–Increased foot flexibility
–Excessive calcaneal eversion
–Uneven weight distribution
–Postural symptoms involving leg, knee, hip, and back
–Is excessively supple and does not resupinate to form a rigid lever for push-off
Pes Planus (Flat foot)
–Uneven weight distribution
–Increased tendency to lateral ankle instability
–Decreased ankle joint dorsiflexion
–The cavus foot is rigid and will not evert to become supple because it does not pronate to unlock the midfoot and subtalar joint
Pes Cavus (High Arch Foot)
•“hypomobility” of the joints of the foot and ankle
•Associated with a rigid structure, decrease shock absorber or adaptor to changing terrain
•Does not demonstrate a progressive breakdown in tissue (hypermobile foot)
•An inflexible foot that causes tissue inflammation with possible joint destruction
•Generally a “flexible flatfoot”
•Decreased push off during gait cycle
calluses under the 2nd/3rd/4th metatarsal heads are associated with this because of lack of push off provided by the 1st ray.
calluses under the 1stand 5th metatarsal heads correlates with this
Pes cavus foot
At what age should orthotics be prescribed?
Treatment for Pes Cavus
- Footwear adaptations
- Ankle support
- Heel and metatarsal pads
- Adequate toe box height
A broad dense band of longitudinally arranged collagen fibers
As increased loads are applied it becomes progressively stiffer to resist deformation
Originates predominently from the plantar medial aspect of the calcaneus
Most common cause of heel pain
Usually associated with heel spur
Causes include inadequate flexibility in the calf muscles, lack of arch support, being overweight, suddenly increasing activity, and spending too much time on the feet
Treatment for plantar fasciitis and Exostosis
- No barefeet
- Calf stretch and orthotics
- Strassburg Sock and night splints
An abnormal bony outgrowth extending from the surface of the bone. It is actually an increase in the bone mass at the
site of an irritated lesion in response to overuse, trauma, or
Exostosis (Bony Spur/Heel Spur)
Severe pain or cramp in the anterior portion of the metatarsals
Occurs when forefoot weight bearing is maldistributed.
Treatment for metatarsalgia
Results in hyperextension of the metatarsophalangeal joints and flexion of the proximal and distal interphalangeal joints
Treatment for claw-toe and hammer-toe deformity
Good shoes with broad toe box, various forefoot devices and orthotics
Consists of an extension contracture at the metatarsophalangeal joint and flexion contracture at the proximal interphalangeal joint; the distal interphalangeal joint may be flexed, straight,
Associated with a flexion deformity of the distal interphalangeal joint. It can occur on any of the four lateral toes.
Treatment for mallet toe
Not really needed. More cosmetic
•Restricted or loss of motion of the joint connecting the great toe to the metatarsal
•Condition in which extension of the big toe is limited because of osteoarthritis or spurring of the first metatarsophalangeal joint.
on dorsum of joint on extension
Treatment for Hallux Rigidus/Limitus
Limiting extension of joint
Medial deviation of the head of the first metatarsal bone occurs in relation to the center of the body and lateral deviation of the head occurs in relation to the center of the foot.
Treatment for hallus valgus
Splints and proper footwear
The second toe is longer than the first.
Morton's (Atavistic or Grecian) Foot
Neuroma like mass of the neurovascular bundle – intermetatarsal spaces
Tenderness found between metatarsal heads not on the metatarsal heads
It is the belief that the interdigital nerve is irritated by the intermetatarsal ligament which sags plantarward toward the nerve as the height of the transverse metatarsal arch decreases
Condition is worsened by pronation and excessive toe off
Usually treated by a device that prevents extension of the first MTP joint
Result of hyperextension of the first metatarsal phalangeal joint
Inflammation and thickening of the bursa of the joint of the great toe, usually with marked enlargement of the joint and lateral displacement of the toe
Causes of bunions (3)
- 1. Heredity
- 2. Degenerative bone or joint disease (ie.Arthritis)
- 3. Wearing of tight fitting shoes and high heels which forces the toes together and displace weight onto the
Traditionally tailors crossed their legs and held their feet in such a way that the lateral aspect of the 5th metatarsal head rested against the floor
It is a painful enlargement or prominence of the 5th
Pain generally precipitated by shearing forces of the shoe creating a bursa overlying the 5th MT head
Tailor's (Bunionette) Bunion
Condition of the thickest and strongest tendon in the body
Can result from inadequate strength of gastroc-soleus
complex; overuse of gastroc-soleus complex; degeneration of the tendon
Tenderness at navicular insertion or just behind medial malleolus along the tendon
Posterior Tibialis Tendonitis
Treatment for Posterior Tibialis Tendonitis
- Exercises to strengthen weakened muscles
Chronic symptoms in peripatellar area
Aggravated by climbing stairs or sitting with a flexed knee position
Abnormal calcaneal eversion leads to excessive internal rotation of tibia relative to femur producing a transverse plane torque at the knee joint
Inflammation of origin of anterior tibialis muscle due to weakness or tight calf muscles
Treatment for shin splints
- ROM exercise
- Support sleeves
Dermatological inflammation as a result of the nail growing in malposition into the edges of the nail bed
Extra care for diabetics
Ingrown Toe Nail
Inflammation of the sesamoid bones
Tx: ice, orthotics, NSAID’s etc
Due to excessive repetitive trauma to a specific area of the foot or leg
Rest, ice and elevation if edema is present, casting if healing does not occur
Metatarsal Stress Fracture
Contracture of the plantar fascia
Surgery for area
Recurring cases -> total excision of plantar fasica
Corn or callus?
Occur to the dorsum of the toes or between the toes
Corns or callus?
Occur to the plantar aspect of the foot
Treatment for metatarsus adductus
- Stretching and splints
- Surgery in rare cases
What % of diabetics have diabetic foot disease?
•Simple wearing and tearing away of the cartilage of the joints.
•Age, excessive weight, ill-fitting shoes and trauma (injury) are the basic causes.
•Causes excessive strain and the wearing away of cartilage in the joints of the foot.
•Movement becomes very difficult and painful.
•Pain and swelling worsens while standing or walking, and stiffness usually occurs after periods of rest.
• A form of arthritis that also leads to foot complications.
•Excess uric acid crystals collect in and around the joints of the big toe.
•The big toe joint is commonly the focal point due to the stress and pressure it experiences during walking and other weight bearing activities.
•This leads to severe pain in the big toe.
•More common in men.
•It can develop at any age and there is no known cause for this condition.
•Most crippling form of the disease that can affect people of all ages.
•It can cause severe deformities of the joints with associated fatigue of the entire body.
•People who suffer from rheumatoid arthritis often develop severe forefoot problems such as bunions, hammer toes, claw toes and others.
Rheumatoid Arthritis (RA)
Treatment for arthritic foot
- Proper footwear
- Orthotics and/or forefoot supports