Week 6 Flashcards
What are the three regions of the foot
rear, midfoot and forefoot
What does the midfoot comprise of
navicular, cuneiforms and cuboid bones and joints
What does the forefoot comprise of
metatarsals and phalanges
list ligaments of the foot (3)
- Plantar calcaneocuboid ligament (short plantar ligament)
- Long Plantar Ligament
- Plantarcalcaneonavicular ligament (spring ligament)
4 functions of the ligaments of the foot
-Plantar reinforcement
-Structural stability to lateral column
PCNL-Structural floor & Wall medially
- Provides support
What does altered sensation of the foot impact on? (4)
Foot health
lower extremity injuries
LBP
Balance
Layer 1 intrinsic muscles of the foot includes and what function they do(3)
Flexor digitorum brevis
Abductor hallucis
Abductor digiti minimi
*abducts & flexes their respective digits
Layer 2 intrinsic muscles of the foot includes and what function they do(2)
Quadratus Plantae
- stabilises FDL tendon
Lumbricals
- Action similar to hand
Layer 3 intrinsic muscles of the foot includes and what function they do(3)
Adductor hallucis - adduct & flex great toe Flexor hallucis brevis Flexor digiti minimi -Both fex MTPs of respective toes
Layer 4 intrinsic muscles of the foot includes and what function they do(2)
Plantar interossei (3) Dorsal interossei (4) -Strutural stability to fot vs dexterity in hand
Name nerves of the foot (6)
Dorsal surface
- Deep peroneal nerve
- sural nerve
- intermediate dorsal cutaneous nerve
- Medial dorsa cutaneous nerve
Sole/Plantar surface
- Lateral plantar nerve
- Medial plantar nerve
Name 3 arches of the foot
Medial longitudinal arch
Lateral longitudinal arch
Transverse arch
Origin and insertion of the Plantar fascia
O- medial calcaneal tubercle
I- metatarsal heads
Function of the plantar fascia
provide stability to the arch of foot and aid in resupination of the foot during propulsion
common causes of rearfoot pain
plantar fasciitis
foot pad contusion
Less common causes of rearfoot pain (6)
Calcaneal fractures (traumatic, stress fractures) Medial calcaneal nerve entrapment lateral plantar nerve entrapment Tarsal tunnel syndrome Talar stress fractures retrocalcaneal bursitis
What causes of pain shouldn’t be missed (3)
Spondyloarthropathies
Osteoid osteoma
CRPS Type 1
-post knee or ankle injury
Common causes of midfoot pain (5)
Navicular stress # Midtarsal joint sprain Extensor tendinopathy Tib post tendinopathy plantar fascia strain
Less common causes of midfoot pain (9)
Cuneiform stress # cuboid stress fracture# Base 2nd MT stress # Peroneal tendinopathy ABD hallucis strain Cuboid syndrome Tarsal syndrome Tarsal coalition -Young adolescent Kohler's - young children Accessory navicular bone
Don’t miss causes of midfoot pain (3)
Lisfranc joint injury - TMT joints -dislocation or # Osteoid osteoma CRPS type 1 - post knee or ankle injury
Common causes of forefoot pain (12)
1st MTP joint sprain Hallux Limitus Moreton's neuroma Synovitis of MTP joints MT stress # Jone's # (5th MT diaphysis) Hallux valgus Sesamoid pathology subungual haematoma Corns, calluses Onychocryptosis
Less common forefoot pain causes (8)
Freiberg's osteochondritis Joplin's neuritis Sesamoid stress # Base MT 2 stress # Synovitis of MT-Cuneiform joint Toe Clawing sublungual extosis plantar warts
Don’t miss causes forefoot pain(1)
CRPS type 1
post knee ankle injury
Most common disorders of the foot (6)
Plantar fasciitis Navicular stress fracture Hallux rigidus/ limitus Moreton's neuroma (metatarsalgia) Hallux valgus Tibialis posterior tendon dysfunction - PTTD
Causes of plantar fasciitis(4)
Pes planus increases risk
Excessive pronation or lack of resupination in late stance
Pes cavus - lack of mobility in foot &reduce absorption
Tight proximal myofascial structures
-esp calf ham and glutes
Pages to review
34, 37
Clinical features of plantar fasciitis (7)
Gradual onset
characterised by medial plantar heel pain
Worse with walking and running
Worse upon rising in the morning / first step
TOP medial tuberosity calcaneus
Gait biomechanics play role
Muscular tightness and weakness impact
Treatment for plantar fasciitis (12)
Avoidance of activity, cryotherapy, stretching (plantar fascia and calf), taping, STM, NSAIDS, corticosteroid, heal pad, strengthening, footwear, orthoses, surgery
causes of navicular stress # (3)
overuse and training error play role
possible impingement between proximal & distal tarsal bones
Decrease DF range - increase risk
Signs and symptoms of Navicular stress #
Insidious onset
Midfoot pain
Localised tenderness at N spot
What to use to find Navicular stress factures
MRI/ CT scans
X-ray has low sensitivity
Treatment of Navicular stress fracture treatment (2)
Rest from WB + Aircast
- 6-8/52
Post immobilisation
What is Hallux limitus (inc 1st MTP Sprain)
Pimarily posttraumatic injury to the plantar ligament, capsule, tendon and sesamoid #
MOI of Hallux limitus
Hyperextension
- turf toe
- limits extension to 5 degrees
Treatment for Hallux limitus
Reduced activity NSAIDs/ corticosteroid PT - increase ROM, biomechanical corrections Orthoses Surgery
What is Morton’s neuroma
swelling of nerve + scar tissue from compression of interdigital nerve ( commonly 3-4 MTs)
Contributing factor to Morton’s neuroma
Excessive pronation - MT hypermobility + impingement
Presenting factors of Morton’s neuroma
Pain radiating into toes
P&N
Pain increase with WB and tight shoes
Treatment of Morton’s Neuroma
Ice MT padding corticosteroid strengthening of foot intrinsic and extrinsics -transverse arch and pronation control Orthoses chronic- nerve ablation
What is Hallux valgus
valgus deformity between 20-30 degrees of the big toe - increases up to 60%
causative factors of hallux valgus (6)
secondary to intrinsic and extrinsic factors
Footwear
Excessive pronation
increase length 1st MT and Hallux
Trauma - medial + plantar ligament, med sesamoid bone
degenerative or neuromuscular disorders
Presentation of hallux valgus (4)
Deformity
Tenderness over medial eminence
Possible blistering
Inflamed bursa medially
Treatment of hallux valgus
Padding, footwear, foot function correction, orthoses, surgery
