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Kin191 A. Ch.4. Foot. Toes. Inuries. Fall 2007[1]
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Kin191 A. Ch.4. Foot. Toes. Inuries. Fall 2007[1]

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  • 1. FOOT/TOES COMMON INJUIRES KIN 191A Advanced Assessment of Lower Extremity Injuries
  • 2. INTRODUCTION
    • COMMON INJUIRES
      • FOOT/TOE PATHOLOGIES
      • GREAT TOE INJURIES
      • METATARSAL/PHALANGEAL INURIES
      • TARSAL INURIES
      • PLANTAR SURFACE INJURIES
      • SOFT TISSUE INJURIES
      • ARCH INJURIES/CONDITIONS
      • NEUROGICAL INJURIES
  • 3. FOOT/TOE PATHOLOGIES
    • Many foot/toe injuries/conditions relative to either biomechanics at the foot or as compensation for abnormal biomechanics elsewhere in the lower extremity
  • 4. GREAT TOE INJURIES
    • M T P joint sprain (aka “turf toe”)
      • Typically associated with hyperextension
      • Especially problematic during push-off and change of direction activities
    • Hallux valgus (aka “bunion”)
      • A typical for traumatic onset
    • Hallux rigidus
      • Ankylosis (joint fusion)
      • Secondary to arthritis or exostosis formation
  • 5. METATARSAL/PHALANGEAL INJURIES
    • Metatarsal fractures
      • Typically traumatic onset
      • Jone’s fracture
        • A fracture of the 5 th MT, 1cm distal to the proximal diaphysis
        • Often require surgical fixation
    • Metatarsal stress fractures
      • Known as “march” fractures from high incidence in military recruits
  • 6.
    • Avulsion fractures
      • Most common at base of 5 th metatarsal
      • Also occur at navicular and calcaneal tuberosity
    • Phalangeal fractures
      • Typically from blunt trauma, usually treated conservatively
  • 7. TARSAL INJUIRES
    • Lisfranc sprain, fracture/dislocation
      • Characteristic location, extended treatment and rehab period, frustrating injury
    • Cuboid syndrome
      • Pain at cuboid/4 th and 5 th metatarsal region from subluxation of cuboid during over pronation
    • Navicular fracture
      • Stress fracture most common due to placement in medial longitudinal arch
      • Can see accessory navicular which is congenital presentation of medial prominence on navicular
  • 8.
    • Calcaneal fracture
      • Typically high velocity injuries (fall from height, MVA, etc.)
    • Calcaneal apophysitis (Sever’s disease)
      • Traction injury to growth plate at calcaneal tuberosity
    • Talus fracture/OCD
      • Most common location is dome, typically not isolated condition but secondary to other injury
    • Retrocalcaneal bursitis (“pump bumps”)
  • 9. PLANTAR SURFACE INJURIES
    • Plantar fasciitis
      • Biomechanical and structural issues predispose tissue to injury
      • Presents typically at calcaneal attachment but may be along length of structure
      • Plantar fascia rupture can occur with forces toe hyperextension to a dorsiflexed ankle
      • Pain when stepping out of bed in the morning
  • 10.
    • Fat pad contusion
      • Associated with direct trauma (falls from height, etc.)
    • Heel spur
      • Bony exostosis (Wolff’s law)
      • May or may not be associated with plantar fasciitis
  • 11. SOFT TISSUE INJURIES
    • Muscle strains
      • Eccentric overload vs. forceful concentric contraction
    • Tendinitis
      • Posterior/anterior tibialis, peroneal, Achilles, flexor/extensor tendons
      • Repetitive stress injuries (microtrauma) associated with biomechanics and changes in training pattern
    • Synovitis
      • Can occur in any synovial joint, in foot most common at the great toe MTP joint
  • 12. ARCH INJURIES/CONDITIONS
    • Pes planus (“flat feet”)
      • Congenital, biomechanical or traumatic onset
      • Rigid (structure) pes planus
        • Tarsal coalition: absence of medial longitudinal arch when the foot is both WB or NWB
      • Flexible (supple) pes planus
        • The arch appears normal during NWB but disappears when the foot is WB
    • Pes cavus
      • Poor ability to attenuate ground reaction forces
      • High incidence of stress fractures
  • 13.
    • Transverse metatarsal arch conditions
      • Pain under heads of 2 nd -5 th metatarsals due to abnormal weight bearing
  • 14. NEUROLOGICAL INJURIES
    • Tarsal tunnel syndrome
      • Tibial nerve entrapment/compression posterior to medial malleolus
      • Neuro symptoms along distal distribution
    • Intermetatarsal neuroma
      • Interdigital nerve entrapment
      • Morton’s neuroma (between 3 rd and 4 th metatarsal heads)
      • Pain at site and neuro symptoms distal to injury site
  • 15. Tarsal Tunnel Syndrome Surgery