Chapter 18 - The Foot Flashcards
function of foot sesamoid bones
reduce pressure in weight bearing
increase mechanical advantage of flexor tendon
act as sliding pulleys for tendon
plantar fascia attaches where posteriorly?
calcanea tuberosity
sustenaculum tali located on the…
calcaneus
shape of the talus
broader anteriorly than posteriorly
bony alignment limits dorsiflexion
cuboid is on which side of the foot
lateral aspect of the foot
cuboid articulates with which metatarsals?
4th and 5th
cuneiforms sit between
the navicular and bases of metatarsals 1-3
medial longitudinal arch formed by
calcaneus, navicular, talus, 1st cuneiform, 1st metatarsal
spring ligament
attaches from calcaneus to navicular
navicular is on the
medial side of the foot
what tendons run along the medial longitudinal arch
posterior and anterior tibialis
lateral longitudinal arch
calcaneus, cuboid, 5th metatarsal
what tendons run along the lateral longitudinal arch
peroneus longus
anterior metatarsal arch
metatarsal heads
transverse arch
across transverse tarsal bones
what tendons run across the transverse arch
peroneal longus, tibialis posterior
plantar fascia supports the foot…
against downward forces
sub-talar joint
talus and calcaneus
sub-talar movements
inver/ever pron/sup
mechanics of pronation
calcaneus everts, talus PF and ADD, flattens medial longitudinal arch
mechanics of supination
calcaneus inverts, talus DF and ABD, increases medial longitudinal arch
pronation
eversion +abduction of forefoot
supination
inversion + adduction of the forefoot
muscles that pronate
peroneus longus/brevis/tertius
extensor digitorum longus
muscles that supinate
tibialis posterior,
flexor digitorum longus,
flexor hallucis longus,
tibialis anterior,
extensor hallucis longus
tibial nerve
posterior leg, plantar foot
common perineal nerve
front of leg, foot
arteries of foot
A/P tibial arteries
forefoot consists of
metatarsals and phlanges
mid foot consists of
navicular, cuboid, cuneiforms
rear foot consists of
calcaneus, talus
stance phase
initial contact of heel to toe off (60% of total gait)
heel strike, mid stance, push-off
heel strike
contact on lateral calcaneus with subtler supination and tibial ER
midstance
subtler joint pronates, and tribal IR (20%)
pronation maintained to provide shock absorption by unlocking the midfoot
push off
foot begins to supinate and will approach neutral subtler position at 70-90% of stance phase
supination locks the mid foot back up to form a rigid lever
swing phase
time between toe off and initial contact (NWB)
initial swing, mid swing, terminal swing
pronation involves what structural deformities
pes planes, forefoot varus, forefoot valgus, rear foot vars (in NWB)
pronation causes increased medial tension of..
post tib. and gastroc/soleus
pronation causes increased lateral compression of what joints
subtler and talocrural
pronation cause what at the knee
valgus force at the knee
excessive pronation
loose foot ->increased forefoot motion
compromises 1st met and attachment of peroneus longus
supination involves what structural deformities
forefoot valgus, pes Cavus
tibial ER compensation
Excessive supination causes
insufficient GRF absorption
puts weight on 1st and 5th mets
limits IR: inversion sprains, MTSS, peroneal tendinitis, IT band friction syndrome, trochanteric bursitis
pump bump aka
Haglaund’s deformity
hallux valgus aka
bunion
sustenaculum tali located
medially
sinus tarsi located
laterally
pulses
posterior tibial (behind medial malleolus)
dorsal pedal
Longitudinal arch angle also known as
feiss line
feiss line test
draw line from medial malleolus, to 1st MTP joint (plantar). mark navicular tubercle (NWB)
they stand WB, ft 12 in apart, note position of navicular tubercle from ground
(+) navicular drops >2/3 to floor
NAvicualr drop test
sitting: mark navicular tuberosity, measure distance to ground
standing measure, looks or greater than 10 mm = (+) test
Morton’s test
food in natural. apply transverse pressure to heads of metatarsals
(+) - sharp pain in forefoot
indicates: metarsalgia or neuroma
achilles tendon reflex
S1
talus fractures (etiology)
occurs in the dome
usually from severe INV/DF (medially) or INV/PF (laterally) with ER of tibia
talus fx s/sx
hx of ankle trauma, pain, catching, snapping, swelling, talar dome is tender over anterior joint line
talus fx management
x-ray, immobilize, protect, NWB progression
calcaneus fx etiology
landing after a jump
s/sx calcanea fx
swelling, pain, cannot WB, deformity
calcanea stress fx etiology
receptive heel strike, see in runners
management of calcanea stress fx
x-ray, bone scan, NWB
apophysitis of calcaneus aka
sever’s disease
apophysitis of calcaneus etiology
occurs in young, physical active athletes - traction injury at apophysis of calcaneus where achilles tendon attaches
apophysitis of calcaneus s/sx
pain at posterior heel, pain during vigorous activity that is received with rest
apophysitis of calcaneus management
Rest, ice, stretching, NSAIDS
retrocalcaneal bursitis etiology
pressure from heel counter inflames bursa between achilles and calcaneus/
exostosis may develop
exostosis
bony outgrowth or callus
heel contusion etiology
sports demanding stop and go response or changes from horizontal to vertical movement.
heel contusion s/sx
pain in heal, cannot WB, warmth/redness
heel contusion management
RICE NSAIDS, heel cup, protective donut, wear shock absorbent footwear
tarsal tunnel formed by
osseous floor and flexor retinaculum
inside the tarsal tunnel
tibialis posterior, flexor hallucis longus, flexor digitorum muscles, tibial artery, tibial vein
tarsal tunnel synodrome s/sx
pain, paresthesia (medial and plantar), (+) Tinel’s,
tarsal tunnel management
surgery (if chronic), NSAIDS, orthotic
Lisfranc Injury
Tarsometatarsal fx/Dislocation
lisfranc etiology
ankle is PF with rear foot locked, sudden forceful hyper PF of forefoot results in dorsal displacement of proximal end of metatarsals
lisfranc s/sx
subtle symptoms:
pain, swelling, tenderness on dorsum of foot, possible fx of metatarsals; disruption of supporting ligaments
lisfranc management
restore alignment (ORIF);
pes planus foot
flat foot
pes planus etiology
fallen ML arch, excessive pronation,
caused by: tight shoes, forefoot varus, trauma, excessive exercise
pes planus s/sx
pain, weakness/fatigue in arch, calcanea eversion, bulging navicular, flattening of arch,
pes planus management
taping, orthotics (medial wedge)
pes cavus foot
high arch, claw foot, hollow foot
pes Cavus foot etiology
excessive supination, congenital or neuro disorder
pes cavus foot s/sx
poor shock absorption, pain, metarsalgia, clawed/hammer toes,
forefoot valgus, shortened achilles, odd calluses on ball and heel of foot
pes cavus management
orthotics with lateral wedges, stretching achilles tendon and plantar fascia
plantar fasciitis etilogy
repeated tensile stress, hyperpronation, leg length discrepancy, toe running, limited DF
plantar fasciitis s/sx
anteromedial heel pain, morning pain, decreased pain with movement, pain w/ toe walking and during DF
plantar fasciitis management
RICE, NSAIDS, correct cause, arch support, taping, orthotics, walking boot, night splint,
Jones Fx Etiology
most common acute fx is fx to the diaphysis at the base of the 5th met
Jones Fx S/sx
swelling and p!, healing is slow; high non-union rate and healing course is unpredictable
Jones Fx Management
crutches, no immobilization, progress to weight bearing; treat early with internal fixation
metatarsal stress fracture etiology
most common - 2nd MT (marcher’s fx) - runner who changed training surfaces.
metatarsal stress fx management
gradual return to activity, rest, orthotic to correct pronation
Bunionettes aka
tailor’s bunions
Bunions etiology
associated with structural forefoot varus
narrow shoes or short shoes also pointed shoes
bursa over 1st MTP joint becomes inflamed and thickens. Joint is enlarged and toe is malaligned
Bunion S/sx
pain, swelling, joint enlargement; poorly fitting shoes increase irritations and pain; angulation of toe progresses
bunion management
wear correctly fitting shoes, orthotics, tape splint along with wedge b/w great toe/ 2nd toe
sesamoiditis etiology
caused by receptive hyperextension of the great toe (dancing/basketball)
sesamoiditis s/sx
pain under great toe, esp during push-off. Palpable tenderness under 1st MT head
sesamoiditis management
orthotics, metatarsal pads, arch supports, metatarsal bar
metatarsalgia etiology
pain under 2-3rd metatarsal heads
heavy callus forms, causes inflexibility of gastroc/soleus
also could be caused by fallen metatarsal arch
metatarsalgia s/sx
p! under met bones 2-4; caves deformity may cause metatarsalgia
metatarsalgia management
pad to elevate depressed met heads; remove callus buildup; stretching of gastroc/soleus; strengthening of intrinsic foot musculature
Morton’s neuroma etiology
neuroma is a mass in nerve sheath between 3 and 4 metatarsals;
predisposing factors: collapse of transverse arch, excessive pronation
morton’s neuroma s/sx
burning paresthesia, severe p! that radiates to toes, hyperextension of toes increases sx
morton’s neuroma management
bone scan to rule out stress fx; teardrop-shaped pad placed b/w 3rd and 4th MT heads; narrow shoes may exacerbate problems
Turf Toes etiology
hyperextension injury resulting from sprain of the MTP joint of great toe
Turf Toe s/sx
pain and swelling, p! increased in push-off during walking, running, jumping
management of turf toe
stiffer forefoot of turf shoes, orthoplast under foot, tapping to prevent dorsiflexion, and rest
Morton’s toe
1st toe is abnormally short
management of morton’s toe
if painful use orthotic with medial wedge
hallux rigidus etiology
bony spurs on dorsal aspect of 1st MTP joint that results in impingement and a loss of active and passive DF
degenerative arthritic process
hallux rigidus s/sx
great toe unable to DF; forced DF increases pain, weight bearing on lateral foot when walking
hallux rigidus management
stiffer she with larger toe box, NSAIDs,
Hammertoe
flexible deformity that can become fixed; flexion contracture at PIP joint
Mallet toe
flexion contracture at DIP joint (involving flexor digitorum longus tendon).
Claw toe
flexion contracture at DIP joint and hyperextension at the MCP joint; callus develops over PIP joint and under metarsal head
subungal hematoma etiology
large force applied to toe, kicking another object. receptive shearing
subungal hematoma s/sx
bleeding may be immediate or slow, producing p!, bluish-purple color
subungal hematoma management
ice, release pressure by drilling hole into nail bed
