foot & toe evaluation

7/31/2019 Foot & Toe Evaluation

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Foot & Toe Evaluation


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Foot Anatomy

26 BonesRearfoot Calcaneus, TalusMidfoot 3 Cuneiforms, Cuboid, NavicularForefoot 5 Metatarsals, 14 Phalanges, 2Sesamoids


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Ankle mortise tibia, fibula, talus

Reference: Starkey, C. (2002). Evaluation of Orthopedic & Athletic Injuries , p. 89.


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RearfootProvides stability & shock absorption during initialstance phaseLever arm for Achilles tendon during plantarflexionTalus no muscles attach to itCalcaneus- Calcaneal tubercle posterior side- Sustentaculum tali

medial side - helps support the talus

flexor hallicus longus - passes through the medialgroove

- Peroneal tubercle lateral sideSubtalar joint inferior talus/superior calcaneus


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Rearfoot

Reference: Primal Pictures, 2001


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Midfoot

Shock absorberMedial longitudinal archNavicular tuberosity Tibialis posterior insertion

Reference: Primal

Pictures, 2001


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Forefoot

Lever during pre-swing phaseMetatarsals proximal base, body, distalheadPhalanges MTP, PIP, DIP, IP jointsPlantar fascia


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Forefoot

Reference: PrimalPictures, 2001


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Metatarsophalangeal Joints Classified as condyloid-type

jointsGreat toemetatarsophalangeal (MP)

joint flexes 45 & extends70MP joints of the four lesser toes

40 of flexion40 of extensionalso abduct & adduct minimally


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JointsGreat toe interphalangeal (IP)

joint flexes from 0 of fullextension to 90 of flexion

Proximal interphalangeal (PIP)

joints in lesser toes flexes from0 extension to 35 flexion

Distal interphalangeal (DIP)

joints flexes 60 & extend 30

Much variation from joint to joint& from person to person


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TerminologyIntrinsic muscles m. contained within the foot

Extrinsic muscles m. originating from lower leg or femurSupination inversion + adduction + plantarflexionPronation - eversion + abduction + dorsiflexionInversion movement of the plantar aspect of the calcaneustoward the midline of the bodyEversion movement of the plantar aspect of the calcaneusaway from the body

Dorsiflexion flexion of the ankle, pulling the foot & toestoward the tibiaPlantarflexion extension of the ankle, pointing the foot &toes

Ray series of bones formed by the MT & phalanges


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Movements of Foot

Pronation combination of ankle

dorsiflexion, subtalareversion, & forefootabduction (toe-out)

Supination combination of ankle

plantar flexion,subtalar inversion, &forefoot adduction(toe-in)

Eversion turning ankle & foot

outward; abduction,away from midline;weight is on medialedge of foot

Inversion turning ankle & footinward; adduction,

toward midline;weight is on lateraledge of foot


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Movements of Toes

Toe flexion movement of toestoward plantarsurface of foot

Toe extension movement of toes

away from plantar

surface of foot


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Intrinsic Muscles of the FootAll originate &insert within thefoot Extensor

digitorumbrevis - dorsumof foot

Remainder arein a plantarcompartment in4 layers onplantar surfaceof foot


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Intrinsic Muscles of the Foot First (superficial) layer: Abductor hallucis, flexor digitorum brevis,

abductor digiti minimi (quinti) Second (middle) layer: Quadratus plantae, lumbricales (4)


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Intrinsic Muscles of the Foot Third (deep) layer: Flexor hallucis brevis, adductor hallucis, flexor digiti

minimi brevis Fourth (deep) layer: Dorsal interossei (4), plantar interossei (3)


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Intrinsic Muscles of the FootGrouped by location Medial - attach to great toe proximal phalanx

Abductor hallucis & flexor hallucis brevis - mediallyAdductor hallucis - centrally beneath metatarsals

Central locationBeneath the foot

Quadratus plantae, 4 lumbricales, 4 dorsal interossei, 3plantar interossei, flexor digitorum brevis

Dorsal compartment

Extensor digitorum brevis Lateral attach on lateral aspect of base of 5 th

phalange proximal phalanxabductor digiti minimi, flexor digiti minimi brevis


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Intrinsic Muscles of the FootGrouped by action 4 muscles act on great toe

abductor hallucis - abduction of great toe & assists flexor hallucis brevis in flexinggreat toe at MP jointadductor hallucis - adduction of great toeextensor digitorum brevis - extension of great toe at MP joint

4 lumbricales flexors of the 2 nd , 3 rd, 4 th, & 5 th phalanges at MP joints

quadratus plantae flexors of 2 nd , 3 rd, 4 th, & 5 th phalanges at DIP joints

3 plantar interosseiadductors & flexors of proximal phalanxes of 3 rd, 4 th, & 5 th phalanges

4 dorsal interosseiabductors & flexors of 2 nd, 3 rd, & 4 th phalanges MP joints

flexor digitorum brevisflexes middle phalanxes of 2 nd, 3 rd, 4 th, & 5 th phalanges

extensor digitorum brevisextends great toe & 2 nd , 3 rd, 4 th phalanges at MP joints

5th toe musclesabductor digiti minimi abducts proximal phalanxflexor digiti minimi brevis flexes proximal phalanx


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LateralFoot & Ankle

Reference: Primal

Pictures, 2001


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MedialFoot & Ankle

Reference: Primal

Pictures, 2001


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Extrinsic Muscles of the FootExtensor hallucis longus (EHL)Extensor digitorum longus (EDL)Flexor hallucis longus (FHL)

Flexor digitorum longus (FDL)Triceps Surae (Gastrocnemius, Soleus, Plantaris)Peroneus longus, brevis, tertius

Tibialis anteriorTibialis posterior

Starkey, Ch. 4, Table 4-2, p. 92-95


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Neurovascular Nerves Tibial n.

medial side Lateral &

MedialCutaneousbranch(comes fromPeroneal n.)

lateral side

Vascular Tibial a. Dorsalis Pedis

pulseReference: Primal Pictures,2001


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Lateral Cutaneous Distribution

Peach Sural N.Purple Lat.Plantar N.

Yellow

SuperficialPeroneal N.

Reference: Primal

Pictures, 2001


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Medial Cutaneous Distribution

Light Green

Saphenous N.Yellow Superficial

Peroneal N.Dark Pink TibialN. (Medial Calcanealbranches)

Dark Green Medial Plantar N.

Reference: Primal

Pictures, 2001


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Dermatome Distribution

Green L4Pink L5

Salmon S1

Reference: Primal

Pictures, 2001


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ArchesLigaments in foot & anklemaintain archesTwo longitudinal arches Medial longitudinal arch -

extends from calcaneusbone to talus, navicular, 3cuneiforms, and proximalends of 3 medialmetatarsals

Lateral longitudinal arch -extends from calcaneusto cuboid and proximalends of 4 th & 5 th metatarsals

Transverse arch extends across foot from 1 st

metatarsal to the 5 th metatarsal


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Evaluation of the FootHistory

What happened? (MOI)Where is the pain?When did it happen?(onset)Has it happened before?What does it feel like?Pain scale (1-10)What type of surface?How old are the shoes?Type of painUnusual noises/sensations

Observation

Toes, ArchesForefoot & RearfootValgus/Varus,Pronation/SupinationCalluses, blisters, warts,etc.

Appearance Bilateral comparisonColor

Deformity Edema, SwellingGait

InfectionWeight bearing vs. non-weight bearingShoe wear pattern


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Evaluation of the FootPalpation

Start away from the pointof painPalpate bony & soft tissuestructuresMedial structures

Lateral structuresDorsal structuresPlantar structures

Crepitus Heat

Swelling Rigidity DeformitiesSoftness

Stress Tests ROM tests (AROM,PROM, RROM- strength )AlignmentLigament & Capsulartests

Fracture testsNeurological testsOther special tests


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Assessment & PlanWhat injuryhave youevaluated?What areyou going todo with thisinjury?


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Common InjuriesRetrocalcaneal bursitisHeel contusionArch strainsPlantar fasciitis

FracturesBunion

Know the signs &symptoms of theseinjuries

SesamoiditisMortons neuroma Sprained toes Turf toe

Fractures &dislocations

foot & toe evaluation

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