsometatarsal Joints Dorsal and Plantar glideDorsal and Plantar glide Box 4-8, page 118Box 4-8, page 118

Midtarsal JointsMidtarsal Joints Dorsal and Plantar glide of cuneiformsDorsal and Plantar glide of cuneiforms Box 4-9, page 119Box 4-9, page 119

Neurologic ExaminationNeurologic Examination

L4 – S2 nerve rootsL4 – S2 nerve roots Neurologic symptomsNeurologic symptoms Box 1-5, Chapter 1Box 1-5, Chapter 1 Tarsal Tunnel Syndrome/Interdigital Tarsal Tunnel Syndrome/Interdigital

neuroma (Figure 4-24, page 117)neuroma (Figure 4-24, page 117)

Pathologies and Related Pathologies and Related Special TestsSpecial Tests

Improper biomechanics or result of Improper biomechanics or result of compensation by foot for biomechanical compensation by foot for biomechanical deficits elsewhere in lower extremitydeficits elsewhere in lower extremity

Arch PathologiesArch Pathologies

Most commonly occur congenitallyMost commonly occur congenitally Increasing or decreasing height of archIncreasing or decreasing height of arch Arch height (Figure 4-25, page 120)Arch height (Figure 4-25, page 120) Navicular drop indicates change in height Navicular drop indicates change in height

from non-weight-bearing to weight-from non-weight-bearing to weight-bearingbearing

Pes PlanusPes Planus

Figure 4-26, page 120Figure 4-26, page 120 Congenital origin, biomechanical Congenital origin, biomechanical

changes, or acute traumachanges, or acute trauma Affects function of subtalar and Affects function of subtalar and

calcaneocuboid jointscalcaneocuboid joints Acute – trauma to supporting structuresAcute – trauma to supporting structures Accessory navicular (Fig. 4-27, pg 121)Accessory navicular (Fig. 4-27, pg 121) Mechanical FactorsMechanical Factors

Rigid (structural) vs. flexible (supple)Rigid (structural) vs. flexible (supple) Box 4-10, page 122Box 4-10, page 122

Navicular drop test (Box 4-11, page 123)Navicular drop test (Box 4-11, page 123) Should not be left untreatedShould not be left untreated

Pes CavusPes Cavus

Figure 4-28, page 124Figure 4-28, page 124 Congenital, neurologic, diseaseCongenital, neurologic, disease Associated with stiffness and impaired Associated with stiffness and impaired

ability to absorb ground contact forcesability to absorb ground contact forces Dorsal pads under calcaneus and MT Dorsal pads under calcaneus and MT

heads appear smaller than normalheads appear smaller than normal Claw toes, calluses over PIP jointsClaw toes, calluses over PIP joints Treatment optionsTreatment options

Transverse Metatarsal Transverse Metatarsal Arch PathologyArch Pathology

Only slightly visibleOnly slightly visible Deficiency can produce pain under heads Deficiency can produce pain under heads

of second through fifth MTsof second through fifth MTs Intertarsal neuromaIntertarsal neuroma Inspect, palpate plantar surfaceInspect, palpate plantar surface

Plantar FasciitisPlantar Fasciitis

Table 4-7, page 125Table 4-7, page 125 Causes of the inflammationCauses of the inflammation Trauma to plantar fascia can lead to Trauma to plantar fascia can lead to

many problemsmany problems Signs and symptomsSigns and symptoms Accompanied by other dysfunctionsAccompanied by other dysfunctions Treatment optionsTreatment options

Heel SpurHeel Spur

Exostosis of medial calcaneal tubercleExostosis of medial calcaneal tubercle Relationship with plantar fasciaRelationship with plantar fascia Similar signs, symptoms and treatments Similar signs, symptoms and treatments

to plantar fasciitisto plantar fasciitis

Plantar Fascia RupturePlantar Fascia Rupture

Dorsiflexion of foot combined with Dorsiflexion of foot combined with extension of toesextension of toes

Risk of ruptureRisk of rupture Signs and symptomsSigns and symptoms

Tarsal CoalitionTarsal Coalition

Bony, fibrous or cartilaginous union Bony, fibrous or cartilaginous union between two or more tarsal bonesbetween two or more tarsal bones

Hereditary condition; calcaneonavicular, Hereditary condition; calcaneonavicular, talonavicualr, talocalcaneal jointstalonavicualr, talocalcaneal joints

Signs and symptomsSigns and symptoms TreatmentTreatment Figure 4-29, page 126Figure 4-29, page 126

Tarsal Tunnel SyndromeTarsal Tunnel Syndrome

Entrapment of posterior tibial nerve as it passes Entrapment of posterior tibial nerve as it passes through tibial tunnelthrough tibial tunnel

Tunnel formed anteriorly by tibia and talus and laterally Tunnel formed anteriorly by tibia and talus and laterally by calcaneusby calcaneus

Flexor retinaculum = fibrous roof (Fig 4-30, pg 127)Flexor retinaculum = fibrous roof (Fig 4-30, pg 127) Acute, predisposing conditions, anatomical factors, Acute, predisposing conditions, anatomical factors,

biomechanicsbiomechanics Patient complaintsPatient complaints Evaluation/TreatmentEvaluation/Treatment Table 4-8, page 127Table 4-8, page 127 Figure 4-31, page 128Figure 4-31, page 128

Metatarsal FracturesMetatarsal Fractures

Direct trauma or overuseDirect trauma or overuse Base of fifth (Figure 4-32, page 128)Base of fifth (Figure 4-32, page 128)

Jones’ fracture (Figure 4-33, page 129)Jones’ fracture (Figure 4-33, page 129)

Stress fracturesStress fractures March fracturesMarch fractures

Signs and symptoms (Figure 4-34, page 129)Signs and symptoms (Figure 4-34, page 129) ManagementManagement Table 4-9, page 130Table 4-9, page 130

Phalangeal FracturesPhalangeal Fractures

Longitudinal force or crushing forceLongitudinal force or crushing force Figure 4-35, page 130Figure 4-35, page 130 Signs and symptomsSigns and symptoms TreatmentTreatment

Intermetatarsal NeuromaIntermetatarsal Neuroma

Entrapment of nerve between two MT Entrapment of nerve between two MT headsheads

Morton’s NeuromaMorton’s Neuroma Causes/predisposing factorsCauses/predisposing factors Signs and symptomsSigns and symptoms TreatmentTreatment Figure 4-36, page 131Figure 4-36, page 131

Hallux RigidusHallux Rigidus

Progressive degeneration of first MTP Progressive degeneration of first MTP jointjoint

Hallux limitus/ankylosisHallux limitus/ankylosis CausesCauses Signs and symptomsSigns and symptoms TreatmentTreatment Figure 4-37, page 132Figure 4-37, page 132

First First Metatarsophalangeal Metatarsophalangeal Joint SprainsJoint Sprains

Mechanism of injuryMechanism of injury ““Turf Toe”Turf Toe” Signs and symptomsSigns and symptoms ManagementManagement

On-Field Evaluation of On-Field Evaluation of Foot InjuriesFoot Injuries

Equipment considerationsEquipment considerations On-field historyOn-field history On-field inspectionOn-field inspection On-field palpationOn-field palpation On-field ROM testsOn-field ROM tests

On-Field Management of On-Field Management of Foot InjuriesFoot Injuries

Plantar fascia rupturesPlantar fascia ruptures Fractures and DislocationsFractures and Dislocations