The Foot Bones Bones 26 14 phalanges 5
The Foot (Bones) ü Bones = 26 14 phalanges ü 5 metatarsals ü 7 tarsals ü
Toes (Phalanges) Designed to give wider base for balance and propelling the body forward. ü 1 st toe (Hallux) ü Two sesamoid bones located under the 1 st MP joint. ü
Metatarsals ü ü 5 Bones 1 st metatarsal is the largest and strongest and functions as the main body support during walking and running. Palpable at the ball of the foot. 5 th metatarsal most common fractured.
Tarsals 7 bones Ø Aids in the support of the body. Ø Calcaneous = largest tarsal bone, supports talus and shapes heel, and provides attachment for achilles tendon. Ø
Joints of the Foot Ø Interphalangeal joint (IP) l Ø Flexion / Extension Metarsalphalangeal joint (MP) l l Flexion / Extension Abduction / Adduction
Bones of the Ankle Ø Tibia l l Ø Fibula l l l Ø Main weight bearing bone of LOWER LEG Forms medial malleolus Non-weight bearing Mainly muscle and ligament attachment Forms lateral malleolus Talus l Main weight bearing bone of the ANKLE
Lateral Ligaments of the Ankle Ø Resist ankle inversion Ø Anterior talofibular (ATF) l Most commonly sprained Calcaneofibular (CF) Ø Posterior talofibular (PTF) Ø
Medial Ankle Ligaments Ø Deltoid Resists ankle eversion Ø Low rate of injury Ø
Quiz 1. 2. 3. 4. 5. 6. 7. Which bone in the lower leg is the most weight bearing? What does ATF stand for? Which ligaments resist inversion? Which ligaments resist eversion? What does MP stand for? How many tarsal bones are there? How many bones are in the foot?
Answers: 1. 2. 3. 4. 5. 6. 7. Tibia Anterior Talofibular, tibiofibular, calcaneofibular (lateral) Deltoid ligaments (medial) Metatarsalphalangeal 7 26
Muscles of the Foot and Ankle Ø Anterior Muscles (3) Ø Extensor Hallucis Longus/Brevis l Ø extension of great toe Extensor Digitorum Longus/Brevis l extension of 2 – 5 phalanges
Muscles of the Foot and Ankle Ø Anterior Muscles cont. (3) Ø Tibialis anterior l inversion and dorsiflexion of foot / ankle
Muscles of the Foot and Ankle Ø Medial Muscles (3) Ø Tibialis Posterior l Ø Flexor Hallucis Longus l Ø Inversion and plantarflexion Flexor of great toe and plantarflexion of ankle Flexor Digitorum Longus l Flexors of 2 – 5 toes and plantarflexion of ankle
Muscles of the Foot and Ankle
Muscles of the Foot and Ankle Ø Posterior Muscles (2) Ø Gastrocnemius l Ø plantarflexion of ankle Soleus l plantarflexion of ankle
Muscles of the Foot and Ankle
Muscles of the Foot and Ankle Ø Lateral Muscles (2) Ø Peroneus Longus / Brevis l eversion, plantar flexion of ankle
Quiz 1. 2. 3. 4. 5. What is the primary function of the Extensor Hallucus Longus and Brevis? What is the primary function of the tibialis anterior? What two motions does the peroneus longus and brevis perform? What motion does the Gastrocnemius/ Soleus perform? What are the two main motions of the tibialis posterior muscle?
Answers 1. 2. 3. 4. 5. Extension of great toe Inversion and dorsiflexion of foot Eversion and plantar flexion of the ankle Plantarflexion of ankle Inversion and plantarflexion
Arches of the Foot
Supinated Arches (High Arches)
Supinated Arches
Pronated Arches (Flat Feet)
Pronated Arches
Pronated Arches
Pronated Arches
Orthotics
Orthotics
Orthotics
Foot and Ankle Injuries
Ankle Sprain Ø Cause: Excessive inversion or eversion of the ankle S/S: Point tenderness, swelling, discoloration, laxity, inability to walk or run properly (extent based on degree). Ø TX: RICE, rehabilitation immediately (Grade III requires immobilization) Ø Prevention: Strengthening exercises, proper shoes/ equipment Ø
Ø 1 st Degree Ankle Sprain Ø Mechanism (MX) l Inversion and/or plantarflexion ATF most common sprained Ø Occurs during contact or non – contact. Ø
v S/S v 1 st v v v degree Mild pain Pt – ATF Possible swelling Fast recovery to FWB and ROM No joint laxity
Ø 2 nd Degree Ankle Sprain Ø MX l Ø Ø Ø Same as 1 st degree, more severe. Involves the ATF, CF Possible growth plate involvement Most cases x-ray needed
Ø S/S Ø 2 nd degree l l l l Felt a pop Localized severe pain Pt – more then one ligament Rapid swelling Decrease ROM Laxity in joint Unable to FWB
Ø 3 rd Degree Ankle Sprain Rupture of ligaments (ATF, CF, PTF) Ø Consider a FX Ø X-ray is mandatory Ø
Ø S/S Ø 3 rd Degree l Felt or heard pop l Extreme pain l Extreme/rapid swelling l No ROM l Unable to FWB
1 st Degree Ankle Sprain 2 nd Degree Ankle Sprain 3 rd Degree Ankle Sprain v. RICE v. Return to Play (Horseshoe w/ compression wrap) v. Crutches 24 hours v. Reevaluate 24 hrs v. Refer to Dr. v. X-rays (Horseshoe w/ compression wrap) v. Crutches v. Posterior Splint v. Refer to Dr. v. X-rays (Toe raise, heel walk, Full go w/ full ROM v. Tape to Play v. Reevaluate 24 hrs
Ø Anterior Drawer Test l l Tests for ligament instability Mainly tests ATF integrity but can also test the CF and PTF depending on severity Ankle must be relaxed Ankle in slight plantar flexion
Ø Talar Tilt l l Test for lateral ankle instability Positive test indicates tear in ATF, and CF
Ø Thompson Test l Test for achilles tendon rupture
Ankle Dislocation Ø Mx: l l Anterior – Heel strikes ground forcefully Posterior – blow to anterior lower leg Ø S/S: l PN deformity, inability to move foot, rapid swelling, refusal to allow moving or touching foot Ø TX: l Splint, ICE, 911 or transport to hospital
Turf Toe Sprain of the 1 st MP joint Ø Mx: Ø l l l Ø Hyperextension/ hyperflexion of great toe Common on artificial surface Flexible types of footwear can contribute S/S l Pain over the first MP joint
Achilles Tendonitis Ø MX: l Ø S/S: l Ø Repetitive motions such as running and jumping that cause tendon breakdown Swelling, crepitus, pn with palpation, pn with dorsiflexion, weak with plantarflexion TX: l l l RICE Limiting or restricting the activity that caused the irritation Aggressive stretching of heel cord • Crepitus (crackling and grinding) may mean it is too late Ø Prevention: l Achilles and gastroc/solues stretching, proper acclimization to activity.
Achilles Tendon Rupture Ø MX: l Ø S/S: l Ø Feel or hear a pop. Feel as if they’ve been kicked in the leg. Inability to plantar flex foot. TX: l Ø Sudden, forceful plantar flexion of the ankle with a chronically tight tendon. Surgery or a cast Prevention: l Stretching and proper care of any tendonitis
Longitudinal Arch Strain Ø Mx – l l Ø Downward force to the foot causing depression of the arch Most common with overuse (running) S/S l l Sharp pain with weight bearing Painful during dorsiflexion
Lower Leg Problems Ø “Shin Splints”: l Ø MX: l Ø constant pounding associated with running S/S: l Ø catch all term related to lower leg pain. sharp pain in lower leg around medial/lateral aspect of lower leg and connective tissue between tibia and fibula TX: l RICE (cold whirlpool), heal lift, arch support, shoes, change running surface
Compartment Syndrome Ø MX: l Ø S/S: l Ø Deep aching pain, tightness, and swelling. Pain with stretching. TX: l l Ø Increased pressure within one of four compartments of lower leg causes compression of the structures in the leg. Acute~ immediate surgery Chronic~ activity modification & ice and some times surgery Prevention: l Stretching (Hard to prevent)
Toe Abnormalities Hammer Toes Ø MX: l l Ø Poor shoe choices Middle joint (PIP) flexed, other joints (MP, DIP) hyperextended TX: l Refer, orthotics or surgery
Bunion / Hallux Valgus Ø MX: l Ø S/S: l Ø Obvious deformity, tenderness, and swelling TX: l Ø Bony enlargement of the head of the 1 st metatarsal caused from wearing improperly fitting shoes Proper shoe selection, protection devices, surgery may be necessary Prevention: l Properly fitting shoes
Ingrown Toenail Ø MX: l Improper shoe fitting and nail cutting Ø S/S: l Increased pain, swelling, redness around the nail bed Ø TX: l Hot, soapy water, antibiotics, raise nail up Ø Prevention: l Proper shoes, proper nail trimming
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