Foot and Toes

Question 1

critical vs non-critical stress fractures

Answer 1

Non-critical = medial tib, fibula 2,3,4 metatarsals

Critical = anterior tibia, medial malleolus, talus, navicular 5 metatarsal and sesamoids

Question 2

Arches of the foot

Answer 2

1. Medial longitudinal
   - navicular = foundation
   - foot posture
2. Lateral longitudinal
3. Transverse
   - 2nd metatarsal = foundation

Question 3

Apophysitis of the calcaneus

Answer 3

Severs disease
7-10 year olds
MOI: growth spurts, decreased flexibility, surfaces/ shoe wear, kicked in the region, or landing off balanced
Px w/ shock absorption

S/S: sever’s sign, px at insertion of achilles

M: refer to physician, heel lift/cups, tapped in slight plantarflexion

Question 4

Retrocalcaneal Bursitis

Answer 4

Pump bump

MOI: external pressure w/ excessive pronation

S/S: pain just anterior to the achilles, pain with active plantarflexion, thickened skin, large mass

M: strengthen muscles associated w/ achilles, shoes, heel lift

Question 5

tarsal tunnel syndrome

Answer 5

MOI: entrapment of tib nerve by trauma, dislocation, hyperplantarflexion, excessive eversion (overuse)
M: rest NSAIDs, orthotics, gradual RTP

Question 6

Lisfranc Injury

Answer 6

disruption of the tarsometatarsal joint w/out associated #
MOI: severe twisting that causes an axial load along the metatarsals

S/S: swelling, compartment syndrome, deformity, severe midfoot pain, paresthesia

M: nondisplaced = cast 6-weeks, walking cast 6-weeks
open reduction and internal fixation

Question 7

Jones fracture

Answer 7

Avulsion fracture at base of 5th metatarsal
(can occur w/) ankle sprain involving plantar flexion and adduction

Tx: refer NWB for 6-10 weeks walking cast 4-weeks

may require surgery

Question 8

Hammer toe

Answer 8

Extension at MTP
Flexed at PIP
Hyperextended at DIP

Question 9

Mallet Toe

Answer 9

neutral MTP and PIP
flexed at DIP

Question 10

Claw toe

Answer 10

hyperflexsion at MTP
Flexion at DIP and PIP