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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


- 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
- 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
- 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
- High-top shoe

Osteoarthritis • Cause

- Degenerative changes
• Clinical Picture

Osteoarthritis • Treatment

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


• 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

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