2. Foot and Toe Pathologies

A fungal infection of the foot, commonly called athlete’s foot.

tinea pedis

How is tinea pedis treated?

Over-the-counter medication or spray

A hematoma beneath the nail.

subungual hematoma

What causes a subungual hematoma?

Localized trauma

What does a subungual hematoma look like?

A dark purple nail with increased pressure that can cause pain

Where is pain located with plantar fasciitis?

At the origin of the plantar fascia

What happens to pain with weight bearing in plantar fasciitis? Where is tenderness found with plantar fasciitis?

Pain occurs with weight bearing and increases after a period of non-weight bearing. At the origin of the plantar fascia; pain may span the fascia

What muscle test may increase pain with plantar fasciitis?

Testing the flexor digitorum brevis

What special tests are used for plantar fasciitis? What neurologic test may be used?

Navicular drop, Windlass test, and Feiss line. Tinel’s sign

What is the MOI for plantar fascia rupture? What injury may be associated with plantar fascia rupture?

Forced dorsiflexion and toe extension. Avulsion fracture

What medication may increase the risk of plantar fascia rupture?

Corticosteroids

What are signs/symptoms of plantar fascia rupture?

Inability to bear weight, a “tearing” sensation on the plantar foot, ecchymosis at the medial calcaneal tubercle, and a palpable defect

A hook-shaped bony exostosis on the medial calcaneal tubercle

heel spur

What condition can occur with a heel spur? During what gait phase is heel spur pain common?

Plantar fasciitis. Heel-strike phase

A hereditary condition involving abnormal rigidity between tarsal bones

tarsal coalition

What does the foot look like with tarsal coalition? What happens to subtalar joint motion?

A rigid flat foot with calcaneal valgus (rigid pes planus). It is restricted

What can restricted subtalar motion cause?

Stress on the midtarsal region, resulting in collapse of the longitudinal arch\

What imaging techniques can diagnose tarsal coalition?

Radiograph, CT, or MRI

At what ages do different coalitions typically occur?

• 3–5 years: talonavicular

• 8–12 years: calcaneonavicular

• 12–16 years: talocalcaneal