The Foot

Question 1

Name the tarsal bones of the foot

Answer 1

medial cunneiform
intermediate cunneiform
lateral cunneiform
cuboid bone
navicular bone
talus
calcaneus

Question 2

what do the arches of the foot provide? (2)

Answer 2

work interdependently to disperse absorption demands of the individual foot bones & assist in propulsion

Question 3

name the 4 arches of the foot

Answer 3

medial longitudinal arch
lateral longitudinal arch
metatarsal arch
transverse arch

Question 4

what is the plantar fascia

Answer 4

thickened fascia on the plantar side of the foot. Slips deviate medial and lateral.

Question 5

functions of the plantar fascia (3)

Answer 5

1. contributes to arch stability
2. functions as a spring that stores mechanical energy
3. protects the plantar aspect of the foot

Question 6

5 joints of the foot

Answer 6

1. Tarsometatarsal joint
2. Intermetatarsal joint
3. metatarsaophalangeal joint
4. Interphalangeal joint
5. subtalar joint

Question 7

name the lower leg extensors (Deep: 4, superficial: 2)

Answer 7

Deep:
- Extensor digitorum longus
-extensor hallucis longus
-extensor hallucis brevis
-extensor digitorum brevis
Superficial:
- extensor digitorum longus
-extensor retinacula

Question 8

what 2 places can you find pulses on the foot

Answer 8

1. Dorsi pedi
2. Tibialis posterior

Question 9

what ‘quality’ words would someone use that typically describe nerve pain?

Answer 9

tingling
burning
shooting/stabbing
electric shock

Question 10

name the lower leg extensors

Answer 10

flexor digiti minimi brevis
flexor hallucis longus tendon
flexor digitorum longus tendon
adductor hallucis

Question 11

functional anatomy & biomechanics of the foot to remember (3)

Answer 11

1. foot, ankle & leg injuries are segments that are joined together to form a kinetic chain
2. each movement of a segment effect the proximal & distal segments
3. chronic and over use injuries have a number of biomechanical factors involved (walking/running)

Question 12

name the 3 main functional demands of the foot

Answer 12

1. absorption- dissipate external forces that arise from the body-environment interaction
2. propulsion- generate sufficient internal force to overcome the external forces acting on the body
3. stability- the ability to provide a stable platform for the transition between absorption & propulsion

Question 13

describe pronation of the foot & what type of foot is in this position

Answer 13

-combination of eversion & abduction of the foot
-results in lowering of the medial boarder of the foot
-flat feet has this position

Question 14

describe supination of the foot & what type of foot is in this position

Answer 14

• combination inversion & adduction of the foot
• results in raising of the medial boarder of the foot
  -high arched feet are in supinated position

Question 15

forefoot varus

Answer 15

1st metatarsal is elevated relative to the 5th metatarsal

Question 16

forefoot valgus

Answer 16

5th metatarsal is elevated relative to the 1st metatarsal

Question 17

rearfoot varus

Answer 17

calcaneus is inverted relative to the tibia

Question 18

rearfoot valgus

Answer 18

calcaneus is everted relative to the tibia

Question 19

how do contusions on the foot happen

Answer 19

result of direct trauma
- dropping a weight on the foot
- being stepped on/kicked
-hit by a speeding ball/implement

Question 20

rare results of contusion complications (3)

Answer 20

1. excessive hemorrhage
2. nerve damage
3. damage to tendon sheaths leading to tenosynovitis

Question 21

Heel Contusions: Etiology, S/S, & Management

Answer 21

Etiology: sudden starts/stops, change of direction, irritation of fat pad. Pain often on lateral aspect of heel.
S/S: severe pain in heel & unable to withstand stress of weight bearing. Often warm & redness over the tender area
Management: Reduce weight bearing for 24 hours, RICE & NASAIDs. Resume activity with heel cup/donut pad

Question 22

Pes Plantus (flatfoot): Etiology, S/S, & Management

Answer 22

etiology: excess pronation, weakening supportive structure:
- wearing tight shoes
-overweight
-excessive exercise placing undo stress on arch.

S/S: pain, weakness/fatigue, calcaneal eversion, buldging navicular, flattening of medial longitudinal arch, dorsiflexion with lateral splaying of first metatarsal.

Management:
-if not causing athlete pain, do nothing
-if painful get orthotics with medial wedge or tape arch

Question 23

Pes Cavus (High arch foot): Etiology, S/S, & Management

Answer 23

Etiology: higher arch than normal, excessive supination & high medial longitudinal arch

S/S: Poor shock absorption resulting in foot pain. Associated with
- shortening of achellies
-shortening of plantar fascia
-heavy callus development on ball and heel of foot

Management: If no pain, no need for correction.
If pain..
- orthotics can be worn with lateral wedge & stretch achellies and plantar facsia

Question 24

Mortons toe: Etiology, S/S, & Management

Answer 24

Etiology: abnormally short 1st metatarsal, making the 2nd toe look longer. More weight bearing on 2nd toe & can impact gait= stress fracture could develop

S/S: Stress fracture and pain during/after activity with point tenderness. Positive bone scan. Callus development under 2nd metatarsal head

Management: no symptoms=nothing needs to be done
Symptomatic (forefoot varus)= orthotics with medial wedge

Question 25

Hallux Valgus deformity (bunion): Etiology, S/S, & Management

Answer 25

Etiology: prolonged pressure against the medial aspect of the first MTP joint. Leads to thickening of the medial capsule and bursa. Caused by.. - foot pronation -arthritis -general ligament laxity between 1st/2nd metatarsal -constant rubbing on the inside of shoe S/S: Pain over MTP joint, difficulty wearing shoes, 2nd metatarsal bears more weight leading to callus (some people are aysptomatic) Management: -wide/soft shoes with broad toe box -toe strap surgical correction in severe cases

Question 26

Sesamoiditis: Etiology, S/S, & Management

Answer 26

Etiology: inflammation of sesamoid bones in the ball of the foot & tendons they are embedded in. Caused by repetitive hyperextension of the great toe resulting in inflammation S/S: Pain under big toe especially during push off & palpable tenderness under first metatarsal head Management: -Treat with orthotics, metatarsal pads, arch supports & metatarsal bars -Decrease activity to allow inflammation to subside

Question 27

Sprained toes: Etiology, S/S, & Management (Metatarophalangeal & Interphalangeal joint sprains)

Answer 27

Etiology: caused by kicking a non-yeilding object. Pushes joint beyond normal ROM or imparting a twisting motion on the toe (disrupting ligaments a joint capsule) S/S: pain is immediate & intense but short lived, immediate swelling and discolouration within 1-2 days, stiffness and residual pain will last several weeks Management: RICE, buddy taping to immobilize. Begin weight bearing as tolerable

Question 28

Overlapping toes: Etiology, S/S, & Management

Answer 28

Etiology: may be congenital or brought upon by improperly fitted shoes (narrow) S/S: outward projection of big toe articulation. Drop in longitudinal arch Management: Some cases surgery - modalities (whirlpool baths for alleviating inflammation) -Taping to prevent contractual tension in the sports shoe

Question 29

Subungual Hematoma: Etiology, S/S, & Management

Answer 29

Etiology: Direct pressure, dropping an object on the toe, or kicking another object. Repetitive shear forces on toenail. S/S: Accumulation of blood underneath toenail. Likely to produce extreme pain and ultimately loss of nail. Management: RICE immediately to reduce pain & swelling. Relieve pressure within 12-24 hours by lance or nail drill (must be sterile to prevent infection)

Question 30

Ingrown toenail: Etiology, S/S, & Management

Answer 30

Etiology: Common & preventable with proper hygiene & nail care. S/S: Nail margin reddens and becomes painful. Soak and apply antiseptic to the area.

Question 31

name the injuries to the toes

Answer 31

-sprained toes -overlapping toes -ingrown toe nail -subungeal hematoma

Question 32

name the injuries to the metatarsal region

Answer 32

-pes plantus (flat foot) -pes cavus (high arch) -mortons toe - hallux valgus deformity (bunion) -sesamoiditis

Question 33

name the injuries to the heel

Answer 33

heel contusion