Advertisement Upgrade to remove ads

Foot Disorders Foot Disorders
Fore-, Mid-, Hind-Foot Divisions

• Forefoot
- Phalanges
- Metatarsals
• Midfoot
- Cuneiforms
- Cuboid
- Navicular
• Hindfoot
- Talus
- Calcaneus

Foot Disorders Foot Disorders
Fore-, Mid-, Hind-Foot Divisions

• Tibiotalar (ankle) joint Between tibia-talus
• Transverse tarsal joint Between talus-navicular Between calcaneus-cuboid

Remember, the "ankle joint" is comprised of THREE ARTICULATIONS

1. Talocrural (tibiotalar)
2. Subtalar
3.Transverse tarsal

1. Talocrural Ankle Joint

- Dorsiflexion and Plantarflexion

2. Subtalar Ankle Joint

- Inversion and Eversion

3. Transverse Tarsal Ankle Joint

- Alternating foot rigidity and flexibility
- Contributes to forefoot AB/ADduction

Arches of the Foot

1. lateral longitudinal arch
2 transverse arch
3 medial longitudinal arch

Forefoot Disorders Metatarsalgia

Pain and inflammation in the ball of the foot.

Forefoot Disorders Metatarsalgia • Cause

- Excessive forefoot pressure
- High-heeled shoes
- Friction or shear inside shoe

Metataralgia Clinical Picture

- Pain under ball of foot
- "Walking with a pebble in my shoe"
-Callous formation under 2nd &/or 3rd met head

Forefoot Disorders Metatarsalgia Treatment

- Transfer weight to longitudinal & metatarsal arches
- Lower heel of shoe
- Limit friction or sheer inside shoe

Forefoot Disorders Metatarsalgia • Orthotic Device

- Longer or wider shoe
- Total contact
- Shock absorbing material
- Shoe modifications
- Goals:
1. Redistribute pressure across entire plantar surface
2. Relieve direct metatarsal head pressure

Forefoot Disorders Morton's Neuroma

- Pain in the ball of the foot
- Specifically between toes
-Thickening of tissue around nerves
- Neuropathy
- Burning, stinging, numbness

Forefoot Disorders Morton's Neuroma Cause

- Excessive forefoot pressure, irritation, trauma
• Clinical Picture
- Pain between digits
- Female > male
- Metatarsal head compression

Forefoot Disorders Morton's neuroma Causes

- Morton's neuroma is not actually a tumor, but a thickening of the tissue that surrounds the digital nerve leading to the toes. • Nerve becomes sandwiched between the bones in the foot as it passes underneath ligaments

Morton's Neuroma • Treatment

- Reduce M-L compression
- Lower heel heights
- Utilize shock absorbing material
• Orthotic Device
- Morton's extension
- Carbon fiber plate
- Stiffer soles
- Rocker bottom

Forefoot Disorders Hallux Valgus (Bunions)

A deviation of the great toe/hallux toward the

lateral border of the foot

...

Hallux Valgus (Bunions) -Cause

- Osteoarthritis of 1st MTP joint
- Toe box too narrow
- High-heels

Clinical Picture Hallux Valgus

- Bunion or bony prominence on medial aspect of 1st MTH
- Lateral deviation of 1st toe
- Pain

Forefoot Disorders Hallux Valgus (Bunions) Treatment

- Reduce pressure & friction to 1st MTP joint
- Utilize shock absorbing material

Hallux Valgus• Orthotic Device

- Deeper, wider toe box shoe
-Stiff sole
- Carbon plate
- Rocker bottom
- Custom FOs

Hallux Rigidus

- Degenerative, osteoarthritis of the 1st MTP joint
- Damage to articular cartilage
- Raw bone ends rub together
- Bone spur overgrowth
- Stiff big toe

Hallux Rigidus

• Cause
- Osteoarthritis of 1st MTP joint

Hallux Rigidus

• Clinical Picture
- Decreased 1st MTP joint ROM
- Painful 'rollover' from mid-to late stance
-Compensatory gait to prevent 1st toe motion

Hallux Rigidus • Treatment

- Utilize shock absorbing materials
• Orthotic Device - Deeper, wider toe box
- Carbon foot plate
- Stiff soles
- Rocker bottom

Hammer Toes

- Deformity of the second, third, and fourth toes
- Toe is flexed at the PIP joint

Claw Toes

• Claw toes are usually associated with nerve damage
• Claw toe position:
- MTP joint extension (dorsiflexion)
- PIP joint flexion (plantar flexion)
- DIP joint flexion (plantar flexion)

Hammer Toes • Cause

- Poor fitting shoes
- Muscle imbalance
• Clinical Picture
- Dorsal toe (PIP) irritation
- Fixed flexion deformity of IP joint(s)
- Calluses

Hammer Toes • Treatment

- Deeper, wider toe box
- Soft, expandable uppers
- Utilize shock absorbing material
• Orthotic Device
- Shoe modifications
- Custom FOs
- Shields & toe separators

Sesamoiditis

- Free-floating bones, connected only to tendons
- Serve as pulleys, aid sliding of tendons
- Susceptible to fracture and inflammation

Sesamoiditis Cause

- Forefoot valgus
- Excessive 1st MTP joint pressure
• Clinical Picture
- Pain under 1st met head with weight bearing
- Significant localized tenderness

Sesamoiditis • Treatment

- Utilize shock absorbing materials
- Lower heels of shoes
- Reduce direct pressure against 1st MTP joint
• Orthotic Device
- Increase toe lever arm
- Reduce dorsiflexion of 1st MTP joint
- Stiff hallux extension

Midfoot Disorders Foot Strain

- Strain = muscle, tendon injury
- Sprain = ligamentous injury
- Soft-tissue injuries
Ex. contusions, tendinitis, bursitis, stress

Foot Strain • Cause

• Clinical picture
- Incorrect shoe size
- Chronic vs. acute
- Soft tissue weakness
- Pain and tenderness
- Obesity
• In arch and calf
• Often worse later in day
- Overexercise
• Edema

Midfoot Disorders Foot Strain • Treatment

- Local treatment
• Hot soaks, ice
- Exercises
• Orthotic Device
-Correct-fitting shoewear
- Arch supports

Midfoot Disorders Pes Planus

Abnormally flat arch (medial longitudinal) upon weight-bearing
• Rarely a problem in children
• Adults - No treatment if asymptomatic

Pes Planus

Arch develops on toe standing. Characteristic finding in flexible flatfeet.

Pes Cavus

Abnormally high arch (medial longitudinal) upon weight-bearing

Pes Cavus • Cause

- Usually effect of more severe foot pathology
- Bony deformity
- Soft tissue contractures
• Clinical Picture
- High medial longitudinal arch
- Foot is shortened
- Prominent met heads & claw toes

Pes Cavus

• Treatment
- Well-cushioned shoewear
- Low-heeled
• Orthotic Device
- Accommodative FO
- Metatarsal bar, pad
- Intimate fitting, flexible arch

Osteoarthritis • Cause

- Arthritis
- Degenerative changes
• Clinical Picture
- Antalgic gait
- Sensitivity along dorsal aspect of foot

Osteoarthritis Treatment

- Reduce painful joint motion
- Increase M-L stability
- Support medial longitudinal arch
- Absorb plantar surface pressures
• Orthotic Device
- Accommodative FO
- Shoewear
• Blucher opening to ease donning
• Long medial counter
• Pad the tongue
• Skip lacing

Hindfoot Disorders Posterior Tibial Tendonitis (Posterior Tibial Tendon Dysfunction, PTTD)

- Inflammation or rupture of posterior tibialis tendon

Hindfoot Disorders Posterior Tibial Tendonitis Onset

- Develops with excessive, repeated pronation
- Stretches PTT along medial, plantar aspect

Posterior Tibial Tendonitis • Cause

-Hindfoot valgus position
- Induces foot pronation
• Clinical Picture
- Irritation/pain along medial ankle & arch
- Lateral malleolus/ankle impingement pain

Posterior Tibial Tendonitis • Treatment

- Correct/accommodate pronation and hindfoot valgus
- Reduce excessive midfoot motion
- Relieve medial aspect pain

Posterior Tibial Tendonitis • Orthotic Device

- Shoes
• Long medial counter
• Blucher opening
• Medial heel wedge
• Medial heel flare Orthotic Device
- Custom FO with medial & hindfoot posting
- Ankle Foot Orthosis for complete rupture

Plantar Fasciitis

- Inflammation of the thick, fibrous tissue underneath the foot
- the plantar fascia
- Plantar fascia connects metatarsal heads to the calcaneus
- Forms the longitudinal arches

Plantar Fasciitis • Cause

- Inflammation of plantar fascia at insertion
- Excessive direct heel pressure
- Chronic pronation
- Acquired foot:
•Occupations that require excessive standing or walking
• Pregnancy
• Improper footwear
• Recent unacclimatized activity

Plantar Fasciitis • Clinical Picture

- Heel pain first thing in the a.m.
- Cramping, spasm of plantar fascia
- Painful/tender palpation of anteriormedial area of calcaneus - Possible osteophyte (heel spur)

Plantar Fasciitis • Treatment

- Support entire plantar fascia
- Provide shock absorption
- Proper footwear
- Stretching exercises
- Reduce inflammation
- Accommodate bone spurs

- Control inducing motions

...

Plantar Fasciitis • Orthotic Device

- Heel cups
- Longitudinal support
- Hindfoot control
- UCBL
- Night-time splint

- Taping

...

Tarsal Coalition

- Anomalous fusion of two or more tarsal bones
- Leads to rigid pes planus deformity Talocalcaneal and calcaneonavicular coalition

Tarsal Coalition

Normal standing
• Fixed flat foot deformity
-Standing on toes
• Arches remain flat
• Implies rigid deformity

Tarsal Coalition • Cause

- Fusion can be osseous,cartilaginous or fibrous
- Most commonly betweentalus-calcaneus and calcaneus-navicular

Tarsal Coalition Clinical Picture

- May be asymptomatic
- Likely congenital, but not symptomatic until late adolescence to adulthood
- Pain due to over use of remaining joints
- Rigid flatfoot

Tarsal Coalition • Treatment

- Severity of pain/discomfort
- Type of coalition
- Surgical resection
• Orthotic Device
- Articulated AFO
- UCBL
- Custom FO

Retrocalcaneal Bursitis

Swelling, inflammation of the fluid-filled sac at the back of the heel bone under the Achilles tendon

Retrocalcaneal Bursitis

- Bursae act as cushions and lubricants between tendons and muscle sliding over bone

Retrocalcaneal Bursitis • Cause

- Friction from ill-fitting shoes
• Shoes too tight
• Shoes too loose - High heel shoes

Retrocalcaneal Bursitis • Clinical Picture

- 'Pump Bumps' - Inflamed & thickened area at back of heel
- Tenderness & swelling in area

Retrocalcaneal Bursitis • Treatment

- Reduce friction & sheer in area
- Improve shoe fit
- Cushioning
• Orthotic Device
- Appropriate fitting shoes
• Remove posterior counter
• Donut pad in posterior counter

Calcaneal Fractures

- Any fracture of the heel bone
- Significantly disabling

Calcaneal Fractures • Cause

- High-impact
- Trauma
- Over-use
• Clinical Picture
- Broadened heel
- Painful calcaneal movements

Calcaneal Fractures • Treatment

- Absorb impact
- Control inversion/eversion motions
• Orthotic Device
-Immobilization cast
- AFO
- High-top shoe

Osteoarthritis • Cause

- Degenerative changes
• Clinical Picture

Osteoarthritis • Treatment

- Assess severity
- Reduce ankle motion (DF, PF, and ML)
- Provide M-L support

Summary

• The foot and ankle complex contains multiple bones and joint articulations
• The summation of motion about all these articulations confers biomechanical stability and flexibility of the anatomical foot
• Pathological conditions of the foot involve anomalies and dysfunction of these anatomical structures and joints
• Each pathology is categorized according to its location - fore-, mid-, hind-foot

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again

Example:

Reload the page to try again!

Reload

Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

NEW! Voice Recording

Create Set