Transcript Evaluation-The Foot and Toes

Ms. Bowman
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26 bones
Phalanges-toes; proximal, middle, and distal
Metatarsals-5; between phalanges and tarsals
Tarsals-calcaneus, talus, navicular, cuboid, 3 cuneiforms
Divided into 3 sections
• Rearfoot-formed by the calcaneus and talus; provides stability and shock
absorption during the initial stance phase of gait and serves as a lever
arm for the Achilles tendon during plantarflexion
• Midfoot-composed of the navicular, three cuneiforms, and cuboid; shock
absorbing section of the foot
• Forefoot and toes-formed by the 5 metatarsals and 14 phalanges; act as
a lever during the preswing phase of gait
• Subtalar Joint-articulation of the
calcaneus and talus
• Midfoot• midtarsal joint formed by the
articulations of the tarsal bones
• Plantar calcaneonavicular ligament
(spring liegament)
• Forefoot• Tarsometatarsal joints-junction
between the midfoot and forefoot
• Intermetatarsal joints-proximal and
distal joints
• Metatarsophalangeal joints
• Interphalangeal joints
• Medial Ligaments
• Deltoid ligament-composed of 4
ligaments
• Posterior tibiotalar ligament
• Tibiocalcaneal ligament
• Anterior tibiotalar ligament
• Tibionavicular ligament
• Lateral Ligaments
• Anterior talofibular ligament
• Calcaneofibular ligament
• Posterior talofibular ligament
• There are many muscles that act on the foot.
• Those that originate and insert in the foot are called intrinsic
foot muscles. These directly influence the foot and toes.
• Those that originate in the lower leg are called extrinsic foot
muscles. These influence motion at the ankle and knee as well
as the foot and toes.
• If the muscle name begins with extensor, then the muscle’s
primary function is extension.
• If the muscle name begins with flexor, then the muscle’s primary
function is flexion.
• Location of p!-trauma to intrinsic structures or secondary to
compensation for improper lower leg biomechanics
• Metatarsal p!-p! that worsens over time can indicate stress fx; p! between
the MTs possibly a result of nerve impingement
• Great toe p!-localized p! to plantar surface can be indicative of sesamoid
fx; p! with flexion or extension can be an indicator for turf toe
• Onset and Mechanism of injury
• Acute onset- can occur from trauma (fx, ligament sprain, muscle strain)
• Insidious onset-result of overuse injuries; may be the result of playing
surface, distance and duration of exercise, shoes
• Analyze gait
• Look for
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Gross deformity
Edema
Redness
Calluses and blisters (indicates improperly fitting shoes, poor mechanics, or
underlying bony or soft tissue dysfunction)
• Observe
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Alignment of the toes
Toenail integrity (ingrown toenails, subungual hematoma)
Arches
Achilles
Calcaneus
Plantar surface of the foot
• When palpating, check for deformity, alignment, edema,
crepitus, and pain
• Medial Structures
• 1st Phalange, 1st MT, 1st Cuneiform, Navicular, Talar head Spring Ligament,
Calcaneus
• Lateral Structures
• 5th phalange, 5th MT, Cuboid, Peroneal tubercle, Calcaneus
• Dorsal Structures
• Rays, Cuneiforms, Navicular, Dome of Talus, Musculature
• Plantar Structures
• Plantar fascia, MT heads, sesamoid bones of great toe
• ROM should be measured with a goniometer
• AROM, PROM, and RROM should be assessed as necessary
• Goniometry measurements
• Fulcrum-placed over joint
• Stationary arm-placed over the proximal (non-moving part of body)
• Movement arm-placed over the distal (moving part of body)
• Valgus and Varus stress tests should be used to test the integrity
of the MTP and IP joints
• Metatarsal gilde test can be used to tests for the integrity of
the ligaments connecting the MT
• Midtarsal joint glide test can be used to test the integrity of the
intertarsal ligaments
• Foot and toes are supplied by L4 and S2 nerve roots
• Can be assessed by doing a lower quarter screen
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Navicular drop test
Tinel’s sign
Long bone compression test
Pencil test