583 Foot

–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

–Limited pronation
–Rigidity
–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

•“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”
•Hypermobile unit
•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

At what age should orthotics be prescribed?

Treatment for Pes Cavus

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

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                            
pressure.

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 

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,
or hyperextended

Associated with a flexion deformity of the distal interphalangeal        joint. It can occur on any of the four lateral toes. 

Treatment for mallet toe

•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.

•pain
on dorsum of joint on extension

Treatment for Hallux Rigidus/Limitus

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

The second toe is longer than the first.

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)

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
metatarsal head
Pain generally precipitated by shearing forces of the shoe creating a bursa overlying the 5th MT head

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

Treatment for Posterior Tibialis Tendonitis

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

Dermatological inflammation as a result of the nail growing in malposition into the edges of the nail bed
Extra care for diabetics

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

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

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.

Treatment for arthritic foot