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Arch - ball of the foot
transverse arch
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Inside longitudinal arch
medial longitudinal arch
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Outside longitudinal arch
lateral longitudinal arch
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Prevention of Foot Injuries
- appropriate footwear
- correcting biomechanical structural deficiencies through orthotics
- paying attention to hygiene
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Selecting Appropriate Footwear
For pronators a rigid shoe is recommended while supinators require more flexible footwear with increased cushioning
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Checking foot pulses
- –Can be assessed at posterior tibial and dorsalis pedis arteries
- –Dorsalis pedis pulse felt between extensor digitorum and hallucis longus tendons
- –Posterior tibial located behind medial malleolus along Achilles tendon
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Apophysitis of the Calcaneus (Sever’s Disease)
- Etiology - Traction injury at apophysis of calcaneus, where Achilles attaches
- Signs -
- •Pain occurs at posterior heel below Achilles attachment in children and adolescent athletes
- •Pain occurs during vigorous activity and ceases following activity
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Tarsal Tunnel Syndrome
- Area behind medial malleolus forming tunnel with osseous floor and roof composed of flexor retinaculum.
- –Etiology
- •Any condition that compromises tibialis posterior, flexor hallucis longus, flexor digitorum, tibial nerve, artery or vein
- •May result from previous fracture, tenosynovitis, acute trauma or excessive pronation
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Tarsometatarsal Fracture Dislocation (Lisfranc Injury)
- –Etiology
- •Occurs when foot hyperplantarflexed with foot already plantaflexed and rearfoot locked resulting in dorsal displacement of metatarsal bases
- –Sign and Symptoms
- •Pain and inability to bear weight, swelling and tenderness localized on dorsum of foot
- •Possible metatarsal fractures, sprains of 4th and 5th tarsometatarsal joints, may cause severe disruption of ligaments
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Pes Planus Foot (Flatfoot)
- –Etiology
- •Associated with excessive pronation, forefoot varus, wearing tight shoes (weakening supportive structures) being overweight, excessive exercise placing undo stress on arch
- –Sign and Symptoms
- •Pain, weakness or fatigue in medial longitudinal arch; calcaneal eversion, bulging navicular, flattening of medial longitudinal arch and dorsiflexion with lateral splaying of 1st metatarsal
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Pes Cavus (High Arch Foot)
- –Etiology
- Higher arch than normal; associated with excessive supination, accentuated high medial longitudinal arch
- –Sign and Symptoms
- •Poor shock absorption resulting in metatarsalgia, foot pain, clawed or hammer toes
- •Associated with forefoot valgus, shortening of Achilles and plantar fascia; heavy callus
- development on ball and heel of foot
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Morton’s Toe
- –Etiology
- •Abnormally short 1st metatarsal, making 2nd toe look longer
- •More weight bearing occurs on 2nd toe as a result and can impact gait
- •Stress fracture could develop
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*Plantar Fasciitis
–Catch all term used for pain in proximal arch and heel
- –Plantar fascia, dense, broad band of connective tissue attaching proximal and medially on the calcaneus and fans out over the plantar aspect of the foot
- –Works in maintaining stability of the foot and bracing the longitudinal arch
- –Etiology
- •Increased tension and stress on fascia (particularly during push off of running phase)
- •Change from rigid supportive footwear to flexible footwear
- •Poor running technique
- •Leg length discrepancy, excessive pronation, inflexible longitudinal arch, tight gastroc-soleus complex
- •Running on soft surfaces, shoes with poor support
- --Sign and Symptoms
- –Pain in anterior medial heel, along medial longitudinal arch
- –Increased pain in morning, loosens after first few steps
- –Increased pain with forefoot dorsiflexion
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Jones Fracture
similar symptoms to lateral ankle sprain
- –Etiology
- •Fracture of metatarsal caused by inversion and plantar flexion, direct force (stepped on) or repetitive trauma
- •Most common = base of 5th metatarsal
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Metatarsal Stress Fractures
- –Etiology
- •2nd metatarsal fracture (March fracture)
- •Change in running pattern, mileage, hills, or hard surfaces
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Bunion (Hallux Valgus Deformity)
- –Etiology
- •Exostosis of 1st metatarsal head; associated with forefoot varus; shoes that are too narrow, pointed or short
- •Bursa becomes inflamed and thickens, enlarging joint, and causing lateral malalignment of great toe
- •Bunionette (Tailor’s bunion) impacts 5th metatarsophalangeal joint - causes medial displacement of 5th toe
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Sesamoiditis
- –Etiology
- •Caused by repetitive hyperextension of the great toe resulting in inflammation
- –Sign and Symptoms
- •Pain under great toe, especially during push off
- •Palpable tenderness under first metatarsal head
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Metatarsalgia
- –Etiology
- •Pain in ball of foot (2nd and 3rd metatarsal heads)
- •Restricted extensibility of gastroc-soleus complex
- •Typically emphasizes toe off phase during gait
- •Fallen metatarsal arch
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Great Toe Hyperextension (Turf Toe)
- –Etiology
- •Hyperextension injury resulting in sprain of 1st metatarsophalangeal joint
- May bethe result of single or repetitive trauma
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Ankle
Lateral ligaments (outside)
deltoid ligaments (inside)
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*Preventing Injury in the
Lower Leg and Ankle
- Achilles Tendon Stretching
- Strength Training
- Neuromuscular Control Training
- Footwear
- Preventive Taping and Orthoses
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Ankle Injuries: Sprains
–Single most common injury in the physically active caused by sudden inversion or eversion moments
- Inversion Sprains
- –Most common and result in injury to the lateral ligaments
- Eversion Ankle Sprains
- - Represent 5-10% of all ankle sprains
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Syndesmotic Sprain
- –Etiology
- •Injury to the distal tibiofemoral joint (anterior/posterior tibiofibular ligament)
- •Torn w/ increased external rotation or dorsiflexion
- •Injured in conjunction w/ medial and lateral ligaments
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Achilles Tendon Rupture
- –Etiology
- •Occurs w/ sudden stop and go; forceful plantar flexion w/ knee moving into full extension
- •Commonly seen in athletes > 30 years old
- –Can be observed at any age
- •Generally has history of chronic inflammation
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knee ligaments
- Anterior Cruciate
- Posterior Cruciate
- Medial Collateral
- Lateral Collateral
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Q-Angle
- –Lines which bisect the patella
- relative to the ASIS and the tibial tubercle
- –Normal angle is 10 degrees for
- males and 15 degrees for females
- –Elevated angles often lead to
- pathological conditions associated w/ improper patella tracking
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Osteochondritis Dissecans
–Etiology
- •Partial or
- complete separation of articular cartilage and subchondral bone
- •Cause is
- unknown but may include blunt trauma, possible skeletal or endocrine
- abnormalities, prominent tibial spine impinging on medial femoral condyle, or
- impingement due to patellar facet
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