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The Foot
one of the highest incidence of sport injuries
account for 20 to 25 % of injuries associated with running and jumping sports
Anatomy
26 bones - 14 phalangeal, 5 metatarsals & 7 tarsels
toes function to smooth the weight shift and to help maintain stability during weight bearing
Arches
function to support and distribute body weight from the talus through the foot , changing weight bearing conditions over varying terrain
Longitudinal Arch
from medial border calcaneus to head of 1st metatarsal
arch is higher medially than laterally - medial is usually the point of reference
supported by spring ligament (calcaneonavicular), plantar fascia
tib post. and ant provide dynamic support
Plantar Fascia
is a thick interconnected band of fascia that covers the plantar surface of the foot, providing support for the longitudinal arch
it extends from the calcaneus to the proximal phalanx of each toe
during the weight bearing phase of the gait cycle the plantar fascia functions like a spring to store mechanical energy that is release to help the foot push off from the surface
Transverse Arch
runs across the anterior tarsal (navicular cuboid and cuneiforms)
supported most by bony structure
1) lnterphalangeal (IP)
PIP& DIP (except 1 st)
hinge joints with support on med and lat collateral , plantar and dorsal surface
2) Metatarsophalangeal (MTP)
condyloid - 2 planes of movement ( flex/ ext, abd/add)
supported by med & lat collat. & plantar and dorsal surfaces
3) Tarsometatarsal
attached base of metarsal to tarsal bone slight gliding in 2 planes (flex/ext ,
abd/add) attached by plantar and dorsal lig
a normal amount of pronation is necessary in reducing peak forces sustained during impact
there is a link between excessive pronation and running related injuries
normal pronation 6- 8 degrees
Pronation
Pronation problems. loose and unlocked 2nd metatarsal #, plantar fasciitis, ant/post
tibialis tendinitis, Achilles tendinitis, tibial stress fractures, PFS ( patella
femoral syndrome)
Supination Problems lack of shock absorption inversion ankle sprains , tibial stress
syndrome, peroneal tendinitis, ITB friction syndrome, trochanteric bursitis
Dorsiflexion / Plantar Flexion Motion occurring in the sagittal plane DF – ankle flexion PF – ankle extension
Inversion / Eversion Movements at the subtalar joint Inversion – medial rotation Eversion – lateral rotation
Hammer and Claw Toes
often congenital - can be caused by improperly fitted shoes - muscle contractures or malalignment of bony structures
hammer toes involve extension of MTP joint and neutral
position of PIP and flexion at the DIP joint
claw toes are a flexion deformities of DIP and PIP
joint and hyperextension of the MTP joint
both can lead to painful callus formation on bottom of toe or under MT head
surgery is often only solution to severe cases
Turf Toe
Sprain of the plantar capsular ligament of the first toe
Results from forced hyperextension of the first toe
related to artificial turf - lightweight shoes that are too flexible and positions that require forced toe hyperextension ( as football linebackers and offensive lineman)
pain - tenderness - swelling at MTP joint
push off phase of running particularly painful - as with passive extension of great toe
Rx - ice, protection from excessive motion (taping) - or stiff -soled shoe
decrease activity - particularly running
Common Fractures
often caused by repeated low magnitude forces
March # - 2nd metatarsal
Jone's # - base of fifth metatarsal -
Stress Fractures Often found in runners
especially long distance runners
Females tend to be more susceptible than males
2nd and 3rd more commonly affected , but a stress fracture may develop any where
MOI : overuse , however it can be due to a traumatic event
s/s
Insidious onset of vague pain Tenderness to palpation Possible loss of function
Bone scan Decreased activity 4- 6 weeks Surgical fixation if necessary
Hallux Valgus
bunion - typically found on the medial aspect of the MTP joint of the great toe
on lateral side of foot they are called - bunionettes
pronation of the foot - arthritis, and generalized ligamentous laxity can lead to thickening on the medial side of the first MT head
as condition worsens , the great toe may shift laterally and overlap the second toe
this condition is exacerbated by high heels, pointed shoes - thus it is more common in women than men
once deformity has occurred little can be done
tapping in more anatomical position may help – or the use of a toe spacer - otherwise surgery is indicated in severe cases
Retrocalcaneal Bursitis pump bump external pressure from a heel cup excessive pronation poorly padded heel counter all these lead to swelling, redness of
the skin and irritation of the bursa (retrocalcaneal bursa located between the anterior Achilles’ tendon and calcaneus)
pain on palpation , active plantar flexion Rx - gentle stretching , shoe modification -
heel lifts pump bump - large bone spur commonly
seen in runners and skaters
Morton's Neuroma
plantar nerve becomes compressed between the MT heads
due to tight fitting shoes or pronated feet this leads to irritation of the nerve - pain Rx - larger shoes - arch supports (MT
pads) local injections
Blisters and Calluses
excessive localized pressure or friction between the skin and shoe
caused by shearing forces which cause fluid accumulation to separate the skin layers
fluid is usually clear - sometimes bloody
should be regularly shaved with a callous file or emory board
blood blisters may appear under calluses that are to large and become detached from the underlying skin
Calluses
Preventing Blisters
wear properly fitted shoes break shoes in gradually lubricants can be applied to susceptible
areas (petroleum jelly, skin lube)
Athlete's foot (tinea pedis) a common fungal infection can be spread
during casual handling of contaminated socks or picked up in a shower often based on an individual susceptibility and may not affect certain people
characterized by extreme itching, burning and irritation on the sole of the foot and between the toes
Rx with topical antifungal agents and proper foot care
Toe Sprains
tripping or stubbing pain , dysfunction, immediate swelling dislocation - obvious deformities strap with next toe for a week to two
weeks
Plantar Fasciitis excessive tightness of Achilles tendon, excessive
pronation , obesity predisposing factors - training errors, overuse ,
hyperpronation pain upon rising in morning - usually subsides with
in a short period of time but builds trough out the day
point tenderness over medial calcaneus - increases with forefoot dorsiflexion and toe extension
Rx - taping of arch - foot orthoses (heel spurs)
Ingrown toenail Preventable with proper care, hygiene
and nail care Toenail should be trimmed straight
across to prevent edges from growing under the skin on the side of the nail
Proper fitting shoes should be worn Problems with shoe size , improper care
of nails and sliding of foot in shoe may cause the edge to grow into the lateral nail fold and surrounding skin
The nail margin reddens and becomes very painful , may become infected
RX- soak the foot in hot (salty) water Lift the nail bed and place cotton under the nail
to elevate it from the skin fold Apply antiseptic over the area daily If infection occurs refer to doctor Also can try to soak the toe and then cut a V in
the centre of the nail As nail grows it pull the nail away from under the
skin again if infected refer to doctor