Bones of the Foot 1 n 26 bones
Bones of the Foot (1) n 26 bones n Phalanges = 14 n Numbered 1 -5 (big toe = Hallux = #1) n distal Interphalangeal joint (DIP) n proximal interphalangeal joint (PIP) n Metatarsal phalangeal joint (MP) n Metatarsals (numbered 1 -5)
Bone of the foot (2) n Tarsals- Fig 12 -2 n Calcaneous (heel bone) n Talus (main weight bearing) n Navicular- medial n 3 cuneiforms n Cuboid-lateral
The arches Fig 12 -10 n Function to support and distribute body weight n Three arches: Fig 12 -10 n Medial longitudinal (higher) n supported by calcaneal-navicular ligament (spring) Lateral longitudinal n Transverse n n Plantar Fascia n Supports longitudinal arch
The Ankle Fig 12 -1/12 -3 n Ankle joint = talocrural joint n Three bones n Tibia (medial malleolus)-major weight bearing n Fibula (lateral malleolus) n Talus n Hinge joint n Dorsi-Flexion n Plantar Flexion
Subtalar Joint n The joint between the talus and the calcaneous n Shifts during weight bearing (WB) Supination/inversion n Pronation/eversion n
Tibiofibular Joint -Fig 12 -3 n Composed of Tibia and Fibula n Ligaments/Membrane n Anterior Tibofibular Lig n Posterior Tibofibular Lig n Interosseious membrane- connects the tibia and fibula; runs the entire diaphysis of both bones
Ankle ligaments (1) – Fig 12 -3 n Medial n Deltoid ligament -4 parts n Triangular shape (very strong) n Lateral n Anterior talofibular (ATF) n Calcaneofibular (CF) n Posterior talofibular (PTF) n Ankle and foot are composed of numerous ligaments; where ever two bones meet
Muscles of the Lower Leg n Thick sheaths of fascia divide muscles into 4 compartments n Anterior Compartment n Dorsiflexion (DF), Toe Extension (EXT), Inversion (INV) n Lateral Compartment n Eversion (EV) n Deep Posterior Compartment n Toe Flexion (flex), Inversion (INV) n Superficial Posterior (Plantar flexion (PF))
Nerves and Blood Supply n Nerves n Sciatic nerve branches into the peroneal (ant/lat) and tibial nerves (post) n Blood Supply n Femoral Artery →Popliteal artery → n Anterior and Posterior Tibial artery n n Anterior Tibial becomes the dorsalis pedis artery →dorsal pedal on the dorsum of foot Posterior Tibial is located behind medial malleolus.
ROM n DF-tibialis anterior, extensor digitorum n PF- gastroc and soleus n INV- tibialis anterior and posteror n EV- peroneals n Toe Ext. -extensor digitorum and hallucis n Toe Flexion flexor digitorum and hallucis
Review n http: //www. csuchico. edu/~sbarker/shock/ Anklequiz. html n http: //www. rad. washington. edu/atlas 2/ n http: //www. medicalmultimediagroup. com/ pated/foot/achilles. html
Prevention of Injury n Stretch achilles tendon n tight achilles increases risk of plantar fasciitis, achilles tendonitis, and ankle sprains n Strengthen anterior leg muscles n important for shin splints n Strengthen lateral/medial leg muscles n Strengthen intrinsic foot muscles n Good shoes; change shoes, correct type of shoes for playing surface
Injury information n Precursors = something that may predispose an athlete to that injury n All injuries should be treated for symptoms thus RICE. This will not be listed with each injury but should be remembered n HOPS includes information typically seen or heard during the HOPS assessment. Most injuries include swelling, discoloration etc in area, this is not included in slides
Lateral Ankle Sprain n MOI: PF and/or Inv n More common than medial ankle sprains due to (make up about 90% of ankle sprains): differing length of malleoli (lateral is longer) n Stronger deltoid ligament n n Precursors: tight achilles, improper shoes, previous ankle injury n HOPS and Tx n See field strategy 12. 2
Medial Ankle Sprain n Less common then lateral ankle sprains n MOI: eversion n Sometimes accompanied by a fracture n HOPS n point tenderness over deltoid anterior/ posterior joint line n Swelling not as obvious n Takes almost twice as long to recover in some cases
Achilles tendonitis n Precursors: achilles tendon tightness, change in shoes, running surfaces, workout changes n HOPS chronic injury n pn during and after activity n Thickening of the tendon n Crepitation n Pn with Resistive PF, Passive DF n n Tx: stretch achilles, heel lift, tape, ultrasound
Achilles Tendon rupture n Precursors: athletes between 30 and 40, power sports (BB); recreational athletes n HOPT MOI: push off with knee extending n sharp pain, feels snap or pop n “kicked in the back of the leg” n visible defect/palpable defect n positive Thompson test n Excessive passive DF n n Tx: refer to physician
Medial Tibial Stress Syndrome (1) n “shin splints” n Precursors: achilles tendon tightness, change in shoes, running surfaces, workout changes, arch problems n HOPS sometimes bilateral; pn along distal 1/3 of medial tibial border n initially: pn at start of activity that decreases with activity, then recurring after activity n Later: pain before during and after activity n
Medial Tibial Stress Syndrome (2) n HOPS (cont) n Pn increased with AROM PF, INV n Usually responds well to treatment n Tx Cryotherapy n stretching of achilles n strengthen deep posterior muscle n strengthen anterior muscles n
Plantar Fasciitis n Precursors: obesity, achilles tendon tightness, overuse, shoes n HOPT chronic injury n pn first thing in the morning n point tenderness over the medial calcaneal tubercle n Pn with toe extension and ankle DF n TX- Hot and Cold Modalities, stretching, rest, orthodics, change in shoes, heel lift, tape, roll foot over soda can n
Compartment Syndrome (1) “Volkman's Ischemic Contracture” n Two types: n Exertional (MOI: previous injury in leg, chronic onset); Read; **Exertional CS can lead to Acute CS Acute (MOI: blow to front of the leg) n Acute-HOPT n Increasing pain in the front of the leg n firm tight skin in front of shin n loss of sensation between 1 st and 2 nd toes
Compartment Syn (2) diminished pulse at dorsalis pedis artery n Inability to DF ankle, or extend toes (progressive) n The 5 Ps (ie, pain, pallor, paresthesias, paralysis, pulselessness) n n Tx Ice and Immobilize n Get to physician (MEDICAL EMERGENCY) n Abnormalities can occur within 30 minutes; irreversible damage can occur within 12 -24 hrs n
“Turf” Toe n Precursors: hard surfaces, lightweight, flexible shoes, artificial turf n HOPT MOI-jamming of hallux, hyperextension of toe n sport position requiring hyperextension n Pn, point tnederness over 1 st MP joint n Push off phase of running is painful n Pn with passive extension of the great toe n n Treatment (TX) n taping, metatarsal pad, stiff soled shoes, manage symptoms
Ingrown toenail n Precursors n improper cutting of toenails, too small shoes, contant sliding of foot in shoes n HOPT n nail grown into the surrounding skin n signs of infection around the nail bed n Tx n See field strategy 12. 5
Motron’s Neuroma n Precursors: tight fitting shoes, n HOPT n pn on the plantar side of the foot, usually between the 3 rd and 4 th metatarsal n Pn and numbness radiates to the 3 rd & 4 th toes n Pain relieved by Non weight bearing (NWB) n Pn caused by squeezing the foot n Treatment (TX) n taping, metatarsal pad, wider shoes, cortisone shots, surgery
Stress Fractures n Precursors: female athletes with menstrual irregularities (amenorrhea) increase in training regimen, old shoes n common sides: tibia, fibula, neck of 2 nd metatarsal n HOPS pn on WB, relieved by NWB n localized pn (often unilateral) n n Tx: complete rest 4 -12 weeks, referral for bone scan
Jones Fracture n Avulsion fracture of the peroneus brevis tendon where it attaches to the base of the 5 th metatarsal n Common with severe inversion ankle injuries n HOPS: pn over base of 5 th metatarsal n MOI: severe, forceful inversion n
Bunions- Hallux Valgus n Medial aspect of 1 st MP joint n HOPT n C/S- Shoes, congenital, lig. laxity, prolonged pronation of foot n Angular deformity of the great toe n Pain around the first MP joint (inflammation) n Treatment (TX) n taping, wider shoes, surgery last option
Tests n ROM- good/bad; n Special Test active/passive; perform bilaterally; award a % n Strength-good/bad; perform bilaterally; award a % n Thompson Test n achilles tendon rupture n Anterior Drawer n ATF ligament n Talar Tilt n CF ligament n Deltoid ligament n Fracture Test- FS 12. 6
Test n Functional Test (p. 235 -236)- heel raises, walking, balancing, squatting, running, jumping, (progression is the key)
Specialized Rehab n n n n Towel crunches Theraband Exercises all ROM Picking up objects (marbles) BAPS (wobble board) Stability Trainers http: //www. promedproducts. com/Merchant 2/merchant. mv? Screen=CTGY&Store_Code=PP&Category_Code =BB Achilles Stretch straight = gastroc n bent = soleus n
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