Lower Body Evaluation ATC 328

1. Lower Body EvaluationATC 328 The Foot and Toes Chapter 4

2. Foot and Toe Anatomy • 26 bones • Plus sesamoids • Rearfoot • Midfoot • Forefoot

3. Rearfoot Anatomy • Calcaneus • Sustentaculum tali • Peroneal tubercle • Talus

4. Midfoot • Navicular • Posterior tibialis • Cuneiforms • Cuboid

5. Forefoot Anatomy • 5 metatarsals • MP or MCP • 14 phalanges • PIP • DIP • IP

7. Articulations

8. Arches • Medial longitudinal arch • Lateral longitudinal arch • Rarely injured • Transverse metatarsal arch • 1st and 5th metatarsal weight bearing

9. Medial Longitudinal Arch • Calcaneus, talus, navicular, first cuneiform, first metatarsal • Supporting structures • Plantar fascia • Plantar calcaneonavicular ligament “spring ligament” • Deltoid ligament • Long plantar ligament

10. Muscular Anatomy • Intrinsic Muscles • Extensor digitorum brevis • Who cares!!! • Extrinsic Muscles • Flexor digitorum longus • Flexor hallucis longus • Gastrocnemius/soleus complex • Peroneals • Plantaris • Tibialis posterior/anterior • Extensor digitorum longus • Extensor hallucis longus

11. Evaluation • History • Blah, blah, blah • Observation • Edema, effusion, deformity, etc • Palpation • Special Tests • ROM • MMT • Stability • Etc.

13. Toe Injuries • MP, DIP, PIP, IP sprains • 1st MP joint sprain (turf toe) • Hyperextension mechanism • Rule out fx • Valgus, varus, glide testing • Treatment options

14. Metatarsal Sprains • Intermetatarsal glides • Tarsometatarsal glides • Midtarsal glides ???

15. Pes Planus vs. Pes Cavus • Most often are congenital abnormalities • Other causes • Ligaments • Muscles • Accessory navicular • Tarsal coalition • Plantar fascia • Navicular drop test • Complications associated with these arch types?

16. Transverse Metatarsal Arch • Most common problem is a loss of this arch. • Consequences of fall TMA

17. Plantar Fasciitis • Causes • Acute and chronic • Signs and symptoms • Pain at medial calcaneal tubercle • AM pain • Decreased ROM/MMT • Treatment • Rupture • Acute and steroids

18. Heel Spurs • Related to Plantar Fasciitis? • Primary complaint • Pain with heel strike • Treatment • Similar to plantar fasciitis • Surgery with chronic cases

19. Tarsal Coalition • Bony, fibrous, or cartilaginous union of tarsal bones • Most often affects talus, calcaneus, and/or navicular • S/S • Rigid flatfoot • Calcaneal valgus • Forefoot abduction • NWB and WB identical • Treatment

20. Tarsal Coalition

21. Tarsal Tunnel Syndrome • Compression of posterior tibial nerve

22. Tarsal Tunnel Syndrome • Causes • Acute: inversion or eversion • Chronic: structural and biomechanical abnormalities • S/S • Plantar/medial foot pain • Positive Tinel sign • Treatment

23. Metatarsal Fractures • Stress fractures • Morton’s toe • Acute fractures • Avulsion of base of 5th • Jones’ fracture

25. Phalangeal Fracture • S/S • Pain • Swelling • Positive compression/percussion • Crepitus • Treatment • Buddy taping • Stiff insert • Relief pad/bar

27. Intermetatarsal Neuroma • 3 interdigital nerve most common • Morton’s Neuroma • Fibrous formation and demyelenization • Causes • Thickened/shortened transverse ligament • Fallen transverse arch • Excessive forefoot weight bearing • Excessive pronation • Shoes?

28. Interdigital Neuroma • S/S • Pain and paresthesia • Nodule • Pain with compression • Decreased pain barefoot • Pencil eraser “test” • Treatment