© 2007 McGraw-Hill Higher Education. All rights reserved. The Foot PE 236 Amber Giacomazzi, MS, ATC

© 2007 McGraw-Hill Higher Education. All rights reserved.

The Foot

PE 236Amber Giacomazzi, MS, ATC


• The foot is designed basically for:– ______________– ______________– ______________– ____________________



Arches of the Foot


Plantar Fascia


Muscle of the Foot and Lower Leg



Prevention of Foot Injuries

• Highly vulnerable area to variety of injuries• Injuries best prevented by selecting __________

_________, correcting __________ __________ _____________ through orthotics

• Foot will adapt to training surfaces over time– Must be aware of potential difficulties associated with

___________ and ______________ training surfaces


Recognition and Management of Specific Injuries

• Foot problems are associated with _______ ________, __________, ____________ ________ __________ or ______________

• Sports place exceptional stress on feet• ATC’s must be aware of potential problems

and be capable of identifying, ameliorating or preventing them


Foot Assessment

• Athletes should be referred to qualified personnel for injury evaluation

• History– Generic history questions– Questions specific to the foot


• Observations– Does athlete ____________, ______, or is

_________________________?– Does foot color change w/ weight bearing?– ____________________?– shoe?

• ____________________________?


Biomechanics of Gait• Walking Gait Cycle

– ____________________– ____________________– ____________________– ____________________

• Running Gait Cycle– ____________________– ____________________– ____________________– ____________________– ____________________


• Palpation– Should assess the bony anatomy first

• Checking for deformities and areas of tenderness– Assessment of soft tissue (muscles and

tendons) will allow for detection of _______ __________, _________, ___________or _____________________

– Circulation must also be monitored using the ______________________• Located on ______________________________


• Retrocalcaneal Bursitis (______________)– Cause of Injury

• The ______________ bursa becomes chronically irritated/inflamed by constant rubbing or pressure from heel contour of shoe causing _____________

– Sign and Symptoms• Tenderness, swelling, warmth, redness • May progress to palpable and tender bony bump on

back of ______________

– Treatment• ______________________• Shoe with a different ___________


• Heel Bruise– Cause of Injury

• Caused by sudden ________, ______ or __________ ____________, ______________________

– Signs and Symptoms• _____________in heel and is ______ to withstand stress

of __________________• May progress to chronic inflammation of bone covering

– Treatment• Reduce ____________ for ______, _____ and ________’s• Resume activity with heel cup or doughnut pad after pain

has subsided (be sure to wear shock absorbent shoes)• Applying tape can also be effective in generating a “heel

cup”



• Plantar Fasciitis– Cause of Condition

• _____________________________• Change from rigid supportive footwear to flexible

footwear• Poor running technique• ___________________, _______________,

__________________, __________________ complex

• Running on soft surfaces, shoes with _____________

– Sign and Symptoms• Pain in ______________ heel, along ____________

_________________ arch• Increased pain in _________, loosens after ________

________, pain with __________________________


– Treatment• Extended treatment (___________) is required• __________ therapy is very useful (soft orthotic

with deep heel cup)• Simple arch taping, use of a ____________to stretch• Vigorous ___________stretching and exercises that

increase ______________________________• __________and occasionally __________________


• Metatarsal Fractures – Cause of Injury

• Direct force or by placing torsional/twisting stresses on bone

– Signs and Symptoms• Difficult to distinguish ________from _________in this case• Generally present with ________, ________,

______________ and possible deformity• _________ will be necessary to distinguish fx from sprain

– Treatment• _____________

– RICE for swelling• _________________________________________________

_________________________________________


• Jones Fracture– Cause of Injury

• Fracture of metatarsal caused by ___________ or _____________________________ forces

• Most common = base of ______________________

– Sign and Symptoms• _____________________, pain over 5th metatarsal• May feel a “______”• High _________________ and course of healing is

____________________

– Treatment• Generally requires ______weeks __________________ with

_______________if non-displaced• If nonunion occurs, ___________________may be required



• Metatarsal Stress Fractures – Cause of Injury

• _____ metatarsal fracture (____________________)

• Change in ____________, __________, _______, or ______________________

• Often the result of ______________________of the foot or ________________(terrain, footwear, surfaces)

• Often associated with _______________

– Signs and Symptoms• Pain and tenderness along second metatarsal• Pain with running and walking• Continued pain/aching when non-weight bearing


– Treatment• Determine cause of injury• Generally good success with ______________ and

training modifications (______________, _________ ________) for _____ weeks

• Return to running should be gradual over a _____ week period with ____________________


• Metatarsal Arch Strain– Cause of Injury

• ____________ of metatarsals caused by _______in ligaments – results in __________________of foot

• Will appear to have __________ arch– Signs and Symptoms

• _______ or ________in metatarsal region• Point tenderness (_______________), weakness• _________________may form in area of pain

– Treatment• Pad to elevate metatarsals just behind ball of foot• ______________ of foot muscles and

_____________ stretching


• Longitudinal Arch Strain– Cause of Injury

• Result of increased stress on arch of foot• Flattening of foot during __________ _______ causing

_______on arch (appear suddenly or develop slowly)– Sign and Symptoms

• Pain with ________and ________, usually below ________________tendon, accompanied by pain and _____________

• May also be associated with sprained ______________ ligament and ____________________________strain

– Treatment• Immediate care, RICE, reduction of weight bearing.• Weight bearing must be pain free• Arch taping may be used to allow pain free walking



• Fractures and Dislocations of the Phalanges– Cause of Injury

• ____________________, ___________, ______ __________________

– Signs of Injury• ___________ and ______________• Swelling and discoloration• ________________with dislocation

– Care• Dislocations should be reduced by a physician• _______ may occur with ________or ___________

_______• Buddy taping is generally sufficient• Shoe with larger toe box may be necessary


• Bunion (_________________________)– Cause of Injury

• ___________of ____ metatarsal head; associated with _______________; shoes that are too _______, _______ or _________

• ________ becomes inflamed and _________, enlarging joint, and causing _____________________of great toe

– Signs and Symptoms• Tenderness, swelling, and enlargement of joint initially• As inflammation continues, _________________

causing painful ________________


• Care– Wear correct fitting

shoes, appropriate orthotics, pad over 1st metatarsal head, tape splint between 1st and 2nd toe

– Surgery may be required during later stages of condition


• Morton’s Neuroma – Cause of Condition

• Thickening of ___________ (_________________) at point where nerve divides into digital branches

• Commonly occurs between ___ and ____ met heads where ________and _______plantar nerves come together

– Signs of Condition• Burning ___________ and severe _____________

pain in forefoot• Pain relieved with non-weight bearing• Toe _____________ ____________symptoms



• Care– Teardrop pad can be

placed between met heads to increase space, decreasing pressure on neuroma

– Shoes with wider toe box would be appropriate


• Turf Toe– Cause of Injury

• ______________ injury resulting in sprain of ___ ___________________ joint

• May be the result of single or repetitive trauma

– Signs and Symptoms• Pain and swelling which increases during

_________ in __________, _______, and _________

– Care• Increase rigidity of forefoot region in shoe• Taping the toe to prevent __________• Rest and discourage activity until pain free

– 3-4 weeks may be required for pain to subside



• Calluses– Cause of Condition

• Develop from ________– may be painful as fatty layer loses __________ and ____________effect

• May be vulnerable to _______and ________ and possible __________development underneath

– Care• Emery callus file may be necessary• Massaging with small amounts of lotion may be

helpful• _________ or __________– care must be exercised• Can be prevented

– Shoes that ___ ______________are recommended– Wear at least _____ layer of socks– Apply ________________ to reduce ____________


• Blisters– Cause of Injury

• __________forces on skin – results in development of _____________________ between layers of skin

• Wearing appropriate footwear (_____ and _____) and applying lubricants may help to reduce friction

– Care• Take action to reduce friction (apply lubricants,

cover with tape/band aid/donut pad)• ________________in order to prevent __________• Puncturing may be necessary if ______________ is

to great and is causing __________________



• Ingrown Toenails– Cause of Condition

• Leading edge of nail grows into nearby soft tissue

– Care• Shoes should be appropriate ______ and

_______• Correct trimming of nails• Nail should be left sufficiently long• Should be cut short enough that it is not

irritated by shoes or socks• Treatment may require ______ and _______

toenail with ______ in order to lift nail away from soft tissue

• Cutting a _____ notch toward the infected side


• ____________Hematoma– Cause of Injury

• ___________, ________an object on toe, ____________ another object

• Repetitive _________ forces on toenail– Signs of Injury

• Accumulation of blood underneath toenail • Likely to produce ____________ and ultimately

______of _____– Care

• ______ immediately to reduce pain and swelling• Relieve pressure within 12-24 hours (_____ or ___

nail) – must be ________ to prevent ___________


Documents

© 2007 McGraw-Hill Higher Education. All rights reserved. The Foot PE 236 Amber Giacomazzi, MS, ATC