Physical Analysis II Exam I

Rearfoot/Hindfoot

Includes talus and calcaneus

Midfoot

Includes navicular, cuboid, and cuneiforms 1, 2, & 3

Forefoot

Includes metatarsals, phalanges, and sesamoids

Proximal Tibiofibular Joint

Type: gliding joint

Interosseous Membrane

Connects long part of the bone; "Strong ligamentous sheet." Attachment point for muscles

Distal Tibiofibular Joint

Type: fibrous joint, reinforced by four ligaments at the ankle

Anterior Talofibular (A), Lateral Talocalcaneal (C), and Calcaneofibular Ligaments (B),

Ligaments in an ankle sprain

Sesamoid Bones

Two bones connected to flexor hallucis brevis; produce force for muscle

MTP Joint

Allows movement of the toes in flexion and extension; important for demi-pointe and walking

Distal and Proximal IP Joints

Hinge joints allowing flexion & extension of the smaller toes

Medial Longitudinal Arch

Higher of the two arches; designed for shock absorption and uneven surfaces

Lateral Longitudinal Arch

Designed for stability and in contact with the ground while standing

Transverse Arch

Referred to as the 'instep' or the top of the foot

Pes Planus

Flat feet

Pes Cavus

High arches

Retinaculum

Thickened bands of connective tissue holding ligaments, tendons, and muscles in place

Heel Pad

Fat pads under the calcaneus and metatarsals for shock absorption

Tibialis Anterior/Anterior Tib

• Proximal Attachment: upper two-thirds of lateral tibia and interosseus membrane

• Distal attachment: plantar surfaces of the first cuneiform base of 1st metatarsal

• Dorsiflexion and Inversion of the foot/leg at tarsal joints

• Irritation of this muscle is often related to shin splints

• One of the “stirrup muscles” which can lift the medial arch

• Distress of this muscle is commonly associated with splints

Extensor Digitorum Longus

• Proximal attachment: anterior aspect of upper tibia and fibula, interosseus membrane

• Distal attachment: dorsal surfaces of lesser toes

• Extends the 2nd -5th toes (Dorsiflexion); Foot eversion

Gastrocnemius

• Proximal attachment: posterior aspect of medial and lateral condyles of the femur

• Distal attachment: posterior calcaneus via Achilles tendon

• Plantarflexion, Knee flexion

Soleus

• Proximal attachment: posterior aspect of upper tibia, fibula, and interosseus membrane

• Distal attachment: posterior calcaneus via Achilles tendon

• Deep to/under the gastroc

• “Slow twitch” - Stability and balance

• Plantarflexion

Tibialis Posterior/Posterior Tib

•Proximal attachment: posterior upper half of interosseus membrane and adjacent tibia/fibula

•Distal attachment: plantar surface of navicular

•Foot inversion, Plantarflexion

Extensor Hallucis Longus

• Proximal attachment: middle portion of anterior fibular and interosseus membrane

• Distal attachment: dorsal surface of big toe

• Extends the big toe, dorsiflexion, inversion

Flexor Hallucis Longus

• Proximal Attachment: posterior aspect of lower fibula, interosseous membrane

• Plantar surface of base of distal big toe

• Big toe flexion, plantar flexion, foot inversion

Flexor Digitorum Longus

•Proximal attachment: posterior surface of tibia and tibialis posterior fascia

•Distal attachment: plantar surface of lesser toes

•Plantarflexion of lesser toes, foot inversion

Tom, Dick, & Harry - muscle insertions

Tibialis Posterior, Flexor Digitorum Longus, Flexor Hallucis Longus

Name the 3 Peroneals/Fibularis and their function

Longus, Brevis, Tertius

Muscles for foot eversion and plantarflexion; 'winging' muscles

Layer 1 of Plantar Foot

Includes flexor digitorum brevis, abductor digiti minimi (abducts 5th toe) , and abductor hallucis

Layer 3 of Plantar Foot

Includes Flexor hallucis brevis: plantarflexes the big toe, connects to sesamoid

(flexor hallucis longus FHL runs through this)

Shin Splints

Tenderness on the anterior and/or medial tibia;

muscles involved: Tibialis Anterior, Tibialis Posterior, Flexor Hallucis Longus, Soleus

AKA: Tibial Stress Syndrome

Treatment: controlling foot pronation with taping, arch supports, orthotics in street shoes, and strengthening/stretching the muscles involved in shin splints

Bunions (Hallux Valgus)

Bony bump at the MTP joint; caused by big toe pushing against the second toe

Bunion Prevention

Preventing Bunions

• Wear wider shoes

• Use a toe separator

• Tape the big toe (Ask your PT)

• Control pronation

• Strengthen the arch muscles

• Strengthen Abductor Hallucus

Ankle Sprains

Grade 1-3 tearing of ligament(s); prevention includes thera-band exercises and relevés for strength

Ligaments do not return to their original length when overstretched

Os Trigonum

Impingement causing pain in relevé under the Achilles tendon

Bone Spurs

Calcification or breaking off of bone causing sharp pain in the joint; RICE and surgery for treatment

Tendinitis

Inflammation causing burning sensation, tenderness, and swelling; worsens with cold and movement

Corns

Hard, soft, and seed types caused by:

• Sandals or other shoes that are tight-fitting

• Shoes that are the wrong shape or size

• Wearing a different design of shoe than you typically do

• Hammertoes, bunions, or other foot issues

• Aging can cause the skin to thin, which can increase the risk of corn formation

Ingrown Toenails

Sharp edge of toenail irritates surrounding skin;

Prevention: cut toenails straight across, not rounded. Don’t cut them too short.

Treatment methods: cut the corners of the toenails as they grow out, place cotton underneath the corner of the toenail to relieve pressure, and/or have ingrown toenail surgery. Warm Epsom salt baths help with the pain.

Plantar Warts

Prevention by avoiding touching warts

Arthritis in the Foot

Symptoms: Trouble moving, walking, or putting weight on it. Joint stiffness, warmth, or swelling. More pain and swelling after you rest, such as sitting or sleeping. Loss of range of motion. Achy, even during rest.

Diagnosis: X-ray to determine bone health and alignment

Treatment: warmth, joint supplements, and supportive shoes

Supplements for Joint Health

Osteo Bi-Flex, Fish Oil, MSM, Glucosamine Chondroitin; some with calcium

Plantar Fascia

Inelastic band of connective tissue supporting the medial longitudinal arch

Plantar Fasciitis

Pain/inflammation under the calcaneus; worsens in the morning and with dorsiflexion

Causes, treatment, and prevention of Plantar Fasciitis

Causes of Plantar Fasciitis

• Hard floors

• Cold temperatures

• Unsupportive footwear/badly-fitted pointe shoes

• Tying pointe shoe ribbons too tightly

• Tight lower leg muscles

• Not warming up fully

• Too much pronation/supination of the foot

• Overuse

Treatment of Plantar Fasciitis

• Rest

• Stretch calves (gastrocnemius and soleus)

• Hanging your heels off the back of a stair

• Downward dog

• Stretching the peroneal muscles of the lower lateral leg

• Massage

• Ice

Prevention of Plantar Fasciitis

• Only dancing on hard floors when necessary

• Take time to warm up the entire body properly, but also focusing on warming up the ankles/feet

• If you don’t like your pointe shoes, get fitted again

• Loosen your pointe shoe ribbons or buy elastic ribbons

• Retrain any bad habits from the hip down

Tarsal Tunnel Syndrome

Ankle pain due to compressed tibial nerve;

Symptoms: burning pain at the sole of the foot that worsens with standing for long periods; numbness/tingling sensation at the base of the foot

Treatment: RICE, wearing orthotics in shoes, steroid shots to reduce inflammation

Signs for Pointe Work

Indications of readiness including age, training, stability, engagement, and maturity

Growth Plates

Tissue at the end of long bones determining future bone length and shape; weaker and vulnerable to injury in children and teens

Growth Plate Injuries

• Persistent pain and tenderness after a sudden or overuse injury

• Change in shape

• Warmth and/or swelling at the end of the bone

• Changes mechanics of the limb

• Inability to move, put pressure on, or bear weight because of pain

Extrinsic Muscles

Muscles crossing the ankle joint

Intrinsic Muscles

Muscles not crossing the ankle joint

Hallucis

Indicates 'big toe'

Digitorum

Indicates the smaller four toes

Extensors of the Foot (location)

Located anteriorly (top of foot)

Flexors of the Foot (location)

Located posteriorly (bottom of foot)

Talocrural Joint

Anatomical term for 'ankle joint'

Medial (1) and Lateral (2) Malleolus

Anatomical term for 'inside and outside ankle bone'