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FOOT/TOESFOOT/TOES COMMON INJUIRES COMMON INJUIRES

KIN 191AKIN 191AAdvanced Assessment of Advanced Assessment of Lower Extremity InjuriesLower Extremity Injuries

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INTRODUCTIONINTRODUCTION

COMMON INJUIRES FOOT/TOE PATHOLOGIES GREAT TOE INJURIES METATARSAL/PHALANGEAL INURIES TARSAL INURIES PLANTAR SURFACE INJURIES SOFT TISSUE INJURIES ARCH INJURIES/CONDITIONS NEUROGICAL INJURIES

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FOOT/TOE PATHOLOGIESFOOT/TOE PATHOLOGIES

Many foot/toe injuries/conditions relative to Many foot/toe injuries/conditions relative to either biomechanics at the foot or as either biomechanics at the foot or as compensation for abnormal biomechanics compensation for abnormal biomechanics elsewhere in the lower extremityelsewhere in the lower extremity

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GREAT TOE INJURIESGREAT TOE INJURIES

MMTTP joint sprain (aka “turf toe”)P joint sprain (aka “turf toe”) Typically associated with hyperextensionTypically associated with hyperextension Especially problematic during push-off and Especially problematic during push-off and

change of direction activitieschange of direction activities

Hallux valgus (aka “bunion”)Hallux valgus (aka “bunion”) A typical for traumatic onsetA typical for traumatic onset

Hallux rigidusHallux rigidus Ankylosis (joint fusion)Ankylosis (joint fusion) Secondary to arthritis or exostosis formationSecondary to arthritis or exostosis formation

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METATARSAL/PHALANGEAL METATARSAL/PHALANGEAL INJURIESINJURIES

Metatarsal fracturesMetatarsal fractures Typically traumatic onset Typically traumatic onset Jone’s fractureJone’s fracture

• A fracture of the 5A fracture of the 5thth MT, 1cm distal to the proximal MT, 1cm distal to the proximal diaphysisdiaphysis

• Often require surgical fixationOften require surgical fixation

Metatarsal stress fracturesMetatarsal stress fractures Known as “march” fractures from high incidence Known as “march” fractures from high incidence

in military recruitsin military recruits

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Avulsion fracturesAvulsion fractures Most common at base of 5Most common at base of 5thth metatarsal metatarsal Also occur at navicular and calcaneal Also occur at navicular and calcaneal

tuberositytuberosity

Phalangeal fracturesPhalangeal fractures Typically from blunt trauma, usually treated Typically from blunt trauma, usually treated

conservativelyconservatively

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TARSAL INJUIRESTARSAL INJUIRES Lisfranc sprain, fracture/dislocationLisfranc sprain, fracture/dislocation

Characteristic location, extended treatment and Characteristic location, extended treatment and rehab period, frustrating injuryrehab period, frustrating injury

Cuboid syndromeCuboid syndrome Pain at cuboid/4Pain at cuboid/4thth and 5 and 5thth metatarsal region from metatarsal region from

subluxation of cuboid during over pronationsubluxation of cuboid during over pronation

Navicular fractureNavicular fracture Stress fracture most common due to placement Stress fracture most common due to placement

in medial longitudinal archin medial longitudinal arch Can see accessory navicular which is congenital Can see accessory navicular which is congenital

presentation of medial prominence on navicularpresentation of medial prominence on navicular

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Calcaneal fractureCalcaneal fracture Typically high velocity injuries (fall from height, Typically high velocity injuries (fall from height,

MVA, etc.)MVA, etc.)

Calcaneal apophysitis (Sever’s disease)Calcaneal apophysitis (Sever’s disease) Traction injury to growth plate at calcaneal Traction injury to growth plate at calcaneal

tuberositytuberosity

Talus fracture/OCDTalus fracture/OCD Most common location is dome, typically not Most common location is dome, typically not

isolated condition but secondary to other injuryisolated condition but secondary to other injury

Retrocalcaneal bursitis (“pump bumps”)Retrocalcaneal bursitis (“pump bumps”)

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PLANTAR SURFACE INJURIESPLANTAR SURFACE INJURIES

Plantar fasciitisPlantar fasciitis Biomechanical and structural issues predispose Biomechanical and structural issues predispose

tissue to injurytissue to injury Presents typically at calcaneal attachment but Presents typically at calcaneal attachment but

may be along length of structuremay be along length of structure Plantar fascia rupture can occur with forces toe Plantar fascia rupture can occur with forces toe

hyperextension to a dorsiflexed anklehyperextension to a dorsiflexed ankle Pain when stepping out of bed in the morningPain when stepping out of bed in the morning

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Fat pad contusionFat pad contusion Associated with direct trauma (falls from Associated with direct trauma (falls from

height, etc.)height, etc.)

Heel spurHeel spur Bony exostosis (Wolff’s law)Bony exostosis (Wolff’s law) May or may not be associated with plantar May or may not be associated with plantar

fasciitisfasciitis

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SOFT TISSUE INJURIESSOFT TISSUE INJURIES

Muscle strainsMuscle strains Eccentric overload vs. forceful concentric contractionEccentric overload vs. forceful concentric contraction

TendinitisTendinitis Posterior/anterior tibialis, peroneal, Achilles, Posterior/anterior tibialis, peroneal, Achilles,

flexor/extensor tendonsflexor/extensor tendons Repetitive stress injuries (microtrauma) associated Repetitive stress injuries (microtrauma) associated

with biomechanics and changes in training patternwith biomechanics and changes in training pattern

SynovitisSynovitis Can occur in any synovial joint, in foot most common Can occur in any synovial joint, in foot most common

at the great toe MTP jointat the great toe MTP joint

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ARCH INJURIES/CONDITIONSARCH INJURIES/CONDITIONS

Pes planus (“flat feet”)Pes planus (“flat feet”) Congenital, biomechanical or traumatic onsetCongenital, biomechanical or traumatic onset Rigid (structure) pes planusRigid (structure) pes planus

• Tarsal coalition: absence of medial longitudinal arch Tarsal coalition: absence of medial longitudinal arch when the foot is both WB or NWBwhen the foot is both WB or NWB

Flexible (supple) pes planusFlexible (supple) pes planus• The arch appears normal during NWB but The arch appears normal during NWB but

disappears when the foot is WBdisappears when the foot is WB

Pes cavusPes cavus Poor ability to attenuate ground reaction forcesPoor ability to attenuate ground reaction forces High incidence of stress fracturesHigh incidence of stress fractures

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Transverse metatarsal arch conditionsTransverse metatarsal arch conditions Pain under heads of 2Pain under heads of 2ndnd-5-5thth metatarsals due to metatarsals due to

abnormal weight bearingabnormal weight bearing

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NEUROLOGICAL INJURIESNEUROLOGICAL INJURIES

Tarsal tunnel syndromeTarsal tunnel syndrome Tibial nerve entrapment/compression Tibial nerve entrapment/compression

posterior to medial malleolusposterior to medial malleolus Neuro symptoms along distal distributionNeuro symptoms along distal distribution

Intermetatarsal neuromaIntermetatarsal neuroma Interdigital nerve entrapmentInterdigital nerve entrapment Morton’s neuroma (between 3Morton’s neuroma (between 3rdrd and 4 and 4thth

metatarsal heads)metatarsal heads) Pain at site and neuro symptoms distal to Pain at site and neuro symptoms distal to

injury siteinjury site

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Tarsal Tunnel Syndrome SurgeryTarsal Tunnel Syndrome Surgery