Matt Weidenbach Ben Hoffmann Taylor Westbrook By:

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 4 th and 5 th 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.

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.

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.

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 1 st /5 th metatarsophalangeal joint 4. Wear a tape splint along with a resilient wedge placed between the great toe and 2 nd toe. 5. Engage in daily foot exercises. Ultimately, surgery may be necessary

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

Etiology: pain in the ball of the foot or under 2 nd or 3 rd 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 2 nd, 3 rd, 4 th metatarsal bones become depressed. Also, a cavus deformity Management: Applying a pad to elevate the depressed metatarsal heads. Regimen of static stretching

Etiology: The heads of the 1 st and 5 th metatarsal bones bear slightly more weight than the heads of 2 nd, 3 rd, & 4 th. 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.

Etiology: Located between the 3 rd & 4 th 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.

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.

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.

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.

Etiology: Caused by the proliferation of bony spurs on the dorsal aspect of the 1 st metatarsophalangeal joint, resulting in impingement. Its 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

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.

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 its 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.

Anterior/posterior calcaneocuboid glides are used for increasing adduction and abduction. Anterior/posterior cuboidmetatarsal glides. Used for increasing the mobility of the 5 th 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

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: o Write alphabet in the air with toes pointed o Patient picks up small objects (ex. Marbles) with toes o Ankle is circumducted o Gripping and spreading the toes. o Towel exercises

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. Pads or soft orthotics. These soft inserts are advocated for mild overuse syndromes. 2. Semirigid orthotics are prescribed for athletes who have increased symptoms. Made of flexible thermoplastics, rubber, or leather 3. Functional or rigid orthotics are from made from hard plastic Orthotics for Correcting Excessive Pronation Supination For structural forefoot varus deformity, orthotic should be rigid type and should have a medial wedge under the 1 st 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 5 th 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 1 st 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

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Matt Weidenbach Ben Hoffmann Taylor Westbrook By: