THE FOOT

Chapter 18

Introduction The traditional sports activities in which athletes

compete at the high school, college and professional level all involve some elements of running, jumping and changing directions. The function of the foot is critical. One instant the foot must be a mobile adapter to absorb shock, and the next minute it must become a rigid lever to propel the body forward. Injury is common.

Foot Anatomy• Muscles and Movements: the

movements of the foot are produced by numerous muscles

• Bones: the foot consists of 26 bones: 14 phalangeal, 5 metatarsal, and 7 tarsal

Foot Anatomy• Articulations: five regions-inter-

phalangeal, meta-tarsophalangeal, inter-metatarsal, tarsometatarsal, sub-talar, and mid-tarsal

• Stabilizing Ligaments: midtarsal joint is given added strength in its plantar aspect by the long plantar ligaments

Foot AnatomyArches of the Foot

– Lateral longitudinal arch- outer aspect

– Anterior metatarsal arch- shaped by the distal heads of the metatarsals

– Transverse arch- extends across the transverse tarsal bones; it gives protection to soft tissue and increases the foot’s mobility

Ligaments

Ligaments

Foot Anatomy• Nerve Supply: the Tibial nerve, largest

division of the sciatic nerve, supplies the muscles of the back of the leg and the plantar aspect of the foot

• Blood Supply: major portion of the blood is supplied to the foot by the anterior and posterior Tibial arteries

Foot Biomechanics• Pronation and Supination

– Excessive Pronation: major cause in stress injury/prolonged into the propulsive phase of running

– Excessive Pronation: compensatory movement at the subtalar joint will not allow the midtarsal joint to unlock, which causes the foot to remain excessively rigid

Assessing Foot Conditions• History:

• Is this the first time this condition has occurred?

• How did the injury occur?• What type of pain is there?• Is there any alteration in sensation?• On what type of surface has the athlete been training on?

etc…………

Assessing Foot Conditions• Observation:

–Is the athlete favoring the foot, walking with a limp, or unable to bear weight?

–Is the injured part deformed, swollen, or discolored?–Is there pes planus (a flatfoot) or pes cavus (a high

arch)?–Is the foor well aligned? Does it maintain its shape on

weight bearing?

Assessing Foot Conditions

• Palpation: besides determining pain sites, swelling, and deformities, palpation is used to determine and evaluate circulation.

Assessing Foot Conditions• Special Tests:

–Movement- both, ex- and intrinsic foot muscles should be assessed for pain and range of motion during active, passive, and resistive isometric movement

–Tinel’s Sign- taping over posterior tibial nerve produces tingling distal to area. Numbness, tingling and paresthesia may indicate the presence of tarsal tunnel syndrome.

cont…

Assessing Foot Conditions• Special Tests: (continued)…

–Morton’s Test- with foot in a supine position, transverse pressure is applied to heads of the metatarsals, causing a sharp pain in the forefoot.

–Neurological Assessment- Reflexes and cutaneous distribution needs testing, skin sensation should be noted for any alteration

Recognition & ManagementSpecific Injuries & Conditions

• Injuries to the Tarsal Region– Etiology: occur laterally from severe

inversion/dorsi-flexion force or medially from inversion and plantar flexion

– Symptoms and Signs: repeated trauma to the ankle; feels pain on weight bearing and complains of catching and snapping/swelling

– Management: X-ray/Protective immobilization/Rehabilitation; if it still contains then surgery is accountable

Recognition & ManagementSpecific Injuries & Conditions

• Injuries to the Tarsal Region– Etiology: fracture of talus; occur laterally from

a severe inversion – Symptoms and Signs: history of repeated

trauma to the ankle/complains on weight bearing and of catching and snapping along with swelling

– Management: X-Ray; protective immobilization with non-weight bearing progressing to full weight bearing depending on symptoms

Recognition & ManagementSpecific Injuries & Conditions

• Injuries to the Calcaneous

– Etiology: from landing after a jump or fall from a height

– Symptoms and Signs: immediate swelling and pain and an inability to bear weight

– Management: RICE; early range of motion exercises are suggested

Recognition & ManagementSpecific Injuries & Conditions

Arches Pes Planus

Etiology: medial longitudinal arch appears to be flat and is sometimes said to be fallen

Signs and Symptoms: pain and feeling of weakness or fatigue in the medial longitudinal arch; calcaneal eversion

Management: if it’s not causing athlete any pain, then absolutely nothing should be done, if done then may content in causing unnecessary problems

Recognition & ManagementSpecific Injuries & Conditions

Arches

Pes Cavus Foot Etiology: an arch that is higher than normal (aka) “claw foot” or “hollow foot” Signs and Symptoms: general foot pain, metetarsalgia, and clawed or hammer toes Management: no attempt should be made to correct the problem, may cause deformity

Foot Rehabilitation• General: Rehab techniques for managing injuries

to lower extremity & the foot, often require athlete to be non-weight bearing

• Weight Bearing: if athlete is unable to walk without a limp, non-weight bearing or limited weight-bearing crutch walking might be employed

• Flexibility: important to restore full range of motion following various injuries to the phalanges

Foot RehabilitationJoint Mobilization

– Anterior/posterior calcaneocuboid glides are used for increasing adduction and abduction. (The calcaneus should be stabilized while the cuboid is mobilized)

– Anterior/posterior tarsometatarsal glides decrease hypomobility of the metatarsals

– Anterior/posterior talonavicular glides also increase adduction and abduction. (One hand stabilizes the talus while the other mobilizes the navicular bone)

Foot Rehabilitation

• Neuromuscular: involves a highly integrativem dynamic process involving multiple neurological pathways.

• Flexibility: important to restore full range of motion following various injuries to the phalanges

Foot Rehabilitation

Foot Orthotics

1. Pads and soft flexible felt supports.

2. Semirigrid orthotics made of flexible thermoplastics, rubber, or leather.

3. Functional or rigid orthotics are made from hard plastic and also require neutral casting.

Summary• The function of the foot is critical to athletic

performance.

• Evaluation and recognition of injuries and conditions can present a challenge to the athletic trainer.

• Many chronic conditions of the lower extremity can be related to foot mechanics.

• Management, rehabilitation, and prevention of foot conditions is essential.