Transcript Arches of the foot - Olympic High School

Vocabulary
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Hallux Valgus
Bunionettes
Hallux Rigidus
Hammer toes
Calcaneal apophysitis
(Sever’s disease)
Exostoses
Metatarsalalgia
Morton’s neuroma
Pronation
Plantar fascia
Stance phase of gait
Supination
Swing phase of gait
• Achilles tendon rupture
• Ankle dislocation
• Apophysitis
• Great toe sprain
• Heel spur
• Ingrown toenail
• Osteochondritis dissecans
• Pes cavus
• Pes planus
• Plantar neuroma
• Plantar wart
• Talotibial exostoses
• Tarsal tunnel syndrome
Arches of the Foot
• Why do we have arches?
– Supporting body weight
– Absorbs shock
– Providing space for blood vessels, nerves, muscles
• Medial longitudinal arch
– Medial border of the calcaneus to distal head of 1st
metatarsal
– Composed of calcaneus, talus, navicular, 1st
cuneiform/metatarsal
– Main ligament is the spring ligament and posterior
tibialis muscle for reinforcement
• Lateral longitudinal arch
– Lateral border of the foot
– Composed of calcaneus, cuboid,5th metatarsal
Arches of the Foot
• Anterior metatarsal arch
– Distal heads of the metatarsal
• Transverse arch
– cuboid and 3rd cuneiform
• Plantar fascia (plantar Aponeurosis)
– Thick white band of fibrous tissue
– From medial tuberosity of calcaneus to proximal heads
of metatarsals
Articulations
• Interphalangeal articulations
– DIP/PIP joints
– Produces flexion/extension
• Metatarsophalangeal articulations
– condyloid type of a joint
– Flexion, extension, adduction, abduction
• Intermetatarsal articulations
– Sliding joints which permits only gliding motions
Articulations
• Tarsometatarsal articulations.
• Saddle shape allows some gliding and limited
flex/ext., Add/abduction.
• Intertarsal articulations.
• Include the subtalar, midtarsal (transverse tarsal),
anterior intertarsal (cuneonavicular). They are
sliding joints.
• Movements include flex/ext, abduction/add,
inversion/eversion, also pronation/supination.
Ligaments of the Foot
• Page 405 fig. 17-5
• Subtalar ligaments
• Articulation between talus and calcaneus
• Talocalcaneal- ant/post, lat/medial
• Major ligament is plantar calcaneonavicular= Spring lig.
• Midtarsal ligaments
• Dorsal talonavicular, bifurcate, dorsal calcaneocuboid
• Anterior tarsal joints
• Cuneinavicular, cuboideonavicular, intercuneiform,
cuneocuboid ligaments.
• Dorsal and plantar ligaments
Muscles and Movements
• Dorsiflexion/plantar flexion
• Plantar- gastrocnemius, soleus, plantaris, peroneous
longus, peroneus brevis, and tibialis posterior
• Dorsiflexion- -tibialis anterior, extensor digitorum longus,
extensor hallucis longus/ brevis, and peroneus tertius
muscles
• Inversion/adduction/supination
• Tibialis posterior, flexor digitorum longus, flexor hallucis
longus
• Tibialis anterior and extensor hallucis longus
• Eversion/Abduction/Pronation
• peroneus longus, peroneus brevis
• peroneus tertius, extensor digitorum longus
• Movement of Phalanges
Anatomy Continued
• Nerve supply.
• Tibial nerve the largest of the sciatic nerve supplies the
muscle of the back of the leg and plantar surface of the
foot.
• Common peroneal nerve smallest of the sciatic nerve
supplies the muscles of the front of the leg and foot.
• Blood supply.
• The major portion of the blood supplied.
• To the foot is by the anterior/posterior tibial arteries.
• Stance Phase or support phase
• Starts with initial contact at heel strike and ends at
toe off
• Foot’s function at heel strike= shock absorber and
adapts to uneven surfaces
• Heel strike running gait= initial contact of the
foot is lat. aspect of calcaneus
• In running both feet are off the surface at the
same time
• Heel strike= leg ext. rotated and foot supinated
then the leg int. rotated and foot pronated
• Swing phase or the recovery phase:
• Immediately after toe off and the leg is moved
from behind the body to the front in preparation
for heel strike.
• In this phase the leg is external rotated and foot
supinates
• Structural concerns:
• Most people will at some time in their lives develop foot
problems
• Genetics and habitual use determines your own foot
structure
• Look for muscular/tendinous tightness, weakness, or
hypermobility
• Footwear:
• Proper footwear (shoe/socks) are essential in injury
prevention
• Proper shoes for activity
• Look for wear on shoes and proper arch support
• Surface concerns:
• Surfaces that are irregular and vary in resistance
can serve to strengthen the foot over time.
• A nonyielding surface can lead to acute/chronic
injuries
• A too resilient/absorbing surface can lead to early
fatigue
Assessment
• History
• How did it happen? Did it happen suddenly or come on
slowly?
• What was the mechanism? Type of pain? Is there any
noises?
• Point to the exact site. When is the pain?
• What type of surface or footwear are you using ?
• Has this ever happened before?
Assessment
• Observation
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Are they favoring the foot? Are they limping?
Is it deformed, swollen, discolored?
Does it change color by weight bearing or not?
Is the foot well aligned and whether it maintains its shape
on weight bearing?
• Look for shoe wear.
Palpation - Bony
• Medial
• Lateral
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Medial calcaneus
Medial malleolus
Talar head
Navicular tubercle
1st cuneiform
1st metatarsal
1st MP joint
1st phalanx
Lateral calcaneus
Lateral malleolus
Peroneal tubercle
Cuboid
Styloid process of 5th
metatarsal
• 5th metatarsal
• 5th MP joint
• 5th phalanx
Dorsal: 2-4 metatarsal/phalanges, 2-3 cuneiform
Palpation – Soft Tissue
• Medial/Plantar
• Lateral/Dorsal
• Tibialis posterior
• Deltoid ligament
• Calcaneonavicular lig
(spring lig)
• Medial longitudinal arch
• Plantar fascia
• Transverse arch
• Bursal head of 1st
metatarsal
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ATF
PTF
CF
Peroneal tendons
Extensor tendons of toes
Tibialis anterior tendon
Special Tests
• Movements and
neurological assessment
• Extrinsic/instrinsic foot muscles
should be assessed for pain &
ROM during active, passive, &
resistive isometric movement
• Tinel test= posterior tibial nerve
• Tendon reflex: Achilles tendon
(S1 nerve root)
• Sensation throughout the whole
foot
Special Tests
• Pulses:
• Taken at the posterior tibial and
dorsalis pedis arteries.
• Posterior tibial is taken
inbetween the medial mallelous
and achilles tendon.
• Dorsalis pedis is taken
inbetween externor hallicus
longus and extensor digitorum
longus.
Special Test Continued
• Flexibility and rigid
flatfeet.
• Check for flexibility put
full weight bearing on foot
then lift foot up.
• Flexible flatfoot is one
that the medial
longitudinal arch is flat
then an arch is present
when weight is removed.
• Care is proper shoes,
exercise, arch supports or
tape.