Athletic Injuries of the Foot

ROP SPORTS HEALTH CARE

MRS. CAMOU

CC #1

• Fools wander…Wise people reach their destination

CC # 2

• It is better to fail while trying than to succeed at doing nothing.

Skeletal Anatomy – 26 Bones• Tarsal bones (7)

– Calcaneous– Talus– Navicular– Cuboid– Cuneiforms

• Medial• Intermediate• Lateral

• Metatarsals (5)– 1-5: medlat

• Phalanges (14)– Proximal (1-5)– Intermediate (2-5)– Distal (1-5)

Skeletal Anatomy

• Forefoot– Phalanges– Metatarsals

• Midfoot– Cuneiforms– Navicular– Cuboid

• Rearfoot– Talus– Calcaneous

Skeletal Anatomy - Arches

• Medial longitudinal

• Lateral longitudinal

• Metatarsal

• Transverse

Skeletal Anatomy - Arches

Skeletal Anatomy - Joints

• Meta-tarso-phalangeal (MP or MTP)

• Subtalar– Talus– Calcaneus

Musculotendinous Anatomy

• Anterior Aspect– Extensors of toes– Extensor digitorum

longus– Extensor digitorum

brevis– Extensor hallucis

longus– Extensor hallucis

brevis

Musculotendinous Anatomy

• Posterior Aspect– Flexors of toes– Flexor digitorum

longus– Flexor digitorum brevis– Flexor hallucis longus– Flexor hallucis brevis

Circulatory Anatomy

• Distal pulse– Posterior tibial artery– Dorsal pedis artery

Circulatory Anatomy

• Where to palpate the Distal PulseA. Posterior tibial artery

B. Dorsal pedis artery

A B

Neurological Anatomy• Tibial nerve – located in

-superficial posterior muscles

• Peroneal nerve- located in– Superficial – lateral compartment– Deep – anterior compartment

• Plantar nerve – located in– Medial and lateral – foot

Common Foot Injuries

• STRAINS- muscles and tendons

• SPRAINS- ligaments

• FRACTURES- bones

• DISORDERS- skin, calluses, bunions

Plantar Fasciitis

Plantar fasciitis (say "PLAN-ter fash-ee-EYE-tus") is the most common cause of heel pain. -The plantar fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. -It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk.

Plantar Fascia Biomechanics

If you strain your plantar fasciait gets:

weak, swollen, and irritated (inflamed).

Then your heel or the bottom of your foot hurts when you stand or

walk.

Treatment(Tx) for Plantar Fasciitis • CAUSES• Your feet roll inward too much when you walk (excessive pronation).• You have high arches or flat feet.• You walk, stand, or run for long periods of time, especially on hard surfaces.(athletes)• You are overweight.• You wear shoes that don't fit well or are worn out.

• You have tight Achilles tendons or calf muscles.• Tx : Rest,Ice,Equipment,NSAID(non-steroidal anti- inflammatory drug)

• Give your feet a rest. Try not to walk or run on hard surfaces.• To reduce pain and swelling, try putting ice on your heel. Take an over-the-counter

pain reliever like ibuprofen, or anti- inflammatory like naproxen (such as Aleve)• NSAID=Non-steroidal Anti-inflammatory Drugs• Do toe stretches , calf stretches   several times a day, especially when you first get

up in the morning.• Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or

try heel cups or shoe inserts (orthotics ). Use them in both shoes, even if only one foot hurts.

Fractures of the Foot• Tarsal bones (rear foot)

– Calcaneous M.O.I- (mechanism of injury)• Direct contact (fall/jump)• Can be complete or stress

– Talus M.O.I• Forced dorsiflexion• Susceptible to avascular necrosis (tissue death due to a lack of

blood supply) and osteochondritis dissecans (piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone)

– Metatarsals • Transverse or spiral• Avulsion @ base of 5th met is a Jones’ fracture• Stress fracture or Marcher fracture – usually 2nd or 3rd metatarsal• Tx: stabilize, splint, send to E.R. for x-rays and cast• Minimum 6-8 wks in a cast / surgery may be needed.

Metatarsal Fractures

Jones Fracture (base of 5th met)

1

2

3

4

5

March Fracture 2nd or 3rd met

Foot Strains and Sprains• Arches

– Medial longitudinal arch strain

• Plantar fasciitis– Heel spur

syndrome

• Phalanges– Great toe MP joint

• “Turf Toe”• Sprain ligaments of

big toe

Contusions to the Foot

• Calcaneous– “Heel bruise”– “Stone bruise”

• Metatarsals– Usually at met heads

Treatment:

rest, ice, protectionMetatarsal heads

Structural Conditions• Morton’s Toe

– Second toe is longer than the Great toe

– Can lead to stress fractures and neuroma (nerve tumor)

• Hallux Valgus– Valgus stress on first

ray– Leads to bunions

Bunions

Structural Conditions• Hammer Toes

– Buckling of an IP joint– Commonly due to muscle

imbalance– Leads to calluses and

bunions

• Pes Planus– Flat feet– Excessive pronation– Shin splints / knee

problems

• Pes Cavus– High arches– Faster runners– Claw feet– Excessive supination

Pes Planus (flat feet)

Other Foot Injuries

• Tinea pedis– “athlete’s foot”– Fungal infection of skin

Tx:

topical ointment, antibiotic

• Verrucae plantaris– Plantar warts– Viral infection of the sole of

the foot

Tx: • topical ointments

Other Foot Injuries

• Morton’s Neuroma– Inflammation of the

nerve typically between the 3rd and 4th metatarsals

Tx: Rest, protection,

injections or surgery• Retrocalcaneal bursitis

– “pump bumps”– Caused by inflammation

of Achilles bursaTx:Rest, Ice, Protection,

NSAID

Other Foot Injuries

• Sever’s Disease– “calcaneal

apophysitis” is the most common cause of heel pain in the growing athlete.

– It is a Traction injury at insertion of Achilles tendon (growth plate injury)

Tx:

Rest, Ice, NSAID