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Kin 337 The Foot and Toes

Terms in this set (48)

Foot Bones
26 bones
-7 tarsal
-5 metatarsals
-14 phalanges
Arches of the Foot
Metatarsal and Transverse Arch (plantar view)
Medial Longitudinal Arch (medial view)
Lateral Longitudinal Arch (lateral view)
Prime Movers
Plantar Flexors
-Gastrocnemius (Tibial N.)
-Soleus (Tibial N.)

Dorsiflexors
-Tibialis anterior (Deep Peroneal N.)
-Extensor digitorum longus (Deep Peroneal N.)
-Peroneus tertius (Deep Peroneal N.)

Inversion
-Tibialis anterior (Deep Peroneal N.)
-Tibialis posterior (Tibial N.)

Eversion
-Peroneal group (Superficial Peroneal N., excet tertius)
Prevention of Foot Injuries
-Appropriate footwear
-Correcting bio-mechanical structural deficiencies through orthotics
-adaptation to training surfaces
Foot Assessment
*Athletes should be referred to qualified personnel for injury eval.
-HOPS
HOPS (Foot Assessment)
History
-location, any surface changes, training changes, footwear (how it feels)

Observations
-Does athlete favor a foot, limp or unable to bear weight?
-Color change w/ weight bearing
-pes planus/cavus
-alignment
-structural deformities
-wear pattern of sole of shoe (symmetrical)

Palpation
-Assess bony anatomy first
-deformities/ tenderness
-Assessment soft tissue (muscles and tendons)
-tenderness, swelling, muscle spasm or muscle guarding
-Circulation (dorsal pedal pulse)
-located on anterior surface of ankle and foot
Retrocalcaneal Bursitis (Pump Bump)
Cause of Injury
-inflammation of bursa beneath Achilles tendon
-result o pressure and rubbing of shoe heel counter of a shoe
-chronic condition
-develops over time
-exostosis may develop (Pump Bump)
-Differentiate From Sever's Disease
Retrocalcaneal Bursitis (Pump Bump)
Sign and Symptoms
-inflammation
-tender, palpable bump or calcaneous
-pain w/ palpation superior and anterior t Achilles insertion, swelling on both sides of the heel cord
Retrocalcaneal Bursitis (Pump Bump)
Care
-routine stretching of Achilles, heel lifts, doughnut pad
-different footwear that increases or decreases height of heel counter
Heel Bruise
Cause of Injury
-sudden starts, stops or changes of direction, irritation of fat pad
ex: Jumping
Heel Bruise
Signs
-severe pain in heel and is unable to withstand stress of weight bearing
-may progress to chronic inflammation of bone covering
Heel Bruise
Care
-Reduce weight bearing for 24 hours
-RICE
-NSAID's
-Heel cup or doughnut pad after pain has subsided (shock absorbent shoes)
Plantar Fasciitis
Cause of Condition
-increased stress on fascia
-change in footwear (rigid support to flexible)
-poor running technique
-change in running surface
-leg length discrepancy, excessive pronation, inflexible longitudinal arch, tight gastroc-soleus complex
Plantar Fasciitis
Sign and Symptoms
-pain in anterior medial heel, along medial longitudianl arch
-increased pain in morning, loosens afer first few steps, pain w/ forefoot dorsiflexing
Plantar Fasciitis
Care
-Extended treatment 8-12 weks
-Orthotic therapy
-Simple arch taping, night splint to stretch
-Vigorous heel cord stretching
-exercises that increase great toe dorsiflexion
-NSAID's and occasionally steroidal injection
Metatarsal Arch Strain
Cause of Injury
-Hypermobility of metatarsals
-laxity in ligaments (excessive splay of foot)
-appear of fallen arch
Metatarsal Arch Strain
Signs of Injury
-pain or cramping in metatarsal region
-point tenderness (metatarsalgia)
-weakness
-heavy callus may form in area of pain
Metatarsal Arch Strain
Care
-pad to elevate metatarsals just behind ball of foot
-strengthening of foot muscles
-heel cord stretching
Fractures and Dislocations of Phalanges
Cause of Injury
-kicking un-yielding object
-stubbing toe
-being stepped on
Fractures and Dislocations of Phalanges
Signs of Injury
-Immediate and intense pain
-swelling and discoloration
-obvious deformity with dislocation
Fractures and Dislocations of Phalanges
Care
*Dislocation should be reduced by a physician
-casting may occur w/ great toe or stiff soled shoe
-Buddy taping
-Larger toe box shoe
Bunion (Hallux Valgus Deformity)
Cause of Injury
-Bursa becomes inflamed and thickens
-enlarging joint; causing lateral malalignment f great toe
Bunion (Hallux Valgus Deformity)
Sign of Injury
-tenderness
-swelling
-enlargement of join initially
-painful ambulation
Bunion (Hallux Valgus Deformity)
Care
-Wear correct fitting shoes
-appropriate orthotics
*surgery may be required during later stages of condition
Jones Fracture
Cause of Injury
-Fracture of metatarsal caused by inversion or high velocity rotational forces
-Most common = base of 5th metatarsal
Jones Fracture
Sign of Injury
-Immediate swelling, pain over 5th metatarsal
-May feel a "pop"
-High nonunion rate and course of healing is unpredictable
Jones Fracture
Care
-Generally requires 6-8 weeks non-weight bearing w/ short leg cast if non-displaced
-if nonunion occurs, internal fixation may be required
Metatarsal Stress Fractures
Cause of Injury
-2nd metatarsal fracture (March fracture)
-Change in running pattern, mileage, hills, or hard surfaces
-Often the result of structural deformities of the foot or training errors (terrain, footwear, surfaces)
-Often associated with Morton's toe
Metatarsal Stress Fractures
Sings of Injury
-Pain and tenderness along second metatarsal
-Pain with running and walking
-Continued pain/aching when non-weight bearing
Metatarsal Stress Fractures
Care
-Determine cause of injury
-Generally good success with modified rest and training modifications (pool running, stationary bike) for 2-4 weeks
-Return to running should be gradual over a 2-3 week period with appropriate shoes
Morton's Neuroma
Cause of Condition
-Thickening of nerve sheath (common plantar nerve)
Morton's Neuroma
Signs of Condition
-Burning paresthesia and severe intermittent pain in forefoot
-Pain relieved with non-weight bearing
-Toe hyperextension increases symptoms
Morton's Neuroma
Care
-Metatarsal bar placed just proximal t the metatarsal heads
-Teardrop-shaped pad placed between the heads of the third and fourth metatarsals (releave weigh bearing)
-Appropriate shoes
Turf Toe
Cause of Injury
-Hyperextension injury
-May be the result of single or repetitive trauma
Turf Toe
Sings and Symptoms
Pain and swelling which increases during push off in walking, running, and jumping
Turf Toe
Care
-Increase rigidity of forefoot region in shoe
-Taping the toe
-Rest and discourage activity until pain free
-3-4 weeks may be required for pain to subside
Calluses
Cause of Condition
-Develop from friction
-Painful as fatty layer loses elasticity and cushioning effect
-Vulnerable to tears and cracks and possible blister development underneath
Calluses
Care
-Emery callus file may be necessary
-Sanding or pumicing - care must be exercised
-Can be prevented
-Shoes that fit appropriately are
recommended
-Wear at least one layer of socks
-Apply petroleum jelly to reduce friction
Blisters
Cause of Injury
-Shearing forces on skin
-Wearing appropriate footwear
Blisters
Care
-Take action to reduce friction
-Avoid puncturing in order to prevent infection
Corns
Cause of Condition
-Result of pressure from improperly fitting shoes
-Hard corns are often associated with hammer toes
-Soft corns result from wearing narrow shoes and excessive foot perspiration
Corns
Signs of Condition
-Form between 4th and 5th toes
-Circular area of thickened, white macerated skin
Corns
Care
-For soft corns - good fitting shoes are necessary in conjunction with good foot hygiene
-Use of padding or cotton to separate toes is helpful
-Soaking in warm soapy water will also aid in softening of corns
Ingrown Toenails
Cause of Condition
-Leading edge of nail grows into nearby soft tissue
Ingrown Toenails
Care
-Shoes should be appropriate width and length
-Prevent with correct trimming of nails
-Treatment may require soaking and packing toenail
-Cutting a "V" notch toward the infected side will allow the nail to grow towards the middle
Subungual Hematoma
Cause of Injury
-Direct pressure, dropping an object on toe, kicking another object
-Repetitive shear forces on toenail
Subungual Hematoma
Signs of Injury
-Accumulation of blood underneath toenail
-Likely to produce extreme pain and ultimately loss of nail
Subungual Hematoma
Care
-RICE immediately to reduce pain and swelling
-Relieve pressure within 12-24 hours (lance or drill nail) - must be sterile to prevent infection
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