The Foot

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The Foot Ankle
By C. Hauge, ATC
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Anatomy of the Foot Ankle
Tibia The tibia serves as the main weight
bearing bone of the leg. The medial malleolus is
the distal end of the tibia.
Fibula The fibula is long and slender on the
lateral side of the lower leg. The main function
of the fibula is to provide for the attachment of
muscles. The lateral malleolus is the distal end
to the fibula

• Tarsal
• Talus
• Calcaneus
• Navicular
• Cuboid
• 1st, 2nd, and 3rd Cuneiform

Metatarsals The Metatarsals articulate with the
tarsals and the phalanges. Although there is
little movement permitted, the ligamentous
arrangement gives elasticity to the foot while
bearing weight.
Toes The toes are similar to the fingers in
appearance but are much shorter and serve a
different function. The toes are designed to
give a wider base both for balance and for
propelling the body forward. The 1st toe, or
hallux, has two phalanges, and the other toes
each have three phalanges.
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Articulations of the Foot Ankle

• Articulations
• Talarcurl
• Subtalar
• Tibiofibular
• Tarsometatarsal
• Mid-tarsal
• Intermetatarsal
• Metatarsophalangeal
• Interphalangeal

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Function of the Foot Ankle
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Function of the Foot Ankle
Arches The bones of the foot are arranged in
arches to absorb the changing forces and
terrains. The shape of the bones and their
relation to each other maintains arches. 1.
Medial longitudinal arch 2. Lateral longitudinal
arch 3. Transverse arch

• Range of Motion
• Inversion 40 degrees
• Eversion 20 degrees
• Plantarflexion 45 degrees
• Dorsiflexion 20 degrees

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Ankle Ligaments

• Calcaneofibular ligament
• Anterior talofibular ligament
• Posterior talofibular ligament (Lateral)
• Anterior tibiofibular ligament
• Posterior tibiofibular ligament
• Deltoid ligament (Medial)
• Plantar calcaneonavicular (spring ligament)
  ligament (medial foot)

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Muscles of the Foot Ankle

• Muscles
• Gastrocnemius
• Soleus
• Peroneus longus
• Peroneus brevis
• Tibialis posterior
• Flexor hallucis longus
• Flexor digitorum longus
• Tibialis anterior
• Extensor hallucis brevis
• Extensor digitorum longus

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Muscles of the Foot Ankle
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Nerve and Blood Supply

• Posterior Tibial Nerve
• Posterior Tibial Artery
• Dorsal Pedis Artery

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Deformities of the Foot
Cavus (high arch) Excessively high longitudinal
arch may include varus heel, clawing of the toes,
and restricted subtalar motion, all of which may
limit the foots ability to absorb the forces
encountered in activity. Secondary problems
include plantar fasciitis and mortons neuroma.
Pes Planus (flat feet) May result from an
excessively pronated subtarlar joint flattening
the longitudinal arch. The hind-foot may be in
vlagus. The arch can be developed by dynamic
input from the tibialis posterior. A rigid flat
foot may be a fixed deformity and the flattening
is unchangeable by dynamic extrinsic input to the
foot.
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Deformities of the Foot
Mortons Foot Characterized by a short first ray
resulting in abnormal weight bearing mechanics
Claw Toes Characterized by a hyperextension of
the metacarpal pharanageal joint and a
hyperflexion of the interpharanageal joint
Hammer Toes Characterize by hyperextension of
the matacarpal pharanageal joint and a deformity
of the distal interpharangeal joint
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Deformities of the Foot
Hallgus Valgus (Bunion) Widening between the
first and second rays produces a prominence of
the first metatarsal head medially.
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Turf Toe

• History Sprains of the first metatarsophalangeal
  joint of the big toe from kicking the ground or
  hyperflexion/hyperextention
• Observation/Palpation
• Extremely painful
• Difficult w/ walking/pushing off
• Pain
• Eechymosis
• Edema in the joint
• Management
• R.I.C.E.
• Taping
• Flat insoles

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Jones Fracture

• History Fractures may occur to any of the
  metatarsals and can be caused by inversion and
  plantar flexion, direct force, or repetitive
  stress. The most common acute fracture is at the
  base of the fifth metatarsal.
• Observation/Palpation
• Edema
• Pain
• Point-tenderness
• Often no deformity
• Management
• R.I.C.E.
• No weight bearing
• Surgery may be warranted

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Tarsal Tunnel Syndrome

• History An area behind the medial malleolus
  forms a tunnel. Through this tunnel passes the
  tibialis posterior, flexor hallicus longus, and
  flexor digitorum muscles with the tibial nerve
  and artery. Onset may occur with chronic overuse
  or acute trauma.
• Observation/Palpation
• Pain
• Paresthesia
• Decreased strength
• Atrophy may gradually appear
• Management
• R.I.C.E.
• Correct excessive pronation
• Surgery may be warranted

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Plantar Fasciitis

• History Tension develops in the plantar fascia
  both during extension of the toes and during
  depression of the longitudinal arch as the result
  of bearing weight. A number of anatomical and
  biomechanical conditions have been studied as
  possible causes of plantar fasciitis.
• Observation/Palpation
• Pain in the anterior medial heel at the
  attachment of the plantar fascia to the calcaneus
• Increased pain in the morning
• Management
• RICE
• Massage Acute Phase
• Stretching
• Sleeping Sock
• Sleeping Boot

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Heel Spur

• History Prolonged inflammatory conditions of the
  plantar aponeurosis secondary to pes
  planus can lead to the formation of an exotosis
  at the attachment site on the calcaneus.
• Observation/Palpation
• Gradual onset
• Pain
• Point-tenderness
• Management
• R.I.C.E.
• Doughnut pad
• Surgical removal

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Inversion (lateral) Ankle Sprain

• History The inversion sprain commonly occurs
  with the foot in inversion, plantar flexion,
  dorsiflexion, or a combination of both.
• Observation/Palpation
• Edema
• Ecchymosis
• Point-tenderness ATFL, PTFL, CFL
• Difficulty weight bearing
• Decreased strength and range of motion
• Special Tests
• Anterior Drawer Test
• Management
• X-ray for 2nd and 3rd degree sprains
• R.I.C.E.
• Horseshoe pad to control edema
• Wear ankle support following return to activity

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Eversion Ankle Sprains

• History The eversion sprain commonly occurs with
  the foot in eversion, dorsiflexion, plantar
  flexion, or a combination of both.
• Observation/Palpation
• Pain
• Edema
• Point-tenderness deltoid ligament
• Difficulty weight bearing
• Decreased strength and range of motion
• Special Tests
• Bump Test
• Percussion Test
• Management
• X-ray to rule out tibial fracture
• R.I.C.E.
• Limit weight bearing
• Horseshoe pad to control edema

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Syndesmotic high ankle Sprains

• History High ankle sprains usually occur with a
  fixed tibia and internal or external rotation.
• Observation/Palpation
• Pain when the ankle is passively externally
  rotated or dorsiflexed
• Decreased strength
• Point-tenderness distally between the tibia and
  fibula
• Management
• R.I.C.E.
• Walking boot

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Peroneal Tendon Subluxation/Dislocation

• History Occurs from a dynamic force usually from
  sharp cutting or a direct blow
• Observation/Palpation
• Audible sound
• Snapping feeling
• Point-tenderness
• Management
• Ice
• Stretching
• Arch taping
• Surgery

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Tibial Stress Syndrome

• History Tibial Stress Syndrome is often
  referred to as shinsplints. Factors that can
  contribute to shinsplints include weakness of leg
  muscles, shoes that provide little support or
  cushioning, biomechanical flaws, and
  over-training.
• Observation/Palpation
• Point-tenderness
• Pain
• No Edema
• Management
• X-rays
• R.I.C.E.
• Tape
• Address biomechanical flaws

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Shin Contusion

• History The tibia, lying just under the skin, is
  exceedingly vulnerable and sensitive to blows or
  bumps. Because of the absence of muscular or
  adipose padding, the periosteum receives the full
  force of any impact delivered to the shin.
• Observation/Palpation
• Pain
• Hematoma, jellylike consistency
• Possible compartment syndrome
• Possible tibia fracture
• Management
• R.I.C.E.
• Range of motion exercises
• Doughnut padding to protect against contact

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Gastrocnemius Strains

• History The medial head of the gastrocnemius is
  particularly susceptible to muscles strains near
  its musculotendinous attachment.
• Observation/Palpation
• Pain
• Edema
• Decreased strength and range and motion
• Management
• R.I.C.E.
• Light stretching
• Heel wedge
• Range of motion exercises

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Achilles Rupture

• History Occurs when athletes have a history of
  chronic inflammation and gradual degeneration.
  Most common in athletes who are thirty years of
  age or older.
• Observation/Palpation
• Audible sound (snap or pop)
• Deformity
• Immediate pain that rapidly subsides
• Point-tenderness
• Special Test
• 1. Thompson Test
• Management
• R.I.C.E.
• Surgical repair
• Walking boot

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Ankle Dislocation

• History Excessive force to the ankle usually due
  to a direct blow
• Observation/Palpation
• Extreme pain
• Deformity
• Edema
• Extreme guarding
• Management
• Medical Emergency (911)
• Ice
• Immobilization
• Check innervations and circulation

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