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Lower Body Evaluation ATC 328

This chapter covers the intricate anatomy of the foot and toes, detailing 26 bones, including the rearfoot, midfoot, and forefoot structures. It explores the arches, their supporting structures such as ligaments and fascia, as well as intrinsic and extrinsic muscles critical for foot function. Evaluation methods including observation, palpation, and special tests are discussed. Common injuries like sprains, plantar fasciitis, and neuromas are examined, alongside their treatments. Understanding these concepts is essential for effective assessment and management of foot-related conditions.

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Lower Body Evaluation ATC 328

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  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

  6. Articulations

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

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

  9. 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

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

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

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

  13. 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?

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

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

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

  17. 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

  18. Tarsal Coalition

  19. Tarsal Tunnel Syndrome • Compression of posterior tibial nerve

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

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

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

  23. 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?

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

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