METATARSAL REGION Flashcards
(14 cards)
Pes Planus Foot (Flatfoot)
Etiology
Congenital conditions
Excessive pronation
Wearing tight shoes
(weakening supportive structures)
Overweight
Excessive exercise
Sign & Symptoms
Pain, weakness,
flattening - medial longitudinal arch
Calcaneal eversion
Bulging navicular
Foot in dorsiflexion
Lateral movement of 1st metatarsal
Pes Planus Foot (Flatfoot)
Management
Orthotic should be constructed w/ medial wedge
Taping of arch can also be used for additional support
Pes Cavus (High Arch Foot)
Etiology
High medial longitudinal arch
Excessive supination
Sign & Symptoms
Poor shock absorption
Foot pain, clawed or hammer toes
Associated with tight Achilles & plantar fascia
Heavy callus development on ball & heel of foot
Management
If asymptomatic, do NOT try to “correct”
Orthotics should be used if problems develop
Stretch Achilles & plantar fascia
Longitudinal Arch Strain
Etiology
Early season injury
Flattening of foot during mid support phase
May appear suddenly or develop slowly
Sign & Symptoms
Pain on posterior tibialis tendon w/ running & jumping
pain & swelling
May also have sprained calcaneonavicular ligament & flexor hallucis longus strain
Management
Reduction of weight bearing & Arch taping
Plantar Fascia
Dense, broad band of connective tissue attaching proximal & medially on the calcaneus & fans out over the plantar aspect of the foot
Works in maintaining stability of the foot & bracing the medial longitudinal arch
Plantar Fasciitis
Etiology
Increased tension & stress on fascia
Change from rigid to flexible footwear
Running on soft surfaces
Poor running technique
Leg length discrepancy
Excessive pronation
Inflexible longitudinal arch or gastroc-soleus complex
Sign & Symptoms
Pain anterior medial heel (plantar aspect), along medial longitudinal arch
Increased pain in morning
Loosens after first few steps
Pain with dorsiflexion
Management
Extended treatment (8-12 weeks)
Orthotic w/ heel cup or pad
Simple arch taping
Night splint to stretch
Exercises that increase great toe dorsiflexion
Steroidal injection for worst case
Jones Fracture – Metatarsal Fx
Etiology - most commonly base of 5th metatarsal
Inversion & plantar flexion
Direct force
Repetitive trauma
Sign & Symptoms
Immediate swelling, pain over 5th metatarsal
High nonunion rate & healing time is slow
Management
Controversial treatment:
Crutches w/ no immobilization
Progressing to weight bearing as pain subsides
May allow athlete to return in 6 weeks
If nonunion occurs, internal fixation may be required
Metatarsal Stress Fractures
Etiology
Change in running pattern
overuse
Increased mileage
Hills or hard surfaces
Short 1st metatarsal
March fracture - 2nd metatarsal
S/S
Pain over 2-3 week period
Begins dull during exercise, then progresses to pain during rest
Pain initially diffuse, then localizes of Fx site
Bunion (Hallux Valgus Deformity)
Bunionette (Tailor’s bunion - 5th)
Etiology
Exostosis (bone spur) metatarsal head
Forefoot varus
Shoes that are too narrow, pointed or short
Bursa becomes inflamed & thickens, enlarging joint, & causing malalignment of toe
Sign & Symptoms
Tenderness, swelling, & enlargement of joint initially
As inflammation continues, angulation increases causing painful walking
Bunion and Bunionette
Management
Early recognition & care is critical
Wear correct fitting shoes, appropriate orthotics, pad over 1st metatarsal head, tape splint between 1st & 2nd toe
Bunionectomy may be necessary
Lisfranc Injury
Etiology
Tarsometatarsal Fx/Dislocation
dorsal displacement of the metatarsals
Relatively uncommon injury, but can causes long-term disability
With ankle in plantar flexion and rearfoot locked, sudden/forceful hyperplantarflexion of forefoot
Sign & Symptoms
Pain and inability to bear weight
Localized swelling and tenderness over dorsal foot
Possible Fx of metatarsals
Metatarsalgia
condition in which the ball of your foot becomes painful and inflamed
Etiology
Burning pain in ball of foot (2nd & 3rd metatarsals)
Heavy callus development
Tight gastroc-soleus complex
Fallen transverse metatarsal arch
Sign & Symptoms
Transverse arch flattened & Pes Cavus foot
Depressed 2nd, 3rd, 4th metatarsal bones
Pain
Morton’s Neuroma
Etiology
Thickening of nerve sheath between 3rd & 4th metatarsals
medial & lateral plantar nerves
Irritated by collapse of transverse arch of foot
Excessive pronation
Signs & Symptoms
Burning paresthesia & severe intermittent pain
Pain relieved w/ non-weight bearing
Toe hyperextension increases symptoms
Morton’s Neuroma
Management
Rule out stress fracture
Teardrop pad placed between 3rd and 4th metatarsals to increase space
Decrease pressure on neuroma
Shoes w/ wider toe box
Surgery may be required
