Chapter 18: The Foot

Foot movement

Arches of the Foot

Plantar Fascia

Joints and ligaments of the Foot

Muscle of the Foot and Lower Leg

Functional Anatomy of the Foot and Biomechanics

Two phases:

Stance or support phase which starts at initial heel strike and ends at toe-off

Swing or recovery which represents time from toe-off to heel strike

Foot serves as shock absorber at heel strike and adapts to uneven surface during stance

Supination

Pronation allows for unlocking of midfoot and shock absorption

Subtalar Joint Pronation and Supination

Excessive Prontation

Excessive Supination

Prevention of Foot Injuries

Highly vulnerable area to variety of injuries

Forces foot encounters can result in acute traumatic and overuse injuries

Injuries best prevented by

Selecting Appropriate Footwear

Straight-lasted vs. curve-lasted

Using Orthotics

Foot Hygiene

Assessing Structure

Draw line bisecting leg from start of Achilles tendon to distal end of calcaneus

Palpate the talus, inverting and everting foot so talus produces even pressure under index finger and thumb

Subtalar neutral

Once subtalar joint is neutral, mild dorsiflexion is applied to observe metatarsal head position relative to plantar surface of calcaneus

Degrees of forefoot and rearfoot valgus and varus can then be assessed

Shoe Wear Patterns

Palpation: Bony landmarks

Palpation: Bony landmarks and soft tissue

Palpation: Soft tissue

Pulses

Special Tests

Mortonπs Test

Neurological Assessment

Injuries to the Tarsal Region

Fracture of the Talus

Fractured fifth metatarsal

Fractures of the Calcaneus

Calcaneal Stress Fracture

Retrocalcaneal Bursitis (Pump Bump)

Heel Contusion

Cuboid Subluxation

Tarsal Tunnel Syndrome

Tarsometatarsal Fracture Dislocation (Lisfranc Injury)

Injuries to Metatarsal Region

Pes Planus Foot (Flatfoot)

Pes Cavus (High Arch Foot)

Longitudinal Arch Strain

Plantar Fasciitis

Jones Fracture

Metatarsal Stress Fractures

Bunion (Hallux Valgus Deformity)

Plantar Warts

Callus leading to wart

Hard Corns & Soft Corns

Ulcer

Sesamoiditis

Metatarsalgia

Metatarsal Arch Strain

Mortonπs Neuroma

Injuries to the Toes

Sprained Toes

Turf Toe

Fractures and Dislocations of the Phalanges

Mortonπs Toe

Hallux Rigidus

Hammer Toe, Mallet Toe or Claw Toe

Overlapping Toes

Foot Rehabilitation

General Body Conditioning

Weight Bearing

Joint Mobilizations

Flexibility

Strengthening

Neuromuscular Control (NC)

Rehab plans are focusing more on closed kinetic chain activities

Exercises should incorporate walking, running, jumping in multiple planes and on multiple surfaces

Foot Orthotics

Three types

Pad and soft flexible felt - soft inserts, readily fabricated and used for mild overuse problems

Semirigid orthotics- composed of flexible thermoplastics, rubber or leather; molded from a neutral cast, well tolerated by athletes whose sports require speed and jumping

Functional or rigid orthotic - made from hard plastic from neutral casting; allow control for most overuse symptoms

Correcting Pronation and Supination

Functional Progression