The Foot and Toes

1. The Foot and Toes

2. Facts about the Foot and Toes • The foot must be rigid but flexible to adapt to even terrain. • As a unit, the foot is required to absorb 7 times the athletes body weight.

3. Anatomy • Calcaneus • Calcaneal Tubercle-Size is important because it provides a powerful lever for increasing muscular force produced by the gastrocnemius and soleus • Talus-articulates in five places with the Tibia, Medial Maleolus, Lateral Maleolus, Calcaneus, and Navicular

4. Navicular-supports medial longitudinal arch Cuneiforms Sub-talar Joint-Supination/Pronation Metatarsals Phalanges Anatomy

5. Arches of the foot • Increases the flexibility of the foot • Serves as a shock absorber to dissipate forces.

6. Medial Longitudinal Arch Most prominent arch Formed by Calcaneus, Talus, Navicular, 1st cuneiform, 1st Metatarsal Key support is the navicular bone if problem occur here dysfunction results. Plantar Fascia supports medial and longitudinal arches Arches

7. Lateral Longitudinal Arch • Contains the calcaneus, cuboids, and 5th metatarsal

8. Formed by the lengths of the metatarsals and tarsals. Originates with the metatarsal heads and fades to the calcaneus Weight bearing structures are the 1st and 5th metatarsals 2nd metatarsal forms the apex of the arch Transverse Metatarsal Arch

9. Arch Conditions • Pes Planus • Flat Footed • Pes Cavis • High Arches

10. Foot Injuries • Sesamoid Fractures • Great Toe Fractures • Turf Toe • Calluses/Blisters/ Corns • Ingrown Toenail • Subungual Hematomas • Stress Fractures • Jones Fracture • Achilles Tendonitis • Plantar Warts • Plantar Fascitis

11. Sesamoid Fractures/Sesamoiditis • Pain on bottom of great toe • May not have specific acute incidence • Hard to read on plan x-ray unless obvious

12. Great Toe Fractures • Mechanism is force or trauma to the great toe that causes a fracture • Splints or Boots for treatment

13. Is a sprain/strain/contusion to the metarsalphalangeal joint. Splints/Taping Ice Slush Immobilization vs Mobilization Turf Toe

14. Calluses/Blisters/Corns • Friction points on the foot • Padding

15. Occurs when toenails are not cut correctly. Repeated pressure on the spot then infection Could cause removal of part or all of the nail Ingrown Toenail

16. Subungual Hematomas • Repeated blows to the end of the nail. • Poor fitting shoes or contact with object or person. • Drain or leave alone

17. Stress Fractures • Usually occurs to the base of the 5th metatarsal. • Should be relatively straight any other line would indicate a regular fracture.

18. Jones Fracture • Fracture to the 5th metarsal • Could be as a result of forced inversion (like an ankle sprain) • Surgical intervention may be needed to speed healing

19. Jones Fx and Surgical Repair

20. Achilles Tendonitis • Inflammation of the Achilles tendon • Repetitive Jumping or explosive actions

21. Achilles Tendonitis/Rupture

22. A virus Looks round and has seeds in the middle If you try to remove yourself it could grow larger. Plantar Warts

23. Pain Worse in the morning Tissue tightens overnight Night Splints Injections Repair Plantar Fascitis

24. Injury Evaluation • History H • Observation O • Palpation P • Stress S

25. History • Acute or Chronic Onset? • What kind of pain? • What increases or decreases pain? • Did you hear a pop or crack? • What were you doing • Can you re-create the mechanism of injury?

26. Observation • How did they enter facility • Obvious deformity • Swelling or Discoloration • Scars • Bleeding • Redness

27. Palpation • Non-weight bearing • Away from pain toward pain ruling out structures • Crepitus? • Point tenderness • Increased skin temperature

28. Special Tests • No real conclusive tests • If you cannot rule out fracture refer to physician.