EXS 301 - Foot and toes

Functions of the foot

-Absorbs force

-Acts a stable base of support

Bones of the foot

-26 bones

-7 tarsal bones

-5 metatarsal bones

-14 phalangeal bones

Talus and calcaneus

tarsal bones that form the ankle

Arches

-Assist the foot in supporting the bodyweight and absorb shock of weight bearing

-Metatarsal arch = stretches from the first to the fifth metatarsal

-Medial & lateral longitudinal arch = originates along the media/lateral border of the calcaneus and extends toward the distal head of the first metatarsal

Medial movements

Adduction and supination

Muscles passing behind medial malleolus

Lateral movements

-Abduction and pronation

-Muscles passing behind the lateral malleolus

Prevention of foot injuries

-Attention should be given to those who may be predisposed to injuries

-Exercising, using orthotics, shoes

Assessments

-Patients should be referred to qualified personnel for injury evaluation

Palpation

-Assess bony structured before assessing muscles and tendons

-Check for deformities and areas of point tenderness

Retrocalcaneal bursitis

-Inflammation of retrocalcaneal area

-An exostosis can form (bony outgrowth)

-Tenderness, swelling,warmth, and redness that could progress into a bony bump

Plantar fasciitis

-Inflexibility of the medial longitudinal arch

-tightness of the gastroc-soleus unit

-pain in anterior medial heel

-Treatment may last for 8-12 weeks

Metatarsal fractures

-direct force

-torsional or twisting stresses

-difficult to distinguish fracture from sprain

-swelling, pain, point tenderness, and palpable deformity

-x ray

5th metatarsal fracture (jones fracture)

-overuse, acute inversion, or high velocity rotational forces

-common consequence of a stress fracture

-sharp pain on the lateral border of the foot usually associated with a popping sound

-possibility of a nonunion, requiring an extended period of rehabilitation

Metatarsal arch strain

-Hypermobility of metatarsals caused by laxity in ligaments, resulting in a splayed foot

-gives the appearance of a fallen metatarsal arch

-Pain or cramping in metatarsal region

-signs of inflammation and weakness in area

-pain in the bottom of the foot

Longitudinal arch strain

-Subjecting musculature on plantar surface of foot to unaccustomed stress when playing on hard surfaces

-flattening or depression of longitudinal arch

-pain experienced below medial malleolus and posterior tibial tendon when running is attempted

-swelling and tenderness

Fractures and dislocation of the phalanges

-Kicking an object, stubbing a toe, or dropping a heavy object on toes

-swelling and discoloration

Bunions

-Exostosis of the first metatarsal head

-wearing shoes that are pointed, too narrow, or too short

-Tenderness, swelling, and enlargement, with calcification of the head of the first metatarsal

Morton’s neuroma

-enlargement of a nerve occurring commonly between the third and fourth metatarsal heads

-Severe intermittent pain radiating from the distal metatarsal heads to the tips of the toes

-burning numbness in the forefoot, localized to the third web space and radiating to the toes

Turf toe

-hyperextension injury resulting in sprain of the great toe

-result of repetitive overuse or trauma

Blisters

-shearing forces on skin that result in development of fluid accumulation below the outer layer of skin

-reduce friction

Ingrown toenails

-leading side edge of nail grows into the nearby soft tissue

-swelling, heat, aching, redness, and accumulation of pus

Blood under toenail (subungual hematoma)

-stepping on toe, dropping an object on toe, or kicking another object

-repetitive shearing forces on toenail

-accumulation of blood underneath toenail

-gentle pressure on toenail greatly exacerbates pain