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foot toe evaluation

Foot Anatomy. 26 BonesRearfoot

daniel_millan
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foot toe evaluation

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    1. Foot & Toe Evaluation

    2. Foot Anatomy 26 Bones Rearfoot Calcaneus, Talus Midfoot 3 Cuneiforms, Cuboid, Navicular Forefoot 5 Metatarsals, 14 Phalanges, 2 Sesamoids

    3. Ankle mortise tibia, fibula, talus Reference: Starkey, C. (2002). Evaluation of Orthopedic & Athletic Injuries, p. 89.

    4. Rearfoot Provides stability & shock absorption during initial stance phase Lever arm for Achilles tendon during plantarflexion Talus no muscles attach to it Calcaneus - Calcaneal tubercle posterior side - Sustentaculum tali medial side - helps support the talus flexor hallicus longus - passes through the medial groove - Peroneal tubercle lateral side Subtalar joint inferior talus/superior calcaneus

    5. Rearfoot Reference: Primal Pictures, 2001

    6. Midfoot Shock absorber Medial longitudinal arch Navicular tuberosity Tibialis posterior insertion

    7. Forefoot Lever during pre-swing phase Metatarsals proximal base, body, distal head Phalanges MTP, PIP, DIP, IP joints Plantar fascia

    8. Forefoot

    9. Metatarsophalangeal Joints Classified as condyloid-type joints Great toe metatarsophalangeal (MP) joint flexes 45 & extends 70 MP joints of the four lesser toes 40 of flexion 40 of extension also abduct & adduct minimally

    10. Joints Great toe interphalangeal (IP) joint flexes from 0 of full extension to 90 of flexion Proximal interphalangeal (PIP) joints in lesser toes flexes from 0 extension to 35 flexion Distal interphalangeal (DIP) joints flexes 60 & extend 30 Much variation from joint to joint & from person to person

    11. Terminology Intrinsic muscles m. contained within the foot Extrinsic muscles m. originating from lower leg or femur Supination inversion + adduction + plantarflexion Pronation - eversion + abduction + dorsiflexion Inversion movement of the plantar aspect of the calcaneus toward the midline of the body Eversion movement of the plantar aspect of the calcaneus away from the body Dorsiflexion flexion of the ankle, pulling the foot & toes toward the tibia Plantarflexion extension of the ankle, pointing the foot & toes Ray series of bones formed by the MT & phalanges

    12. Movements of Foot Pronation combination of ankle dorsiflexion, subtalar eversion, & forefoot abduction (toe-out) Supination combination of ankle plantar flexion, subtalar inversion, & forefoot adduction (toe-in) Eversion turning ankle & foot outward; abduction, away from midline; weight is on medial edge of foot Inversion turning ankle & foot inward; adduction, toward midline; weight is on lateral edge of foot

    13. Movements of Toes Toe flexion movement of toes toward plantar surface of foot Toe extension movement of toes away from plantar surface of foot

    14. Intrinsic Muscles of the Foot All originate & insert within the foot Extensor digitorum brevis - dorsum of foot Remainder are in a plantar compartment in 4 layers on plantar surface of foot

    15. Intrinsic Muscles of the Foot First (superficial) layer: Abductor hallucis, flexor digitorum brevis, abductor digiti minimi (quinti) Second (middle) layer: Quadratus plantae, lumbricales (4)

    16. Intrinsic Muscles of the Foot Third (deep) layer: Flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis Fourth (deep) layer: Dorsal interossei (4), plantar interossei (3)

    17. Intrinsic Muscles of the Foot Grouped by location Medial - attach to great toe proximal phalanx Abductor hallucis & flexor hallucis brevis - medially Adductor hallucis - centrally beneath metatarsals Central location Beneath the foot Quadratus plantae, 4 lumbricales, 4 dorsal interossei, 3 plantar interossei, flexor digitorum brevis Dorsal compartment Extensor digitorum brevis Lateral attach on lateral aspect of base of 5th phalange proximal phalanx abductor digiti minimi, flexor digiti minimi brevis

    18. Intrinsic Muscles of the Foot Grouped by action 4 muscles act on great toe abductor hallucis - abduction of great toe & assists flexor hallucis brevis in flexing great toe at MP joint adductor hallucis - adduction of great toe extensor digitorum brevis - extension of great toe at MP joint 4 lumbricales flexors of the 2nd, 3rd, 4th, & 5th phalanges at MP joints quadratus plantae flexors of 2nd, 3rd, 4th, & 5th phalanges at DIP joints 3 plantar interossei adductors & flexors of proximal phalanxes of 3rd, 4th, & 5th phalanges 4 dorsal interossei abductors & flexors of 2nd, 3rd, & 4th phalanges MP joints flexor digitorum brevis flexes middle phalanxes of 2nd, 3rd, 4th, & 5th phalanges extensor digitorum brevis extends great toe & 2nd, 3rd, 4th phalanges at MP joints 5th toe muscles abductor digiti minimi abducts proximal phalanx flexor digiti minimi brevis flexes proximal phalanx

    19. Lateral Foot & Ankle

    20. Medial Foot & Ankle

    21. Extrinsic Muscles of the Foot Extensor hallucis longus (EHL) Extensor digitorum longus (EDL) Flexor hallucis longus (FHL) Flexor digitorum longus (FDL) Triceps Surae (Gastrocnemius, Soleus, Plantaris) Peroneus longus, brevis, tertius Tibialis anterior Tibialis posterior Starkey, Ch. 4, Table 4-2, p. 92-95

    22. Neurovascular Nerves Tibial n. medial side Lateral & Medial Cutaneous branch (comes from Peroneal n.) lateral side Vascular Tibial a. Dorsalis Pedis pulse

    23. Lateral Cutaneous Distribution Peach Sural N. Purple Lat. Plantar N. Yellow Superficial Peroneal N.

    24. Medial Cutaneous Distribution Light Green Saphenous N. Yellow Superficial Peroneal N. Dark Pink Tibial N. (Medial Calcaneal branches) Dark Green Medial Plantar N.

    25. Dermatome Distribution Green L4 Pink L5 Salmon S1

    26. Arches Ligaments in foot & ankle maintain arches Two longitudinal arches Medial longitudinal arch - extends from calcaneus bone to talus, navicular, 3 cuneiforms, and proximal ends of 3 medial metatarsals Lateral longitudinal arch - extends from calcaneus to cuboid and proximal ends of 4th & 5th metatarsals Transverse arch extends across foot from 1st metatarsal to the 5th metatarsal

    27. Evaluation of the Foot History What happened? (MOI) Where is the pain? When did it happen? (onset) Has it happened before? What does it feel like? Pain scale (1-10) What type of surface? How old are the shoes? Type of pain Unusual noises/sensations Observation Toes, Arches Forefoot & Rearfoot Valgus/Varus, Pronation/Supination Calluses, blisters, warts, etc. Appearance Bilateral comparison Color Deformity Edema, Swelling Gait Infection Weight bearing vs. non-weight bearing Shoe wear pattern

    28. Evaluation of the Foot Palpation Start away from the point of pain Palpate bony & soft tissue structures Medial structures Lateral structures Dorsal structures Plantar structures Crepitus Heat Swelling Rigidity Deformities Softness Stress Tests ROM tests (AROM, PROM, RROM-strength) Alignment Ligament & Capsular tests Fracture tests Neurological tests Other special tests

    29. Assessment & Plan What injury have you evaluated? What are you going to do with this injury?

    30. Common Injuries Retrocalcaneal bursitis Heel contusion Arch strains Plantar fasciitis Fractures Bunion Know the signs & symptoms of these injuries Sesamoiditis Mortons neuroma Sprained toes Turf toe Fractures & dislocations

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