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Understanding Foot Anatomy and Common Injuries

Learn about the complex anatomy of the foot, the bones and ligaments involved, common injuries like plantar fasciitis and turf toe, and how to manage them. Take care of your feet to prevent issues and maintain overall health and mobility.

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Understanding Foot Anatomy and Common Injuries

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  1. CHAPTER 15 – FOOT, ANKLE AND LOWER LEG

  2. FOOT ANATOMY

  3. FOOT ANATOMY • It is complex! • 26 bones • 33 joints • Over 100 muscles, tendons and ligaments

  4. ANATOMY - BONES • PHALANGES (Toes) – 14 • Big toe has two phalanges, the rest of the toes have three • Proximal, middle, and distal

  5. FOOT ANATOMY - BONES • METATARSALS – 5 • 1ST one is medial and 5th one is lateral

  6. FOOT ANATOMY – 26 BONES • TARSAL BONES – 7 • Calcaneus – heel bone • Talus – forms the ankle • Navicular – medial in respect to the talus • Cuboid - lateral • Cuneiforms (3)

  7. FOOT ANATOMY • PLANTAR FASCIA • Broad, flat tendonous structure that runs on the undersurface of the foot • Starts on the calcaneus and inserts onto the heads of the metatarsals • Supports the arch of the foot

  8. FOOT ANATOMY - ARCHES • Support body weight and absorb shock • There are four arches: • MEDIAL LONGITUDINAL ARCH • LATERAL LONGITUDINAL ARCH • METATARSAL ARCH • TRANSVERSE ARCH

  9. FOOT - MOTIONS • Toes • Flexion and Extension • Foot • Pronation – like fallen arch • Supination – high arch

  10. ANKLE ANATOMY - BONES • BONES • Two bones in the lower leg • Tibia – medial, larger, weight bearing • Medial Malleolus • Fibula • Lateral Malleolus • Two tarsal bone • Talus • Calcaneus

  11. ANKLE ANATOMY - JOINTS • TRUE ANKLE JOINT • Tibia, fibula and talus • Mortise • Definition: where the talus fits into the tibia and the fibula

  12. ANKLE ANATOMY - JOINTS • Subtalar joint • Between the Talus and the Calcaneus

  13. ANKLE ANATOMY - LIGAMENTS • LATERAL – • 3 ligaments named for bones • Anterior talofibular • (ATF) • Calcaneofibular • (CF) • Posterior talofibular • (PTF)

  14. ANKLE ANATOMY - LIGAMENTS • MEDIAL • Deltoid • Strong ligament • 4 parts that form one ligament

  15. ANKLE ANATOMY - LIGAMENTS • TIBIOFIBULAR LIGAMENTS – holds tibia and fibula together • Anterior tibiofibular • Posterior tibiofibular

  16. ANKLE MOTIONS • Dorsiflexion • Plantarflexion • Inversion • Eversion

  17. LOWER LEG ANATOMY • Bones • Tibia • Fibula

  18. LOWER LEG MUSCLES • The muscles are in four compartments with 2-4 muscles in each compartment • Compartments are held together by fascia

  19. LOWER LEG MUSCLE COMPARTMENTS • LATERAL – everts the ankle • ANTERIOR – dorsiflexes the ankle • DEEP POSTERIOR – plantarflexes the ankle (the calf muscle) • POSTERIOR MEDIAL – inverts and plantarflexes the ankle

  20. LOWER LEG - Major Muscles and Actions • Anterior Tibialis - dorsiflexor • Peroneals - evertors • Gastrocnemius – plantarflexor • Soleus – plantarflexor • Posterior Tibialis – invertor

  21. INJURIES

  22. PLANTAR FASCIITIS • Common with athletes who are on toes and/or have high arches • Causes: Not enough arch support in shoes, tight calf muscle • Signs/Symptoms: Sharp pain occurs in the heel to mid-foot, especially with dorsiflexion • Hurts in the morning, feels better as they warm up • Treatment: Gentle stretches, roll on tennis ball or frozen can, arch taping or orthotics.

  23. JONES FRACTURE • Fracture of the base of the 5th metatarsal • Causes: inversion; rotational forces; overuse • S/S: Feel and hear a ‘pop’; pain in the lateral foot over 5th metatarsal, swelling, inability to walk • Tx: immobilization (cast) 6-8 weeks or longer, often requires surgery

  24. BUNIONS (HALLUX VALGUS) • Deformity of the head of the 1stmetatarsal/big toe • Can have bunion on 5thmetatarsal/toe too • Cause: extra bone is laid down on head of 1stmetatarsal – poor shoes, genetics, on toes • Great toe and 1st Metatarsal become malaligned • S/S: Pain, swelling and deformity of big toe joint, shoes are painful • Treatment: Proper shoes; doughnut pad over the bunion; surgery

  25. TURF TOE • Great Toe sprain • Cause: Hyperextension of the big toe at the metatarsal phalangeal joint; kicking something • Common on artificial turf b/c turf shoes allow more motion • S/S: swelling and pain in the MTP joint, pain with hyperextension (pushing off toe) • Tx: RICE, rigid insoles or toe boxes, taping to prevent hyperextension of toe

  26. INGROWN TOENAILS • Cause: leading side of toenail grows into skin, usually results in infection and pain • May trim nails too short or ill-fitting shoes • S/S: Inflammed and red nail bed at corner of toenail, may have drainage/pus • Tx: May need to refer to doctor; soak in betadine bath; pack cotton under toenail, surgical shaping of toenail

  27. PUBLIC SERVICE ANNOUNCEMENT • HIGH HEELS • Loads 5 times your body weight onto your heel • Overloads forefoot • Deforms the arch • Reduces shock absorption • Plantar fasciitis • Leads to inflamed nerves in your toes • Morton’s Neuroma • Shortens your calf • Achilles tendinitis • Changes your center of gravity – more forward • Have to extend back to compensate

  28. TYPES OF ANKLE SPRAINS • Inversion • Most common type of ankle sprain • Accounts for 80% of all sprains • AKA ‘a lateral ankle sprain’ • First degree sprain • Only involves the anterior talofibular ligament • Mild pain, tenderness, and swelling • No instability • Out 1-2 weeks

  29. TYPES OF ANKLE SPRAINS • Inversion • Second degree sprain • Anterior talofibular ligament is torn and calcaneofibular ligament is injured as well • Most painful • Moderate swelling • Discoloration • Hears/feels a pop • Mild Instability • Out 4-6 weeks

  30. TYPES OF ANKLE SPRAINS • Inversion • Third degree sprain • Complete tear of all three lateral ligaments • Uncommon • Feel and hear multiple pops • Lots of pain, but it can subside • Significant swelling • Very unstable • Usually requires surgery

  31. ANKLE SPRAIN TREATMENT • Prevention • Exercises • Rest • No activity • Ice 20 minutes on, 40 minutes to an hour off • No heat • Compression – Ace Wrap • Elevation – above heart • Support • Crutches, braces

  32. TYPES OF ANKLE SPRAINS • Eversion • Not as common • Can occur more on tartan surfaces and artificial turf • Everything is worse (pain, swelling, etc) when compared to an inversion injury • If the deltoid tears, the tibiofibular ligaments may tear also

  33. HIGH ANKLE SPRAIN • Involves Anterior Inferior Tibiofibular (AITFL) Ligament • Injury allows tibia and fibula to separate

  34. HIGH ANKLE SPRAIN • Cause: Inversion with rotation; rotation of foot • S/S: pain with external rotation of foot; tender over AITFL, swelling, does not want to weight bear • Treatment: RICE, may need to be immobilized; possible surgery if severe enough

  35. TIBIA/FIBULA FRACTURES • Always need to suspect a fracture when evaluating a potential sprained ankle • Cause: Too much motion • S/S: immediate swelling, point tender over the malleoli, deformity, does not want to weight bear • Treatment: splint, ice, x-ray Cast 6-8 weeks

  36. MEDIAL TIBIAL STRESS SYNDROME • ‘SHIN SPLINTS’ • Occurs in distal 2/3 of posterior/medial tibia • Causes: pronation, lack of flexibility in the lower legs, hard surfaces, hills, muscle weakness, poor shoes, increasing running distance too quickly • S/S: resisted plantar flexion and inversion should hurt, pain is just off the tibia, achy or sharp pain • Treatment : prevention (shoes, arch support), strengthening, stretching, ice massage, contrast bath, tape arches • Refer to MD if no improvement to rule out stress fracture

  37. COMPARTMENT SYNDROME • Occurs when pressure increases in compartment and shuts off blood and nerve supply to the foot • Most often occurs in the anterior and deep posterior compartment • THREE TYPES • Acute • Acute Exertional • Chronic

  38. ACUTE COMPARTMENT SYNDROME • Medical emergency • Causes: direct blow to the lower leg • Usually in the anterior lower leg • Symptoms come about several hours later • S/S: compartment is tense, warm, red and shiny; complains of (c/o) deep aching pain; circulation and sensory problems in foot • Tx: ice, elevation – refer to ER immediately

  39. ACUTE EXERTIONAL/CHRONIC COMPARTMENT SYNDROME • Cause: running and jumping activities • S/S: With activity, foot goes to sleep, crampy pain, and tingling. When activity stops, it goes away. Consistent as to when it comes on with activity • Tx: ice, activity modification, stretching, massage, and referral to the doctor (possible surgery)

  40. ACHILLES TENDINITIS • Chronic, overuse condition that comes about gradually • Causes: running and jumping, repetitive stress, running up hills, poor flexibility • S/S: achy type pain in Achilles, Achilles is tender on palpation, pain with standing plantarflexion, may have crepitus, hurts to warm up and to cool down • TREATMENT • If there is crepitus, no running for 1-2 weeks • Stretch! • Heel lift in both shoes • Orthodics • Heat and/or ice

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