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Chapter 4

Chapter 4. The Foot and Toes continued. Range of Motion Testing. Focus on MTP joints (flexion & extension) Bilateral comparison Box 4-4 Foot Goniometry, page 113. Active ROM (first MTP) Extension 75-85 0 Flexion 35-45 0 Compensatory motion Passive ROM Figures 4-22 & 4-23, page 114

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Chapter 4

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  1. Chapter 4 The Foot and Toes continued

  2. Range of Motion Testing • Focus on MTP joints (flexion & extension) • Bilateral comparison • Box 4-4 Foot Goniometry, page 113

  3. Active ROM (first MTP) • Extension 75-850 • Flexion 35-450 • Compensatory motion • Passive ROM • Figures 4-22 & 4-23, page 114 • Resisted ROM • Box 4-5, page 115

  4. Ligamentous and Capsular Testing • MTP and IP Joints • MCL, LCL, joint capsule • Overpressure • Box 4-6, page 116 • Intermetatarsal Joints • Deep transverse ligament and interosseous ligaments • Gliding • Box 4-7, page 117

  5. Ligamentous and Capsular Testing • Tarsometatarsal Joints • Dorsal and Plantar glide • Box 4-8, page 118 • Midtarsal Joints • Dorsal and Plantar glide of cuneiforms • Box 4-9, page 119

  6. Neurologic Examination • L4 – S2 nerve roots • Neurologic symptoms • Box 1-5, Chapter 1 • Tarsal Tunnel Syndrome/Interdigital neuroma (Figure 4-24, page 117)

  7. Pathologies and Related Special Tests • Improper biomechanics or result of compensation by foot for biomechanical deficits elsewhere in lower extremity

  8. Arch Pathologies • Most commonly occur congenitally • Increasing or decreasing height of arch • Arch height (Figure 4-25, page 120) • Navicular drop indicates change in height from non-weight-bearing to weight-bearing

  9. Pes Planus • Figure 4-26, page 120 • Congenital origin, biomechanical changes, or acute trauma • Affects function of subtalar and calcaneocuboid joints • Acute – trauma to supporting structures • Accessory navicular (Fig. 4-27, pg 121) • Mechanical Factors

  10. Rigid (structural) vs. flexible (supple) • Box 4-10, page 122 • Navicular drop test (Box 4-11, page 123) • Should not be left untreated

  11. Pes Cavus • Figure 4-28, page 124 • Congenital, neurologic, disease • Associated with stiffness and impaired ability to absorb ground contact forces • Dorsal pads under calcaneus and MT heads appear smaller than normal • Claw toes, calluses over PIP joints • Treatment options

  12. Transverse Metatarsal Arch Pathology • Only slightly visible • Deficiency can produce pain under heads of second through fifth MTs • Intertarsal neuroma • Inspect, palpate plantar surface

  13. Plantar Fasciitis • Table 4-7, page 125 • Causes of the inflammation • Trauma to plantar fascia can lead to many problems • Signs and symptoms • Accompanied by other dysfunctions • Treatment options

  14. Heel Spur • Exostosis of medial calcaneal tubercle • Relationship with plantar fascia • Similar signs, symptoms and treatments to plantar fasciitis

  15. Plantar Fascia Rupture • Dorsiflexion of foot combined with extension of toes • Risk of rupture • Signs and symptoms

  16. Tarsal Coalition • Bony, fibrous or cartilaginous union between two or more tarsal bones • Hereditary condition; calcaneonavicular, talonavicualr, talocalcaneal joints • Signs and symptoms • Treatment • Figure 4-29, page 126

  17. Tarsal Tunnel Syndrome • Entrapment of posterior tibial nerve as it passes through tibial tunnel • Tunnel formed anteriorly by tibia and talus and laterally by calcaneus • Flexor retinaculum = fibrous roof (Fig 4-30, pg 127) • Acute, predisposing conditions, anatomical factors, biomechanics • Patient complaints • Evaluation/Treatment • Table 4-8, page 127 • Figure 4-31, page 128

  18. Metatarsal Fractures • Direct trauma or overuse • Base of fifth (Figure 4-32, page 128) • Jones’ fracture (Figure 4-33, page 129) • Stress fractures • March fractures • Signs and symptoms (Figure 4-34, page 129) • Management • Table 4-9, page 130

  19. Phalangeal Fractures • Longitudinal force or crushing force • Figure 4-35, page 130 • Signs and symptoms • Treatment

  20. Intermetatarsal Neuroma • Entrapment of nerve between two MT heads • Morton’s Neuroma • Causes/predisposing factors • Signs and symptoms • Treatment • Figure 4-36, page 131

  21. Hallux Rigidus • Progressive degeneration of first MTP joint • Hallux limitus/ankylosis • Causes • Signs and symptoms • Treatment • Figure 4-37, page 132

  22. First Metatarsophalangeal Joint Sprains • Mechanism of injury • “Turf Toe” • Signs and symptoms • Management

  23. On-Field Evaluation of Foot Injuries • Equipment considerations • On-field history • On-field inspection • On-field palpation • On-field ROM tests

  24. On-Field Management of Foot Injuries • Plantar fascia ruptures • Fractures and Dislocations

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