The FootChapter 17

Foot Anatomy 26 Bones

7 Tarsal 5 Metatarsal 14 Phalanges

38 Joints 4 Arches

Bones of the Foot

Bones of the Foot

Bones of the Foot

Tarsal Bones

Talus Calcaneus Navicular Cuboid Cuniforms

Medial Intermediate Lateral

Metatarsals & Phalanges

Sesamoid Bones 2 (medial and lateral) Under great toe Functionpulley, increase leverage of

tendons that control great toe

Joints of the Foot

Tibiotalar Talocrural Subtalar Talonavicular Calcaneocubiod Metarsocunieform

Joints of the Foot

Metatarsophalangeal Joint

Proximal Interphalangeal Joint

Distal Interphalangeal Joint

Regions of Foot

Forefoot Metatarsals Phalanges

Midfoot Navicular Cuboid 3 Cuniforms

Hindfoot Calcaneus Talus

Regions of the Foot

• Thick white band of fibrous tissue originating from the medial tuberosity of the calcaneus and ending at the proximal heads of the metatarsals

• Work with ligaments to support arches during weigh bearing and downward forces

Plantar Fascia

Foot Arches

Functions1. Support body weigh in an economical fashion2. Absorb the shock of weight bearing3. Provide a space on the plantar aspect of foot for

blood vessels, nerves, and muscles

Medial Longitudinal Arch

• Highest of 3 arches of foot

• Calcaneus, Talus, Navicular, Cuniforms & 1st three metatarsals

• Supports—– Ligaments:

• Spring ligament

• Plantar fascia

– Tendons:• Tibialis posterior

• Tibialis anterior

Lateral Longitudinal Arch

• Lower and flatter• Calcaneus, Talus,

Cuboid, 4th & 5th metatarsals

• Supports—– Ligaments:

• Short plantar ligament• Plantar fascia

– Tendons:• Peroneus longus

Transverse Arch

• Cuniforms, Cuboid, & 5th metatarsal

Shoe Wear Patterns

• Excessive Pronation– Wear out front of shoe

under 2nd metatarsal

• Excessive Supination– Wear out lateral border of

shoe

• Common Misconception– Wearing out the back

lateral corner of the shoe means you pronate

– This is normal wear pattern

Gait

Pulse

• Posterior Tibial Artery• Medial Malleolous• Dorsalis Pedis artery• Extensor Tendon

Great Toe

Foot Movements

Dorsiflexion Plantar Flexion Pronation

Inversion Eversion Supination

Muscles of FootIntrinsic Muscles• Relate to specific body

part or bone

• Flexor hallucis longus• Flexor hallucis brevis• Flexor digitorum longus• Extensor digitorum longus• Abductor hallucis• Abductor digiti minimi• Tibialis posterior

Extrinsic Muscles

• Muscle outside a body part, organ, or bone

• Gastrocnemius

Muscles of the Foot

Muscles of the Foot

Muscles of the Foot

Common Injuries

of the Foot

Fractures & Stress Fractures

• Impair ability to perform competitively

• NWB

• More swelling & pain than ligament sprain

• Point tenderness present

• Obvious deformity often present

• Usually occur acutely; result of traumatic episode

Jones Fracture

• Fracture to the diaphysis at the base of the 5th metatarsal

• Repetitive stress, direct force, or inversion and PF of foot

• Healing slow; high nonunion rate

Retrocalcaneal Bursitis

• Swelling of the bursa at the back of the calcaneus under the Achilles tendon

• S/sxs: – Pain in heel– Painful to touch– Pain worse when

rising on toes– Red, warm skin over

back of heel

Plantar Fascia

• Wide, non-elastic ligamentous tissue that extends from the anterior portion of calcaneus to heads of metatarsals

• Supplies support to longitudinal arch

Plantar Fasciitis

• Strain/irritation of the plantar fascia

• Caused by:– Overuse– Unsupportive footwear– Tight Achilles tendon– Running on hard

surfaces– Chronic irritation

• Pain, tenderness on bottom of foot near heal (especially in am)

• Untreated will lead to:– Bone imbalance– Heel spurs– Muscle strains– Shin splints

• Correct training errors• Ice• Massage• Evaluate shoes &

activity level• Arch support• Heel cup or cushion

Plantar Fasciitis—Treatment

Arches

Pes Planus

• Flat foot• Associated with excessive

pronation• Multiple causes:

– Lack of shoe support– Weak muscles

• Pain & weakness in medial longitudinal arch• Calcaneal eversion• Navicular bulging• Flattening of arch

Pes Cavus

• aka Clawfoot, hollow foot

• Associated with excessive supination

• Shock absorption poor

• General foot pain and metatarsalgia common

• Abnormally short Achilles tendon

• Calluses ball and heel

Arch Sprains

• Ligaments stretch, thus fail to hold bones of foot in position

• When arch weakened, it cannot absorb shock normally

• Causes:– Overuse– Overweight– Fatigue– Training on hard

surfaces– Non-supportive shoes– Shoes in poor

condition

Turf Toe

• Great toe strain

• Hyperextension of the first MTP joint of the big toe

• Treatment:– RICE & Support– Limit movement– Turf toe taping

Heel Spur

• Bony growth on calcaneus

• Causes painful inflammation

• Aggravated by exercise

• As foot flattens, plantar fascia is stretched & pulled where it attaches to calcaneus

calcaneus reacts by

forming spur of bony material

Heel Contusion

• Irritation of the lateral aspect of the heel

• Sudden stop-and-go or sudden change in movement

Heel Contusion—Treatment

• Cold application before activity

• Ice & elevation after activity

• Absorb shock—– Heel cups– Donut pad

Sever’s Disease

• Traction injury at the apophysis of the calcaneus where the Achilles tendon attaches

• Young, physically active athletes– Comparable to Osgood-Shlatter’s disease (at

tibial tubercle of knee)

• Pain occurs during vigorous activity and does not continue during rest

Blisters

• Occur on any part of body where there is friction

• Most common on feet or heels

• Treatment Goals: – Relieve pain– Keep from enlarging– Avoid infection

Blisters—Treatment

• Wash area thoroughly• Use sterile blade to

cut small hole in blister

• Squeeze out clear fluid

• Do not remove skin

• Prevention:– Wear work gloves– Break in new skin– Petroleum jelly/skin

lube– Adhesive bandage

Prevention of Foot Injuries

• Selecting appropriate footwear

• Using shoe orthotic

• Foot hygiene

Rehabilitation of the Foot

• Towel pulls

• TheraBand®

• Marble pick-up