Chapter 18

Question 1

The foot

Answer 1

• bony structure lots of tiny structures, hard to palpate

- lots of ligaments cuz of small bones

Question 2

3-4 separate arches of the foot

Answer 2

• metatarsal arch (can be seen plantar view)
• transverse arch (can be seen plantar view)
• medial long arch (medial view)
• lateral longitudinal arch (lateral view)

Question 3

Achilles tendon

Answer 3

Plantar fascia morphs with Achilles tendon

overlap at back of calcaneus

Question 4

Functional anatomy of the foot and biomechanics

Answer 4

• Athletic trainers must realize that when considering foot, ankle, and leg injuries, that these segments are joined together to form a kinetic chain
• Each movement of a segment, has an effect on proximal and distal segments
• Lower-extremity chronic and overuse injuries have a number of biomechanical factors involved particularly when considering walking and running

Question 5

Two phases of gait

Answer 5

–Stance or support phase which starts at initial heel strike and ends at toe-off (foot in contact with the ground)
–Swing or recovery which represents time from toe-off to heel strike

Question 6

Sprinters gait

Answer 6

Heel never touches the ground

Question 7

Subtalar joint

Answer 7

Made up of calcaneus and talus

Question 8

Stance phase

Answer 8

.Accounts for 60% of gait cycle
–Involves weight bearing in closed kinetic chain
–Five periods
•Initial contact (double limb support)
•Loading response (double limb support)
•Mid stance (single limb support)
•Terminal stance (single limb support)
•Pre swing

Question 9

Swing phase of gait

Answer 9

.Period of non-weight bearing
–Three periods
•Initial swing
•Mid swing
•Terminal swing

Question 10

Running gait

Answer 10

-Running and walking gait have same components
•During running gait
–Loading and mid-stance = more rapid
–After toe off: period of no ground contact
–Stance phase = 33% of gait cycle

Question 11

Prevention of foot injuries

Answer 11

-Highly vulnerable area to variety of injuries
-evaluate and treat
•Forces foot encounters can result in acute traumatic and overuse injuries
•Injuries best prevented by:
-selecting appropriate footwear (#1)
-correcting biomechanical structural deficiencies through orthotics
-paying attention to hygiene

Question 12

.selecting appropriate footwear

Answer 12

–Footwear should be appropriate for existing structural deformities (as evaluated by AT)
-look at cleats especially: look at points of contact, need to spread force out throughout shoe
–For pronators: a rigid shoe is recommended
-supinators: require more flexible footwear with increased cushioning
–dictates stability of shoe

Question 13

Last

Answer 13

Refers to the Basic form shoe is constructed on
Dictates the stability of the shoe
-Slip last shoe (moccasin style) is very flexible
•Board last provides firm inflexible base
•Combination last provides rearfoot stability and forefoot mobility

Question 14

Subtalar joint supination and pronation

Answer 14

.Excessive or prolonged pronation or supination can contribute to overuse injuries
•Subtalar joint allows foot to make stable contact with ground and get into weight bearing position
•Excessive motion, compensates for structural deformity

Question 15

Structural deformities in the foot

Answer 15

-Forefoot and rearfoot varus are usually associated with over-pronation
–Forefoot valgus causes excess supination of subtalar joint
–May interfere with shock absorption of subtalar joint

Question 16

.excessive pronation

Answer 16

-Major cause of stress injuries
due to overload of structures during extensive stance phase or prolonged pronation into propulsive phase
•Negative effect on pulley mechanism of cuboid relative to peroneal, decreasing stability of first ray
•Causes more pressure on metatarsals and increases tibial rotation at knee
–Will not allow foot to resupinate to provide rigid lever = less powerful and less efficient force produced
(Puts force on medial part of foot)
-stress fracture
-tends to go up kinetic chain and cause patella problems
-ALot more MOTIon vs supination

Question 17

Excessive supination

Answer 17

.Causes foot to remain RIGID decreasing mobility of the calcaneocuboid joint and cuboid
–Results in increased tension of peroneus longus and decreased mobility in first ray causing weight absorption on 1st and 5th metatarsals and inefficient ground reaction force absorption
–Limits internal rotation and can lead to inversion sprains, tibial stress syndrome, peroneal tendinitis, IT-Band friction syndrome and trochanteric bursitis

Question 18

Orthotics

Answer 18

-Used to correct for biomechanical problems in the foot
–Can be constructed of plastic, rubber, cork, or leather
–Can be prefabricated or custom fitted

Question 19

Foot hygiene

Answer 19

-Keeping toenails trimmed correctly
–Shaving down excessive calluses
–Keeping feet clean
–Wearing clean and correctly fitting socks and shoes
–Keeping feet as dry as possible to prevent development of athlete’s foot

Question 20

Foot assessment (history and observations)

Answer 20

.History
–Generic history questions
–Questions specific to the foot
•Location of pain - heel, foot, toes, arches?
•Training surfaces or changes in footwear?
•Changes in training, volume or type?
•Does footwear increase discomfort?
Observations
–Does patient favor a foot, limp, or is unable to bear weight?
–Does foot color change w/ weight bearing?
–Is there pes planus/cavus?
–How is foot alignment?
–Are there structural deformities?

Question 21

Subtalar neutral

Answer 21

Talus sits neutral in mortis (formed by tibia and fibula over talus)

Question 22

What all goes into a foot assessment?

Answer 22

• history
• observations (structural deformities: put in subtalar neutral, shoe wear patterns)
• Palpation (both bony and soft structures, a lot to palpate, evaluates circulation, pain, deformities)
• pulses (ensure proper circulation to foot, posterior tibial and dorsalis pedis arteries)
• special tests (Mortons test, tinels sign, movement assessment: extrinsic and intrinsic muscles assessed for pain, neurological assessment: Achilles’ tendon reflex assessed)

Question 23

Recognition and management of specific injuries

Answer 23

-Foot problems are associated with improper footwear, poor hygiene, anatomical structural deviations or abnormal stresses
•Sports place exceptional stress on feet
•Athletic trainers must be aware of potential problems and be capable of identifying, ameliorating( make better) or preventing them