THE FOOT
Chapter 18
Introduction
The traditional sports activities in which
athletes compete at the high school, college
and professional level all involve some
elements of running, jumping and changing
directions. The function of the foot is
critical. One instant the foot must be a
mobile adapter to absorb shock, and the
next minute it must become a rigid lever to
propel the body forward. Injury is common.
Foot Anatomy
• Bones
– Phalanges, metatarsls, Tarsal Bones (Calcaneus,
talus, navicular, cuboid, 3 cuneiform)
• Articulations
• Stabilizing Ligaments
Foot Anatomy
• Nerve Supply and Blood Supply
– Nerve: tibial (back of leg/ plantar surface of foot) *
common peroneal (front of leg & dorsal foot)
– Blood: anterior and posterior tibial arteries
• Arches
– Longitudinal (medial and lateral)
– Anterior metatarsal (runs across distal metatarsal heads;
runs medially to laterally)
– Transverse metatarsal (across tarsal bones; medially to
laterally)
• Plantar Fascia (medial calcaneus to proximal
metatarsal heads)
Muscles and Movements
• Dorsiflexion: tibialis anterior, EDL, EHL,
Peroneus Teritus
• Plantar flexion: Gastrocnemius, soleus, planatris,
peroneus longus and brevis, posterior tibialis, etc
• Inversion, Adduction, Supination: tibialis
posteriror, FDL, FHL, EHL, tibialis anteior
• Eversion, Abduction, Pronation: peronus longus
and brevis, peroneus tertius, EDL
• Movement of phalanges: FDL, Quadratus plantar,
lumbrical, interossei, EDL, EHL, EDB, etc
Foot Biomechanics
• Normal Gait Patterns
• Pronation and Supination
– Excessive Pronation (internal rotation of the leg);
hypermobility at the joint
– Excessive Supination (external rotation of the leg)
• Other Structural Deformities
Prevention of Foot Problems
• Shoes & Socks
– Construction
•
•
•
•
Last: basic form shoe built on
Upper: portion controling foot
Midsole: affects stbaility
Heel counter: control rearfoot motion
– Selection
• For pronated foot: less flexible; good rearfoot control; straightlasted (forefoot does not curve)
• Proper Foot Care & Hygiene
– Toenails trimmed, shaving calluses, keeping dry,
wearing proper devices
Foot Orthotics and Devices
• Forefoot varus (excessive pronation)
– Rigid type and medial wedge under head of 1dt
metatarsal
• Forefoot Valgus (excessive supination)
– Semirigid and lateral wedge under 5th metatarsal
• Rearfoot Varus
– Semirigid and have wedge under medial calcaneus and
small wedge under 1st metatarsal
Assessing Foot Conditions
• History
• Observation
• Palpation
• Special Tests
Recognition & Management
Specific Injuries & Conditions
• Injuries to the Tarsal Region
–
–
–
–
–
–
–
Talar Fracture
Calcaneous Fracture / stress fracture
Sever’s Disease
Retrocalcaneal Bursitis
Heel Contusion
Cuboid Subluxation
Tarsal Tunnel Syndrome
Recognition & Management
Specific Injuries & Conditions
• Metatarsal Region
– Flat foot (aka?)
– High Arch (aka?)
– Longitudinal Arch Strain
(lateral )
– Plantar Fascitis (braces
arch)
– Jones Fracture (base of 5th)
– Metatarsal stress fracture
• Most common : 2nd –
March Fx
– Bunion (hallux valgus; 1st
met.)
– Sesamoditis
– Metatarsalgia (2nd, 3rd
met head)
– Metatarsal arch strain
– Morton’s Neuroma (b/t
3rd & 4th )
–
Recognition & Management
Specific Injuries & Conditions
• Toes
– Sprain
– Turf Toe
• Hyperextension injury to great toe
–
–
–
–
–
Fracture / dislocations (usually dorsal)
Morton’s toe (short 1st met, WB on 2nd met)
Hallux Rigidus (DJD, bony spurs dorsal aspect of 1st met)
Hammer/Claw toes
Overlapping toes
Foot Rehabilitation
• General body conditioning
• Weight Bearing (pay attention to kinetic chain)
• Joint Mobilization maintain/normalize joint
motion)
• Flexibility (especially as impact the phalanges)
• Neuromuscular (strength & kinetic chain)
• Foot Orthotics
• Prevention from Reinjury
Summary
• The function of the foot is critical to athletic
performance.
• Evaluation and recognition of injuries and
conditions can present a challenge to the
athletic trainer.
• Many chronic conditions of the lower
extremity can be related to foot mechanics.
• Management, rehabilitation, and prevention
of foot conditions is essential.