foot and toes Flashcards
- what bones are in the rear foot?
- what bones are in the mid foot?
- what bones are in the forefoot? MT
- Talus and calcaneus
- navicular, cuboid, and medical, intermediate, lateral cuneiform bones.
- metatarsals and phalanges.
what are the 3 regions of the foot?
rear, mid, forefoot
what is the function of the ankle?? MT
- shock absorption
- adaptation to uneven terrain
- propulsion of our body through space.
- stability for keeping body upright.
what are the 6 classifications of joints in the foot? MT
- subtler joint (talocalcaneonavicular joint)
- talonavicular joint.
- calcaneocuboid joint
- tarsometatarsal joint
- metatarsophalangeal join
- interphalangeal joint
what are the 3 arches of the foot and which bone is the point of reference for them? MT
medial longitudinal arch
- navicular bone
lateral longitudinal arch
transverse arch
- 2nd metatarsal
what are 4 main passive supporting structures of the foot? MT
- plantar fascia
- spring ligament (plantar calcaneonavicular)
- long plantar (long plantar calcaneocuboid)
- short plantar (short plantar calcaneocuboid)
what is the difference between extrinsic and intrinsic foot muscle?
extrinsic
- muscles in the lower leg that cross the ankle into the foot because of their muscle bellies, and exit on the outside of the foot.
intrinsic
- have both attachments that are contained within the ankle. muscles do not cross the talaco joint.
what is an overview of a fracture of the talus? MT
- cause by acute hyper-dorsiflexion with inversion.
- fracture of the lateral process and neck of the talus.
s/s for fracture of the talus? MT
- severe posterior pain when jumping, running, or kicking.
- pain is increased on force of plantar or dorsiflexion.
- increased pain with resisted flexion of the great toe, bc of insertion point of flexor hallucinations longs tendon.
- mod to sev swelling, tenderness, and dicoloration.
what is management for a fractured talus?
immediate immobilization of the talus and refer to a physician.
what is the overview of a calcaneus fracture? MT
- they are high-energy axial loads. (failing from a height and landing on the bottom (flat feet))
- factures occire at the anterior process by forceful plantar flexion or compression.
list the s/s of a calcaneus fracture? MT
-severe heel pain
- inability to walk or weight bear.
- palpable intense pain over the process of the calcaneus.
how do you manage a calcaneus fracture?
- immobilization
- ice and elevation to control edema.
- short leg cast or walking boot for 6 weeks.
- repair by surgery, patient experiences stiffness of the subtalar joint.
how can stress fractures develop? MT
- running and jumping activities.
- increase in training mileage
- change in surface, hard to soft to uneven.
- change in intensity.
- change in shoe type.
what is the difference between non-critical and critical stress fracture?
non-critical
- fracture of medial tibia, fibula, 2,3,4 metatarsal.
critical
- fracture of anterior tibia, medial malleolus, talus, navicular, 5th metatarsal, sesamoids.
what are the s/s of stress fractures? MT
- pain begins insidiously, and progressively gets worse over time.
- pain limited to the fracture site.
- prolonged pain.
which bones can be irritated in a stress fracture, and with which movements. MT
talus
- excessive pronation
calcareous
- excessive heel strikes
navicular
- jumping, ballet dancers.
how do you manage a stress fracture?
- x-rays
- bone scans and MRI
- person needs to go through the full process of doing weight bearing actives as per to how the bone is healing.
- rest, stretching, strengthening.
- protected weight bearing, stiff shoe or walking cast.
what is severs disease?
- seen in 7-10 yr olds
- associated with growth spurts, decreased flexibility of hamstrings and tricep surae.
- open growth plates
what causes sever disease?
hards surfaces
poor shoes
kicked in the region or landing off balance.
what are s/s of severs disease?
- unilateral, bilateral, intermittent or continuous posterior heel pain.
- pain worsen during and after activity.
- pain improves with rest.
- point tenderness anterior to the insertion of the achilles tendon along the posterior boarder of the calcareous.
how does someone manage severs disease?
- Rice
- modify training
- donut pad (taping)
- increased strength and flexibility in tricep surae group.
what is retrocalcaneal bursitis?
- someone over the age of 7-10.
- irritation of the retrocalcaneal bursa located between the achilles tendon and calcaneus.
- excessive pronation.
s/s of retrocalcaneal bursitis?
- pain on palpation of the soft tissue just ANTERIOR to Achilles tendon.
- increased pain during plantar flexion when athlete pushes off.
- inflamed bursa can lead to a large mass referred to as pump bump.
how do you manage retrocalcaneal bursitis?
- consider tendinopathys if necessary.
- shoe modification.
- standard acute care.
- stretching exercise that associate with achilles tendon.
what is a cuboid subluxation?
happen with plantar-flexion and inversion injuries.
- this is when a strong reflex contraction occurs of the peroneus longs muscle. bc of the contraction the cuboid bone acts as a fulcrum and the tendon applies a force on the cuboid causing infer-medial displacement
what is tarsal tunnel syndrome?
- what causes tarsal tunnel syndrome? MT
- entrapment of the posterior tibial nerve or one of its medial or lateral branches.
- tarsal fracture or dislocation
- hyperplantar flexion or excessive eversion.
what are the s/s of tarsal tunnel syndrome? MT
- diffuse pain
- burning, numbness, pin and needles (along plantar and medial aspect of the foot)
what is an lisfranc injury?
- disruption of the tarsometatarsal joint (with or without an associated fracture.)
- occurs along all 3 cuneiform bones. (medial to lateral)
what is a MOI for a lisfranc injury?
- severe twisting of the first metatarsal
axial load along the first metatarsal.
what are s/s for a lisfranc injury?
- dislocation of the first cuneiform.
- severe mid foot pain
- pins and needles
- swelling along mid foot region.
how is lisfranc injuries managed?
- short leg, non-walking cast for 6 weeks.
- short leg, walking cast for 6 weeks.
- surgery required.
how does a longitudinal arch strain work?
- flattening of the foot during mid-support phase causing the arch to be strained.
- can be associated with a calcaneonavicular lig. sprain and flexor hallucis longs strain.
s/s of longitudinal arch strain?
- what is treatment for longitudinal arch strain?
- pain with running and jumping.
- pain and swelling below the posterior tibalis tendon.
- RICE
- reduce weight bearing (pain free)
- arch taping.
what is plantar fasciitis?
- this is when the fascia on the plantar side of the foot thickens.
- pain is normally worse in the morning, and decreases in pain over time, 5-10 minutes.
- their are 3 fascia muscles in the foot.
- pain increases with weight bearing
what are in and extrinsic factors of plantar fasciitis?
Intrinsic factoria
- pes cavus or planes
- decreased plantar flexion
- reduced flexibility of plantar flexors
- excessive pronation.
Extrinsic factors
- improper footwear
- playing on uneven surfaces
how do you treat plantar fasciitis?
- standard acute care
- Ice
- deep friction massage
- strengthen of the posterior chain, ex. hamstrings and glutes.
what is a jones fracture?
- a avulsion fracture at the BASE of the 5th metatarsal
- is overlooked bc it is often seen as a severe ankle sprain where the foot goes into plantar flexion and adduction.
- lateral ankle sprain can cause a jones fracture.
what is treatment for jones fracture?
- refer to physical
- NWB 6-10 weeks, fallowed by walking cast for 4 weeks.
- what is metatarsalgia?
- what are s/s of metatarsalgia? MT
- general discomfort of the metatarsal heads.
- factors of metatarsalgia are: age, arthritic disease, gout, diabetes. - flattening of the transverse arch
- callus formation over the middle of the 3 metatarsals
- increase of pain intensity and duration
what are in and extrinsic factors of metatarsalgia? MT
intrinsic
- excessive weight bearing
- fallen transverse arch
- valgus collages of the knee.
- overpronation
Extrinsic
- narrow toe box
- improper shoe cleats
- repetitive jumping, or excessive running without proper rest.
how do you manage metatarsalgia? MT
- strengthen metatarsal muscles
- activity modification
- footwear examination
- metatarsal pads or bars.
what is Mortons neuroma? MT
- entrapment of the nerve inside the foot between 2 metatarsal heads, normally 3 and 4 MTs
- stress fracture must be ruled out.
- what are treatments for Mortons neuroma?
- what are s/s of Mortons neuroma? MT
- modify footwear,
- orthotics to decrease pressure
- NSAIDSs - dull and achy pain
- squeeze the toes together which will irratate the nerve.
- specific and point tender.
what is turf toe? MT
- sprain of the plantar capsular ligament of the 1st MTP joint.
- results from a hyperextension of the great first toe.
s/s of turf toe? MT
- pain
- tenderness
- swelling on plantar aspect.
- great toe extension is painful
- sometimes associated with tearing flexor tendons
management for turf toe?
- standard acute care
- taping to limit motion
- use of a metatarsal pad
- if severe restrictions activity for 3-6 weeks.
- what can cause fractures or dislocations of the phalanges?
- s/s of fractures and dislocations of the phalanges?
- management for fractures and dislocation of the toes?
- kicking on an uneven surface.
- stubbing toe
- being stepped on. - immediate and intense pain
- obvious deformity with dislocation - casting may be required with great big toe or multiple toe fractures.
- buddy tapping taping is generally sufficient.
what is the difference between hammer, mallet, and claw toe? MT
HAMMER TOE
- extension at the MTP joint
- flexed at PIP joint
- hyperextension at the DIP joint
MALLET TOE
- neutral at the MTP and PIP joint
- flexed at the DIP
CLAW TOE
- hyperextension oat the MTP joint
- flexion at the DIP and PIP joint.
management for hammer, mallet and claw toe? MT
- wearing footwear with more room for toes.
- padding or tapping to prevent irritation
- shave calluses
- extreme case, surgery
