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Evaluation-The Foot and Toes. Ms. Bowman. Anatomy Review-Bones. 26 bones Phalanges-toes; proximal, middle, and distal Metatarsals-5; between phalanges and tarsals Tarsals-calcaneus, talus, navicular , cuboid, 3 cuneiforms Divided into 3 sections

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Evaluation-The Foot and Toes

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anatomy review bones
Anatomy Review-Bones
  • 26 bones
  • Phalanges-toes; proximal, middle, and distal
  • Metatarsals-5; between phalanges and tarsals
  • Tarsals-calcaneus, talus, navicular, cuboid, 3 cuneiforms
  • Divided into 3 sections
    • Rearfoot-formed by the calcaneus and talus; provides stability and shock absorption during the initial stance phase of gait and serves as a lever arm for the Achilles tendon during plantarflexion
    • Midfoot-composed of the navicular, three cuneiforms, and cuboid; shock absorbing section of the foot
    • Forefoot and toes-formed by the 5 metatarsals and 14 phalanges; act as a lever during the preswing phase of gait
anatomy review articulations and ligaments
Anatomy Review-Articulations and Ligaments
  • Subtalar Joint-articulation of the calcaneus and talus
  • Midfoot-
    • midtarsal joint formed by the articulations of the tarsal bones
    • Plantar calcaneonavicular ligament (spring liegament)
  • Forefoot-
    • Tarsometatarsal joints-junction between the midfoot and forefoot
    • Intermetatarsal joints-proximal and distal joints
    • Metatarsophalangeal joints
    • Interphalangeal joints
  • Medial Ligaments
    • Deltoid ligament-composed of 4 ligaments
      • Posterior tibiotalar ligament
      • Tibiocalcaneal ligament
      • Anterior tibiotalar ligament
      • Tibionavicular ligament
  • Lateral Ligaments
    • Anterior talofibular ligament
    • Calcaneofibularligament
    • Posterior talofibular ligament
anatomy review muscles
Anatomy Review-Muscles
  • There are many muscles that act on the foot.
  • Those that originate and insert in the foot are called intrinsic foot muscles. These directly influence the foot and toes.
  • Those that originate in the lower leg are called extrinsic foot muscles. These influence motion at the ankle and knee as well as the foot and toes.
  • If the muscle name begins with extensor, then the muscle’s primary function is extension.
  • If the muscle name begins with flexor, then the muscle’s primary function is flexion.
  • Location of p!-trauma to intrinsic structures or secondary to compensation for improper lower leg biomechanics
    • Metatarsal p!-p! that worsens over time can indicate stress fx; p! between the MTs possibly a result of nerve impingement
    • Great toe p!-localized p! to plantar surface can be indicative of sesamoidfx; p! with flexion or extension can be an indicator for turf toe
  • Onset and Mechanism of injury
    • Acute onset- can occur from trauma (fx, ligament sprain, muscle strain)
    • Insidious onset-result of overuse injuries; may be the result of playing surface, distance and duration of exercise, shoes
  • Analyze gait
  • Look for
    • Gross deformity
    • Edema
    • Redness
    • Calluses and blisters (indicates improperly fitting shoes, poor mechanics, or underlying bony or soft tissue dysfunction)
  • Observe
    • Alignment of the toes
    • Toenail integrity (ingrown toenails, subungual hematoma)
    • Arches
    • Achilles
    • Calcaneus
    • Plantar surface of the foot
  • When palpating, check for deformity, alignment, edema, crepitus, and pain
  • Medial Structures
    • 1st Phalange, 1st MT, 1st Cuneiform, Navicular, Talar head Spring Ligament, Calcaneus
  • Lateral Structures
    • 5th phalange, 5th MT, Cuboid, Peroneal tubercle, Calcaneus
  • Dorsal Structures
    • Rays, Cuneiforms, Navicular, Dome of Talus, Musculature
  • Plantar Structures
    • Plantar fascia, MT heads, sesamoid bones of great toe
rom testing
ROM Testing
  • ROM should be measured with a goniometer
  • AROM, PROM, and RROM should be assessed as necessary
  • Goniometry measurements
    • Fulcrum-placed over joint
    • Stationary arm-placed over the proximal (non-moving part of body)
    • Movement arm-placed over the distal (moving part of body)
ligamentous testing
Ligamentous Testing
  • Valgus and Varus stress tests should be used to test the integrity of the MTP and IP joints
  • Metatarsal gilde test can be used to tests for the integrity of the ligaments connecting the MT
  • Midtarsal joint glide test can be used to test the integrity of the intertarsal ligaments
neurological assessment
Neurological Assessment
  • Foot and toes are supplied by L4 and S2 nerve roots
  • Can be assessed by doing a lower quarter screen
special tests
Special Tests
  • Navicular drop test
  • Tinel’s sign
  • Long bone compression test
  • Pencil test