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Lower Body EvaluationATC 328
The Foot and Toes
Chapter 4
Foot and Toe Anatomy
• 26 bones– Plus sesamoids
• Rearfoot
• Midfoot
• Forefoot
Rearfoot Anatomy• Calcaneus
– Sustentaculum tali
– Peroneal tubercle
• Talus
Midfoot• Navicular
– Posterior tibialis
• Cuneiforms
• Cuboid
Forefoot Anatomy
• 5 metatarsals– MP or MCP
• 14 phalanges– PIP– DIP– IP
Articulations
Arches
• Medial longitudinal arch
• Lateral longitudinal arch– Rarely injured
• Transverse metatarsal arch– 1st and 5th metatarsal weight bearing
Medial Longitudinal Arch
• Calcaneus, talus, navicular, first cuneiform, first metatarsal
• Supporting structures– Plantar fascia– Plantar calcaneonavicular ligament “spring
ligament”– Deltoid ligament– Long plantar ligament
Muscular Anatomy
• Intrinsic Muscles– Extensor digitorum brevis– Who cares!!!
• Extrinsic Muscles– Flexor digitorum longus– Flexor hallucis longus– Gastrocnemius/soleus complex– Peroneals– Plantaris– Tibialis posterior/anterior– Extensor digitorum longus– Extensor hallucis longus
Evaluation
• History– Blah, blah, blah
• Observation– Edema, effusion, deformity, etc
• Palpation
• Special Tests– ROM– MMT– Stability– Etc.
Toe Injuries
• MP, DIP, PIP, IP sprains
• 1st MP joint sprain (turf toe)
– Hyperextension mechanism– Rule out fx– Valgus, varus, glide testing– Treatment options
Metatarsal Sprains
• Intermetatarsal glides
• Tarsometatarsal glides
• Midtarsal glides ???
Pes Planus vs. Pes Cavus
• Most often are congenital abnormalities
• Other causes– Ligaments– Muscles– Accessory navicular– Tarsal coalition– Plantar fascia
• Navicular drop test
• Complications associated with these arch types?
Transverse Metatarsal Arch
• Most common problem is a loss of this arch.
• Consequences of fall TMA
Plantar Fasciitis
• Causes– Acute and chronic
• Signs and symptoms– Pain at medial calcaneal tubercle– AM pain– Decreased ROM/MMT
• Treatment
• Rupture– Acute and steroids
Heel Spurs
• Related to Plantar Fasciitis?
• Primary complaint– Pain with heel strike
• Treatment– Similar to plantar fasciitis– Surgery with chronic cases
Tarsal Coalition
• Bony, fibrous, or cartilaginous union of tarsal bones
• Most often affects talus, calcaneus, and/or navicular
• S/S– Rigid flatfoot– Calcaneal valgus– Forefoot abduction– NWB and WB identical
• Treatment
Tarsal Coalition
Tarsal Tunnel Syndrome• Compression of posterior tibial nerve
Tarsal Tunnel Syndrome
• Causes– Acute: inversion or eversion– Chronic: structural and
biomechanical abnormalities
• S/S– Plantar/medial foot pain– Positive Tinel sign
• Treatment
Metatarsal Fractures
• Stress fractures– Morton’s toe
• Acute fractures– Avulsion of base of 5th
– Jones’ fracture
Phalangeal Fracture
• S/S– Pain– Swelling– Positive compression/percussion– Crepitus
• Treatment– Buddy taping– Stiff insert– Relief pad/bar
Intermetatarsal Neuroma
• 3 interdigital nerve most common– Morton’s Neuroma
• Fibrous formation and demyelenization
• Causes– Thickened/shortened transverse
ligament– Fallen transverse arch– Excessive forefoot weight bearing– Excessive pronation– Shoes?
Interdigital Neuroma
• S/S– Pain and paresthesia– Nodule– Pain with compression– Decreased pain barefoot– Pencil eraser “test”
• Treatment