Transcript Foot PPT

By:
Matt Weidenbach
Ben Hoffmann
Taylor Westbrook
 The
foot consists of 26 bones: 14
phalangeal, 5 metatarsal, and 7 tarsal.
 Toes are used to balance and propel the
body.
 Metatarsal Bones gives elasticity to the
foot in weight bearing.
 Tarsal Bones located between the bones
of the lower leg and the metatarsals are
extremely important for support and
locomotion.
 Foot
arches assist the foot in supporting
the body weight; in absorbing shock of
weight bearing; and in providing a space
on the plantar aspect of the foot for the
blood vessels, nerves, and muscles.
 There are 4 arches: The metatarsal,
transverse arch, medial longitudinal arch,
lateral longitudinal arch.
 Interphalangeal
Joint: located at the distal
extremities of the proximal and middle
phalanges. Designed for flexion and
extension.
 Metatarsophalangeal Joint: Permits flexion,
extension, adduction, and abduction.
 Intermetatarsal Joint: Permits slight gliding
movements.
 Tarsometatarsal Joint: allows some gliding
and restriction of flexion, extension
adduction and abduction.
 Midtarsal Joint: Provides shock absorption.
 Produce
medial movements of the foot.
 These muscles pass behind and in front
of the medial malleolus.
 Produce
lateral movements of the foot.
 Muscles passing behind the lateral
malleolus are the fibularis longus and the
fibularis brevis.
 Nerve
Supply: The medial and lateral
plantar nerves which are branches of the
tibial nerve, supply all of the intrinsic
muscles on the plantar surface of the foot.
The deep peroneal nerve supplies the
extensor.
 Blood Supply: The primary blood supply
for the foot comes from the anterior tibial
artery and posterior tibial arteries.
 Forefoot
varus, forefoot valgus and
rearfoot varus produce excessive
pronation or supination.
 The deformities will make the foot more
difficult to act like a shock absorber.
 The compensation usually causes
overuse injuries.
 Appropriate
Footwear; selecting an
appropriate shoe is a critical consideration
in preventing a foot problem.
 Shoe Orthotics; an orthotic device can be
used to correct biomechanical problems
that exist in the foot and that can cause
injury.
 Proper foot hygiene; simple tasks such as
keeping toenails trimmed, shaving down
calluses, keeping feet clean and dry can
reduce a number of problems.
 To
correctly assess the foot trainers must
understand that the foot is part of a kinetic
chain that includes both the ankle and the
lower leg.
 History of the patients foot must also be
assessed.
 Observations such as if the patient is
favoring the foot, walking with a limp or
unable to bear weight should be assessed.
 Structural Deformities should also be
observed.
 Fracture
of the Talus
Symptoms: Patient often has a history of
repeated trauma to the ankle. Sharp pain
during weight bearing and complains of
catching and snapping along with swelling
Management: X-ray is essential.
Nonsurgical management. Protective
immobilization, and no weight bearing.
 Symptoms
and signs: occurs mostly from
landing or falling from a high place. There is
usually immediate swelling and pain and an
inability to bear weight.
 Management: RICE must be used
immediately to minimize pain and swelling
before referring the athlete to an X-ray. With
non displacement fractures immobilization
and early range of motion exercises are
recommended as soon as pain and swelling
go down or is tolerated.
Occurs with repetitive impact during heel strike
and is most commonly found in distance runners.
 Symptoms and signs: weight bearing and
complaints of pain tend to continue after an
exercise stops. May not come up on X-rays so a
bone scan may be the best option.
 Management: for the first 2 or 3 weeks rest is
important with little as possible weight bearing
on the foot. Active range of motion exercises of
the foot and ankle during rest. After 2 or 3 weeks,
gradually work the athlete back into it with
cushioning shoes.

 Occurs
in the young and physically
active.
 Symptoms and Signs: Pain occurs at the
posterior heel below the attachment of
the Achilles tendon insertion of the child
or adolescent athlete.
 Management: Best treated with rest, ice,
stretching and antiinflamatory
medications.
 Caused
by inflammation of the bursa that
lies between the Achilles tendon and the
calcaneal.
 Symptoms and Signs: Swelling on both
sides of the heel cord.
 Management: RICE and NSAIDs. The use
of ultrasound can reduce inflammation.
 Seen
mostly in sports that have a sudden
stop and go response or a sudden
change from horizontal to vertical
movement.
 Symptoms and Signs: Severe pain in the
heel, unable to withstand the stress of
weight bearing.
 Management: No bearing weight on heel
for 24 hours, RICE, and wear shock
absorbent footwear.
 Pronation
and trauma have been
reported to be prominent causes of
cuboid subluxation.
 Symptoms and Signs: Pain in the 4th and
5th metatarsals as well as over the cuboid.
Often pain in the heel area as well.
 Management: Cuboid manipulation is
done to restore the cuboid to the natural
position. Orthotic helps support it.
 Symptoms
and Signs: Complaints of pain
and paresthesia are typical, along the
medial and plantar aspects of the foot.
 Management: Antiinflamatory modalities.
 Pes
planus is associated with excessive foot
pronation and may be caused by a number
of factors, including a structural forefoot
varus deformity, shoes that are too tight or
trauma that weakens supportive structures.
 Symptoms and Signs: Pain or a feeling of
weakness or fatigue in the medial
longitudinal arch.
 Management: Arch support with an orthotic.



Etiology: Pes Cavus refers to a foot that has an arch that
is higher than normal.
Symptoms/Signs: Shock absorption is poor, thus
problems include general foot pain, metatarsalgia, &
hammertoes.
Management: If problems occur, orthotic should be
constructed using lateral wedge. Stretching of the
Achilles tendon and the plantar fascia is helpful



Etiology: Abnormally short first metatarsal, thus the
second toe appears to be longer than the great toe.
Weight bearing becomes uneven, with more weight
now on the second metatarsal. Not an injury but can
develop into one.
Symptoms/Signs: Symptoms are those of stress
fractures in general.
Management: If there are no problems, nothing should
be done. If problems occur, an orthotic with a medial
wedge would be helpful.



Etiology: Caused by subjecting the musculature of the
foot to stress produced by repetitive contact with hard
surfaces. There is a flattening or strain to the
longitudinal arch.
Symptoms/Signs: Pain is experienced only during
running or jumping. The pain usually appears just
below the posterior tibialis tendon.
Management: RICE followed by therapy and reduction
of weight bearing.
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Used to describe pain in the proximal arch and heel.
The function of the plantar fascia is to assist in
maintaining the stability of the foot and in securing the
longitudinal arch
Etiology: Tension develops in the plantar fascia during
the extension of the toes and during depression of the
longitudinal arch as a result of weight bearing
Symptoms/Signs: pain in the medial heel, and
eventually moves to central portion of plantar fascia.
Management: Extended period of treatment. Orthotic
therapy useful. Taping may reduce symptoms. Should
engage in Achilles tendon stretching, and stretch the
plantar fascia.

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
Etiology: Can be caused by inversion and plantar
flexion of the foot, by direct force, or repetitive stress.
Most common acute fracture to the diaphysis at the
base of the fifth metatarsal.
Symptoms/Signs: Immediate swelling and pain over the
fifth metatarsal. Healing is slow. Injury has a high
nonunion rate. Nonunion fractures heal with cartilage
between the bone fracture.
Management: Use of crutches with no immobilization,
progressing to full weight bearing as pain subsides.

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Etiology: Most common metatarsal stress fractures
involve the shaft of the second metatarsal.
Symptoms/Signs: Over 2-3 week period, dull pain
begins to occur during exercise, then progresses to
pain at rest. Usually occurs when patients increase the
intensity or duration of their exercise.
Management: Partial weight bearing and 2 weeks of
rest. Return to running should be very gradual.
Etiology: Bunion occurs at the head of the first metatarsal. Often
caused by shoes. Bunionette the toe angulates toward the fourth
toe, causing an enlarged metatarsal head.
In all bunions, both the flexor and extensor tendons are malaligned,
creating more angular stress on the joint.
 Symptoms/Signs: During formation there is tenderness, swelling,
and enlargement of the joint. Angulation of the toe progresses.
 Management: Early recognition and care can often prevent
increased irritation & deformity.
1.
Wear correctly fitting shoes
2.
Wear an appropriate fitting orthotic
3.
Place a sponge rubber doughnut pad over the 1st/5th
metatarsophalangeal joint
4.
Wear a tape splint along with a resilient wedge placed between
the great toe and 2nd toe.
5.
Engage in daily foot exercises. Ultimately, surgery may be
necessary
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Etiology: Two sesamoid bones lie within the flexor &
adductor tendons of the great toe. Sesamoiditis is
caused by repetitive hyperextension of the great toe
Symptoms/signs: patient complains of pain under the
great toe, especially during a push off
Management: treated with orthotic devices. Decrease
activity to allow inflammation to subside

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Etiology: pain in the ball of the foot or under 2nd or 3rd
metatarsal head. A heavy callus forms. One of the
causes is restricted extensibility of the gastrocnemiussoleus complex
Signs/symptoms: As the transverse arch becomes
flattened and the heads of the 2nd, 3rd, 4th metatarsal
bones become depressed. Also, a cavus deformity
Management: Applying a pad to elevate the depressed
metatarsal heads. Regimen of static stretching

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Etiology: The heads of the 1st and 5th metatarsal bones
bear slightly more weight than the heads of 2nd, 3rd, &
4th. If the foot tends to pronate excessively, & spread
abnormally (splayed foot), fallen metatarsal arch
results
Symptoms/signs: Patient has pain or cramping in
metatarsal region. Point tenderness in the area.
Management: Apply pad to elevate. Pad placed in the
center just behind the ball of the foot.
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Etiology: Located between the 3rd & 4th metatarsal
heads where the nerve is the thickest. With the collapse
of the transverse arch of the foot, it stretches metatarsal
ligaments which then compresses the digital nerves &
vessels.
Symptoms/signs: Burning paresthesia and pain in the
forefoot. Hyperextension of the toes can increase the
symptoms.
Management: Bone scan often necessary. Use a pad.
Shoe selection is important for treatment.

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Etiology: Sprains of the phalangeal joints of the toes are
caused often by kicking an object. Joint is extended
beyond normal range of motion (jamming), or toe is
twisted.
Symptoms/signs: Pain immediate & intense but
generally short lived. Immediate
swelling/discoloration. Stiffness & residual pain may
last several weeks.
Management: RICE. Buddy taping the injured toe to the
adjacent toes.

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
Etiology: Results in a sprain of the metatarsophalangeal
joint. Typically occurs on turf since shoes for artificial
turf allow more dorsiflexion of the great toe.
Symptoms/signs: Pain & swelling. Pain is exacerbated
when patient tries to push off the foot.
Management: Shoes with steel or other materials
added to the forefoot help stiffen them. Tape, ice,
ultrasound. Important to rest injury until the toe is pain
free.

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Etiology: usually occur by kicking an object, stubbing
toe, or being stepped on. Dislocation is less common
than fractures.
Symptoms/signs: Immediate intense pain. Swelling &
discoloration.
Management: Toe dislocations should be reduced by a
physician. Buddy taping injured toe to adjacent toes
usually provides sufficient support.

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
Etiology: Caused by the proliferation of bony spurs on
the dorsal aspect of the 1st metatarsophalangeal joint,
resulting in impingement. It’s a degenerative arthritic
process.
Symptoms/signs: Great toe is unable to dorsiflex.
Forced dorsiflexion increases pain. Weight bearing is
on the lateral aspect of the foot.
Management: Stiffer shoe with larger toe box.
Antiinflammatory medication. Osteotomy(surgically
removing piece of bone) to remove mechanical
obstruction to dorsiflexion

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
Etiology: Flexion contractures in the toes. Caused by
wearing shoes that are too short over a long period of
time
Symptoms/signs: In all 3 conditions the MP, PIP, or DIP
joints can become fixed. There may be blistering, pain,
swelling, callus formation, and occasionally infection.
Management: Wear footwear with more room for the
toes. Use of padding and protective taping. Once
deformities become fixed, surgical procedures that
involve straightening the toes and maintaining position
using Kirshner Wire is necessary.

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Etiology: Congenital, or improperly fitting footwear.
Symptoms/signs: Outward projection of the great toe or
a drop in the longitudinal or metatarsal arch.
Management: Surgery. Therapeutic modalities like
whirlpool bath help alleviate inflammation. Taping



Etiology: Toe being stepped on, dropping object on
toe, or kicking an object. Blood that accumulates is
likely to produce extreme pain & loss of nail.
Symptoms/signs: Bleeding into the nail may be
immediate or slow. Bluish purple color, and gentle
pressure on the nail exacerbates pain.
Management: Ice pack applied immediately. Elevation.
Within next 12-24 hrs physician should drill hole to
release pressure.


Managing injuries to the foot often require that the
patient be non weight bearing for some period of time.
No running activities so it’s necessary to substitute
alternative conditioning activities. Ex: running in a
pool, working on upper extremity ergometer. Continue
in strengthening & flexibility exercises as allowed by
the injury.
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Anterior/posterior calcaneocuboid glides are used for
increasing adduction and abduction.
Anterior/posterior cuboidmetatarsal glides. Used for
increasing the mobility of the 5th metatarsal.
Anterior/posterior tarsometatarsal glides decrease
hypomobility of the metatarsals
Anterior/posterior talonavicular glides increase
adduction and abduction.
Anterior/posterior metatarsophalangeal glides. The
anterior glides increase extension and the posterior
glides increase flexion.

Restoring full range of motion following various
injuries to the phalanges is important. Critical to
engage in stretching activities in the case of plantar
fasciitis. Also stretch gastrocnemiussoleus complex for
number of injuries
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Strength exercises can be done with a variety of
resistance methods including rubber tubing, towel
exercises, and manual resistance.
Strengthening muscles involved in foot motion:
Write alphabet in the air with toes pointed
Patient picks up small objects (ex. Marbles) with toes
Ankle is circumducted
Gripping and spreading the toes.
Towel exercises
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Neuromuscular control in the foot is the single most
important element dictating movement strategies
within the kinetic chain
Exercises for reestablishing neuromuscular control in
the foot should include a variety of walking, running,
and hopping involving directional changes performed
on varying surfaces.
Exercise sandals are excellent for increasing muscle
activation in the foot and lower leg
Foot Orthotics and Taping


Orthotics are used to control abnormal compensatory movements
of the foot.
The orthotic provides a platform of support so that soft tissues can
heal properly without undue stress.
3 types of Orthotics:
1.
2.
3.
Pads or soft orthotics. These soft inserts are advocated for mild
overuse syndromes.
Semirigid orthotics are prescribed for athletes who have
increased symptoms. Made of flexible thermoplastics, rubber, or
leather
Functional or rigid orthotics are from made from hard plastic
Orthotics for Correcting Excessive Pronation Supination

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For structural forefoot varus deformity, orthotic should be rigid type and
should have a medial wedge under the 1st metatarsal. For more comfort
add a small wedge
Structural forefoot valgus deformity in which the foot excessively
supinates, orthotic should be semirigid and have a lateral wedge under
the head of the 5th metatarsal. For more comfort add a small wedge
Structural rearfoot varus deformity, the orthotic should be semirigid and
have a wedge under the medial calcaneus and a small wedge under the
head of the 1st metatarsal.
Non weight bearing
 Partial weight bearing
 Full weight bearing
 Walking
-Normal
-Heel
-Toe
-Side step / shuffle slides
 Logging
-Straightaways on track
-Walk turns
-Jog complete oval of track

Short sprints
 Acceleration/deceleratio
n sprints
 Carioca
 Hopping
-Two feet
-One Foot
-Alternate
 Cutting jumping hopping
on command
