Chapter 14: The Foot and Toes PDF

Access Provided by: Essentials of Athletic Injury Management, 11e Chapter 14: The Foot and Toes ©William E. Prentice OBJECTIVES When you finish this chapter you will be able to: Briefly describe the anatomy of the foot. Explain the process of injury assessment for the foot. Formulate steps that can be taken to minimize foot injuries. Identify the causes of various foot injuries commonly seen in athletes. Describe the appropriate care for injuries to the foot. FOOT ANATOMY Bones The human foot must function both to absorb forces and to provide a stable base of support during walking, running, and jumping. It contains 26 bones (7 tarsal, 5 metatarsal, and 14 phalangeal) that are held together by an intricate network of ligaments and fascia and moved by a complex group of muscles (Figure 14–1). The tarsal bones that form the ankle include the talus and calcaneus. The navicular, cuboid, and three cuneiform bones form the instep of the foot. FIGURE 14–1 Bony structure of the foot. (Modified from Van De Graaff, K., Human anatomy, 6th ed. Dubuque, IA: McGrawHill Higher Education, 2001.) Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 1 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility the instep of the foot. FIGURE 14–1 Access Provided by: Bony structure of the foot. (Modified from Van De Graaff, K., Human anatomy, 6th ed. Dubuque, IA: McGrawHill Higher Education, 2001.) Ligaments Arches of the Foot The foot is structured, by means of ligamentous and bony arrangements, to form several arches. The arches assist the foot in supporting the body weight and in absorbing the shock of weight bearing. There are four arches: the medial longitudinal, the lateral longitudinal, the metatarsal, and the transverse (Figure 14–2). FIGURE 14–2 Arches of the foot: ( A ) Metatarsal and transverse arches. (B) Medial longitudinal arch. (C) Lateral longitudinal arch. ©William E. Prentice The metatarsal arch is shaped by the distal heads of the metatarsals. The arch stretches from the first to the fifth metatarsal. The transverse arch Downloaded 2024828 1:18 P Your IP is 149.150.236.147 extends across the transverse tarsal bones and forms a half dome. The medial longitudinal arch originates along the medial border of the calcaneus Chapter 14: The Foot and Toes, Page 2 / 26 and extends ©2024 forward McGraw Hill. to Allthe distal Rights head of theTerms Reserved. first metatarsal. The main of Use Privacy supporting Policy Noticeligament of the medial longitudinal arch is the plantar Accessibility calcaneonavicular ligament, which acts as a spring by returning the arch to its normal position after it has been stretched. The lateral longitudinal arch is on the lateral aspect of the foot and follows the same pattern as the medial longitudinal arch. It is formed by the calcaneus, cuboid, and fifth Access Provided by: The metatarsal arch is shaped by the distal heads of the metatarsals. The arch stretches from the first to the fifth metatarsal. The transverse arch extends across the transverse tarsal bones and forms a half dome. The medial longitudinal arch originates along the medial border of the calcaneus and extends forward to the distal head of the first metatarsal. The main supporting ligament of the medial longitudinal arch is the plantar calcaneonavicular ligament, which acts as a spring by returning the arch to its normal position after it has been stretched. The lateral longitudinal arch is on the lateral aspect of the foot and follows the same pattern as the medial longitudinal arch. It is formed by the calcaneus, cuboid, and fifth metatarsal. Plantar Fascia (Plantar Aponeurosis) The plantar fascia is a thick white band of fibrous tissue originating from the medial aspect of the calcaneus and ending at the distal heads of the metatarsals. Along with ligaments, the plantar fascia supports the foot against downward forces (Figure 14–3). FIGURE 14–3 The Achilles tendon is continuous with the plantar fascia on the plantar surface of the foot. ©William E. Prentice Muscles The medial movements include adduction (medial movement of the forefoot—metatarsals) and supination (a combination of inversion and adduction). Muscles that produce these movements pass both behind and in front of the medial malleolus. Muscles passing behind are the tibialis posterior, flexor digitorum longus, and flexor hallucis longus. Muscles passing in front of the medial malleolus are the tibialis anterior and the extensor hallucis longus (Figure 14–4A). FIGURE 14–4 Muscles originating in the lower leg that produce movements of the foot. (From Van De Graaff, K., Human anatomy, 6th ed. Dubuque, IA: McGrawHill Higher Education, 2002.) The lateral movements of the foot include abduction (lateral movement of the forefoot—metatarsals) and pronation (a combination of eversion and Downloaded 2024828 1:18 P Your IP is 149.150.236.147 abduction). Chapter 14: Muscles The Foot passing behind the lateral malleolus are the fibularis longus and the fibularis brevis. Muscles passing in front of the lateral and Toes, Page 3 / 26 ©2024 McGraw malleolus are theHill. All Rights fibularis Reserved. tertius Terms and extensor of Use longus digitorum Privacy Policy (Figure Notice 14–4 A and B). Accessibility In general, the small intrinsic muscles on the plantar surface of the foot cause toe flexion, whereas those muscles on the dorsum of the foot cause toe Access Provided by: The lateral movements of the foot include abduction (lateral movement of the forefoot—metatarsals) and pronation (a combination of eversion and abduction). Muscles passing behind the lateral malleolus are the fibularis longus and the fibularis brevis. Muscles passing in front of the lateral malleolus are the fibularis tertius and extensor digitorum longus (Figure 14–4 A and B). In general, the small intrinsic muscles on the plantar surface of the foot cause toe flexion, whereas those muscles on the dorsum of the foot cause toe extension and abduction (Figure 14–5) (Table 14–1). Visual examples of the movements of the foot appear in Appendix C (Figures C–46, C–47, C–48, C– 49). FIGURE 14–5 Intrinsic muscles of the foot. ( A ) First layer. (B) Second layer TABLE 14–1 Muscles of the Foot Adduction and supination Tibialis posterior Flexor digitorum longus Flexor hallucis longus Tibialis anterior Extensor hallucis longus Abduction and pronation Fibularis longus Fibularis brevis Fibularis tertius Extensor digitorum longus Toe flexion Flexor digitorum brevis Flexor digitorum longus Flexor hallucis brevis Flexor hallucis longus Flexor digiti minimi brevis Quadratus plantae Lumbricals Toe extension Extensor digitorum brevis Extensor digitorum longus Extensor hallucis longus Toe abduction Abductor hallucis Dorsal interrosi Abductor digiti minimi Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter Toe14: The Foot and Toes, adduction Adduction hallucis Page 4 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Plantar Notice interossi Accessibility Access Provided by: TABLE 14–1 Muscles of the Foot Adduction and supination Tibialis posterior Flexor digitorum longus Flexor hallucis longus Tibialis anterior Extensor hallucis longus Abduction and pronation Fibularis longus Fibularis brevis Fibularis tertius Extensor digitorum longus Toe flexion Flexor digitorum brevis Flexor digitorum longus Flexor hallucis brevis Flexor hallucis longus Flexor digiti minimi brevis Quadratus plantae Lumbricals Toe extension Extensor digitorum brevis Extensor digitorum longus Extensor hallucis longus Toe abduction Abductor hallucis Dorsal interrosi Abductor digiti minimi Toe adduction Adduction hallucis Plantar interossi PREVENTION OF FOOT INJURIES Understanding the foot's structure and mechanics, types of footwear (see Chapter 6), and surface concerns is important in preventing foot injuries.23 Particular attention should be given to athletes who may be predisposed to injuries caused by muscular or tendinous tightness or, conversely, weakness or hypermobility. Such situations, when recognized early, can usually be remedied by exercise, by the use of appropriate shoe inserts or orthotics, or by selecting appropriate shoes.25,29 orthotic A customdesigned insert that can be placed in the shoe and worn to correct a variety of biomechanical abnormalities that can potentially lead to injury. Many injuries to the foot can be prevented by using an orthotic device to correct biomechanical problems that may exist in the foot and that can potentially cause an injury.8 The orthotic is a plastic, rubber, or leather support that is placed in the shoe as a replacement for the existing insert.32 Readymade Downloadedorthotics 2024828 can be purchased 1:18 P Your IPin issporting goods or shoe stores. Some patients will need to have orthotics that are custom fitted or made by 149.150.236.147 the athletic Chapter 14:trainer, The Footphysical therapist, or podiatrist. Athletes who have abnormal foot stresses caused by faulty mechanics may find the usePage and Toes, of custom 5 / 26 ©2024 McGraw Hill. All orthotics to be helpful.29 Rights Reserved. Terms of Use Privacy Policy Notice Accessibility Strengthening, stretching, and mobility exercises should be performed routinely by athletes in sports that place a great deal of stress and strain on the lead to injury. Many injuries to the foot can be prevented by using an orthotic device to correct biomechanical problems that may exist in the foot Access and that canby: Provided potentially cause an injury.8 The orthotic is a plastic, rubber, or leather support that is placed in the shoe as a replacement for the existing insert.32 Readymade orthotics can be purchased in sporting goods or shoe stores. Some patients will need to have orthotics that are custom fitted or made by the athletic trainer, physical therapist, or podiatrist. Athletes who have abnormal foot stresses caused by faulty mechanics may find the use of custom orthotics to be helpful.29 Strengthening, stretching, and mobility exercises should be performed routinely by athletes in sports that place a great deal of stress and strain on the feet.18 The foot must continually adapt to the contact surface. Training on surfaces that are irregular and variable in resilience can ultimately serve to strengthen the foot over time. However, a nonyielding surface may in some cases overstress joints and soft tissue, eventually leading to an acute or chronic pathological condition in the foot or somewhere in the kinetic chain. In contrast, a surface that is too resilient and absorbs too much of the impact energy may lead to early fatigue in sports such as basketball and indoor tennis.12 The majority of foot skin conditions are preventable.17 The athlete should be instructed on proper foot hygiene, which includes proper washing and drying of the feet following activity and changing to clean socks daily. Wearing properly fitting shoes and socks (see Chapter 6) should be emphasized. Not everyone has the same kind of foot and can wear the same type of shoe. Each individual should select a shoe that is most appropriate for him or her. Nearly all blisters, calluses, corns, and ingrown toenails are preventable. FOOT ASSESSMENT Generally, fitness professionals, coaches, and others working in areas related to exercise and sports science are not adequately trained to evaluate injuries. It is strongly recommended that injured athletes be referred to qualified medical personnel (i.e., physicians, athletic trainers, physical therapists) for injury evaluation. Information on the following special tests has been included simply to give some idea about the different basic tests that nonmedical personnel may do to determine the nature and severity of the athlete's injury. The primary responsibility of those who are not health care personnel is to be able to recognize any potential "red flags" associated with the injury, provide appropriate first aid for the injury, and make correct decisions about how the injury should be managed initially, including immediate return to play or activity decisions. (Refer to Chapter 8.) History When deciding how to manage a foot injury, nonmedical personnel must make an assessment to determine the type of injury and its history.4 The following questions should be asked: How did the injury occur? Did it occur suddenly or come on slowly? Was the mechanism a sudden strain, twist, or blow to the foot? What type of pain is there? Is there muscle weakness? Are there noises such as crepitus during movement? Is there any alteration in sensation? Can the athlete point to the exact site of pain? When is the pain or other symptoms more or less severe? On what type of surface has the athlete been training? What type of footwear was being used during training? Is it appropriate for the type of training? Is discomfort increased when footwear is worn? Is this the first time this condition has occurred, or has it happened before? If so, when, how often, and under what circumstances? Observation Downloaded 2024828 The athlete should 1:18 P toYour be observed IP is 149.150.236.147 determine the following: Chapter 14: The Foot and Toes, Page 6 / 26 ©2024 McGraw Whether Hill. he or sheAllisRights Reserved. favoring Terms of the foot, walking Use with Privacy a limp, Policyto bear or unable Notice Accessibility weight. Whether the injured part is deformed, swollen, or discolored. training? Is discomfort increased when footwear is worn? Is this the first time this condition has occurred, or has it happened before? If so, when, how often, and under what circumstances? Access Provided by: Observation The athlete should be observed to determine the following: Whether he or she is favoring the foot, walking with a limp, or unable to bear weight. Whether the injured part is deformed, swollen, or discolored. Whether the foot changes color when bearing weight and not bearing weight (changing rapidly from a darker to a lighter pink when not bearing weight). Whether the foot is well aligned and whether it maintains its shape when bearing weight. What the wear patterns look like on the sole of the shoe. Is there symmetry between the two shoes? Whether the athlete has a high arch (pes cavus) or a flat foot (pes planus). Palpation Palpation of the bony structures should be done first to check for deformities or areas of point tenderness. Palpation of the muscles and their tendons in the foot is essential to detect point tenderness, abnormal swelling or lumps, or muscle guarding.3 The dorsal pedal pulse, located on the anterior surface of the ankle and foot, should be palpated to check for normal circulation. point tenderness Pain that is produced when the site of injury is palpated. RECOGNITION AND MANAGEMENT OF FOOT INJURIES Retrocalcaneal Bursitis (Pump Bump) Cause of Injury The retrocalcaneal bursa lies between the calcaneus and the Achilles tendon on the back of the heel (Figure 14–6A). This bursa can become chronically irritated and inflamed by constant rubbing or pressure from the heel counter of a shoe.20 If inflammation continues for many months, a bone callus, or exostosis, is likely to form on the back of the heel (Figure 14–6B). This exostosis has been referred to as a pump bump. (A pump is a type of woman's shoe with a heel counter that tends to cross right over the retrocalcaneal bursa.) This condition should be differentiated from Sever's disease, which involves a chronic inflammation at the attachment of the Achilles tendon on the posterior calcaneus in young athletes. FIGURE 14–6 ( A ) The retrocalcaneal bursa between the attachment of the Achilles tendon and the calcaneus, becomes inflamed and eventually (B) develops a pump bump, which can be (C) protected using a doughnut pad. (B and C) ©William E. Prentice Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 7 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility FIGURE 14–6 ( A ) The retrocalcaneal bursa between the attachment of the Achilles tendon and the calcaneus, becomes inflamed and eventually (B) develops a pump Access Provided by: bump, which can be (C) protected using a doughnut pad. (B and C) ©William E. Prentice exostosis (eksostosis) A bony outgrowth. Sever's disease Chronic inflammation of Achilles tendon attachment. Signs of Injury All the signs of bursitis—tenderness, swelling, warmth, and redness—will be present and may progress eventually to a palpable and tender bony bump on the back of the calcaneus. Care A doughnuttype Downloaded 2024828 pad should 1:18 be constructed P Your and placed around the area of tenderness to disperse pressure created by the heel counter (Figure IP is 149.150.236.147 14–6C). Also, a heel lift can help to change the site of pressure. The athlete may also want to choose a shoe with a heel counter that is eitherPage Chapter 14: The Foot and Toes, a little8 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility higher or lower than the one presently being worn. Heel Bruise Sever's disease Chronic inflammation of Achilles tendon attachment. Signs of Injury All the signs of bursitis—tenderness, swelling, warmth, and redness—will be present and may progress eventuallyAccess to a palpable Provided by: and tender bony bump on the back of the calcaneus. Care A doughnuttype pad should be constructed and placed around the area of tenderness to disperse pressure created by the heel counter (Figure 14–6C). Also, a heel lift can help to change the site of pressure. The athlete may also want to choose a shoe with a heel counter that is either a little higher or lower than the one presently being worn. Heel Bruise Cause of Injury Of the many contusions and bruises that an athlete may receive, none is more disabling than the heel bruise on the bottom of the calcaneus.30 Sport activities that demand a sudden stopandgo response or a sudden change from a horizontal to a vertical movement, such as basketball jumping, high jumping, and vaulting in gymnastics, are particularly likely to cause heel bruises.30 The heel has a thick, cornified skin layer and a heavy fat pad covering, but even this thick padding cannot protect against a sudden abnormal force directed to this area. The athlete who is prone to heel bruises should routinely wear a padded heel cup. Signs of Injury When injury occurs, the athlete complains of severe pain in the heel and is unable to tolerate the stress of weight bearing. An acute bruise of the heel may progress to chronic inflammation of the bone covering (periosteum). Care Initially, cold is applied to the heel bruise, and if possible, the athlete should not step on the heel for at least 24 hours. If pain when walking has subsided by the third day, the athlete may resume moderate activity—with the protection of a heel cup or protective doughnut (Figure 14–7). An athlete who is prone to or who needs protection from a heel bruise should routinely wear a heel cup with a foam rubber pad as a preventive aid. Surrounding the heel with a firm heel cup diffuses traumatic forces and compresses the fat pad under the calcaneus, providing additional cushioning. This can also be accomplished by applying athletic tape as if it were a heel cup. FIGURE 14–7 Protection of a heel bruise using ( A ) a heel cup and (B) a felt doughnut pad. ©William E. Prentice 14–1 Critical Thinking Exercise A distance runner is complaining of pain that started on the bottom of her heel and now seems to also be bothering the long arch. She states that pain seems to be the worst in the morning when she first gets out of bed. ? What condition usually results in these complaints, and how should this problem be managed? Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 9 / 26 Plantar Fasciitis ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility Cause of Condition Heel pain is a very common problem in both the athletic and nonathletic populations. The plantar fascia runs the length of the Access Provided by: 14–1 Critical Thinking Exercise A distance runner is complaining of pain that started on the bottom of her heel and now seems to also be bothering the long arch. She states that pain seems to be the worst in the morning when she first gets out of bed. ? What condition usually results in these complaints, and how should this problem be managed? Plantar Fasciitis Cause of Condition Heel pain is a very common problem in both the athletic and nonathletic populations. The plantar fascia runs the length of the sole of the foot (refer to Figure 14–3). It assists in maintaining the stability of the foot and in supporting the medial longitudinal arch.26 A number of conditions have been studied as possible causes of plantar fasciitis. They include leg length discrepancy, inflexibility of the medial longitudinal arch, tightness of the gastrocnemiussoleus unit, wearing shoes without sufficient arch support, a lengthened stride during running, and running on soft surfaces.14 Signs of Condition The athlete complains of pain in the anterior medial heel, usually at the attachment of the plantar fascia to the calcaneus that eventually moves more centrally into the middle of the plantar fascia.8 This pain is particularly troublesome when the athlete rises in the morning or bears weight on the foot after sitting for a long period. However, the pain lessens after a few steps. Pain also is intensified when the toes and forefoot are forcibly dorsiflexed. Care Management of plantar fasciitis generally requires an extended period of treatment.16 It is not uncommon for symptoms to persist for as long as 8 to 12 weeks. Vigorous stretching of the gastrocnemius and soleus muscles and the Achilles tendon should be done, along with exercises to stretch the plantar fascia in the arch.10 Wearing a night splint that gently dorsiflexes the foot and stretches the plantar fascia during sleep is recommended and widely used (Figure 14–8).14 Use of a heel cup compresses the fat pad under the calcaneus and provides a cushion under the area of irritation (refer to Figure 14–7). A simple arch taping often allows painfree ambulation. Orthotic therapy is very useful in the treatment of this problem.2 In some cases, particularly during a competitive season, the athlete may continue to train and compete if symptoms and associated pain are not prohibitive. FIGURE 14–8 A night splint for plantar fasciitis is worn while sleeping. ©William E. Prentice Fractures of the Metatarsals Cause of Injury Fractures of the metatarsals can be caused by direct force, such as having the foot stepped on by another player, being kicked or kicking another object, or twisting or torsional stresses.5 The most common acute fracture is of the neck of the fifth metatarsal (Jones fracture).15 Signs of Injury It is very difficult to differentiate a fracture from a sprain of the metatarsal ligaments. Fractures of the metatarsals are characterized by Downloaded 2024828 1:18 P Your IP is 149.150.236.147 swelling and pain. A fracture may be more point tender, and occasionally it may be possible to palpate a deformity. The most definitive way to 10 / 26 Chapter 14: The Foot and Toes, Page ©2024 McGraw distinguish Hill. All a fracture fromRights Reserved. a sprain Terms is to get an of7Use Privacy Policy Notice Accessibility Xray. Fractures of the Metatarsals Cause of Injury Fractures of the metatarsals can be caused by direct force, such as having the foot stepped on by another player, being kicked or Access Provided by: kicking another object, or twisting or torsional stresses.5 The most common acute fracture is of the neck of the fifth metatarsal (Jones fracture).15 Signs of Injury It is very difficult to differentiate a fracture from a sprain of the metatarsal ligaments. Fractures of the metatarsals are characterized by swelling and pain. A fracture may be more point tender, and occasionally it may be possible to palpate a deformity. The most definitive way to distinguish a fracture from a sprain is to get an Xray.7 Throughout the remainder of this text, when the Dr. Icon appears, it signifies that for this condition the athlete should be referred to a physician for injury management. Care Treatment is usually symptomatic, with POLICE used to control swelling. Once swelling has subsided, a short leg walking cast is applied for 3 to 6 weeks. Ambulation is usually possible by the second week. A shoe with a large toe box should be worn.6 If there is a fracture of the metatarsal with displacement of the fractured bone, surgery might be necessary to reposition the fractured segment. Fifth Metatarsal Fracture (Jones Fracture) Cause of Injury A Jones fracture involves a fracture of the neck of the fifth metatarsal that can occur from overuse, acute inversion, or highvelocity rotational forces (Figure 14–9). A Jones fracture occurs most often as a consequence of a stress fracture.15 FIGURE 14–9 ( A ) A Jones fracture occurs of the neck of the fifth metatarsal. (B) Xray. (B) Courtesy of Jordan B. Renner, MD, Departments of Radiology and Allied Health Sciences, University of North Carolina Signs of Injury The athlete complains of a sharp pain on the lateral border of the foot and usually reports hearing a "pop." Because of a history of poor blood supply and delayed healing, a Jones fracture may result in nonunion, requiring an extended period of rehabilitation.31 Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 11 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility Care A Jones fracture of the fifth metatarsal usually requires a nonweightbearing short leg cast for 6 to 8 weeks for nondisplaced fractures.11 With cases of delayed union, nonunion, or especially displaced fractures, the Jones fracture requires internal fixation, with or without bone grafting. In Access Provided by: Signs of Injury The athlete complains of a sharp pain on the lateral border of the foot and usually reports hearing a "pop." Because of a history of poor blood supply and delayed healing, a Jones fracture may result in nonunion, requiring an extended period of rehabilitation.31 Care A Jones fracture of the fifth metatarsal usually requires a nonweightbearing short leg cast for 6 to 8 weeks for nondisplaced fractures.11 With cases of delayed union, nonunion, or especially displaced fractures, the Jones fracture requires internal fixation, with or without bone grafting. In the highly competitive athlete, immediate surgical internal fixation should be recommended.31 Second Metatarsal Stress Fractures Cause of Injury Second metatarsal stress fractures, also referred to as march fractures, occur most often in running and jumping sports. As with other overuse injuries in the foot, the most common causes include structural deformities in the foot, training errors, changes in training surfaces, and wearing inappropriate shoes.6 Morton's toe is a condition in which the first metatarsal is abnormally short, making the second toe appear longer than the great toe (Figure 14–10). In a normal walking gait, the first metatarsal bears most of the weight. However, because the first metatarsal in a Morton's toe is short, the second metatarsal must bear a greater percentage of the forces during walking and even greater forces in a running gait. Thus, a Morton's toe increases the chance of a stress fracture of the second metatarsal.5 FIGURE 14–10 In a Morton's toe, the first metatarsal is abnormally short. (right) ©William E. Prentice Signs of Injury The athlete usually complains of pain and point tenderness along the second metatarsal. Commonly, the athlete indicates the presence of pain during running and perhaps also during walking. The athlete may also feel ongoing pain and aching during nonweightbearing movements.6 Care Treatment for stress fractures should focus on determining the precipitating cause or causes and alleviating those that created the problem. Athletes with second metatarsal stress fractures tend to do well with modified rest and nonweightbearing exercises such as pool running or using an upperbody ergometer or stationary bike to maintain cardiorespiratory fitness for 2 to 4 weeks. These exercises are followed by the athlete's progressive return to running and jumping sports over a 2 to 3week period, using appropriate shoes. Metatarsal Arch Strain Cause of Injury Athletes with hypermobility of the metatarsals caused by laxity in the ligaments are prone to sprain of the metatarsal arch.4 Hypermobility allows the metatarsals in the foot to spread apart (splayed foot), giving the appearance of a fallen metatarsal arch.19 Fatigue, poor posture, overuse, excessive weight, or improperly fitting shoes may damage the supporting tissue of the arch. Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 12 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility Signs of Injury The athlete has pain or cramping in the metatarsal region. There is point tenderness, with signs of inflammation and weakness in the area. Pain in this region is called metatarsalgia.5 Although metatarsalgia is a general term to describe pain or cramping in the ball of the foot, it is Metatarsal Arch Strain Cause of Injury Athletes with hypermobility of the metatarsals caused by laxity in the ligaments are prone to sprain of the metatarsal arch.4 Access Provided by: Hypermobility allows the metatarsals in the foot to spread apart (splayed foot), giving the appearance of a fallen metatarsal arch.19 Fatigue, poor posture, overuse, excessive weight, or improperly fitting shoes may damage the supporting tissue of the arch. Signs of Injury The athlete has pain or cramping in the metatarsal region. There is point tenderness, with signs of inflammation and weakness in the area. Pain in this region is called metatarsalgia.5 Although metatarsalgia is a general term to describe pain or cramping in the ball of the foot, it is more commonly associated with pain under the second and sometimes the third metatarsal head. A heavy callus often forms in the area of pain. metatarsalgia (metahtarsalgeeah) Pain in the bottom of the foot. Care Treatment of acute metatarsalgia usually consists of applying a pad to elevate the depressed metatarsal heads. The pad is placed in the center and just behind the ball of the foot (metatarsal heads) (Figure 14–11). A daily regimen of exercise should concentrate on strengthening foot muscles and stretching the heel cord. FIGURE 14–11 A metatarsal bar (felt pad) placed just proximal to (behind) the metatarsal heads is used to reduce metatarsalgia (plantar view). ©William E. Prentice Longitudinal Arch Strain Cause of Injury Longitudinal arch strain is usually caused by subjecting the musculature on the plantar surface of the foot to unaccustomed stresses and forces when coming in contact with hard playing surfaces. In this condition, there is a flattening or depression of the longitudinal arch (pes planus) while the foot is in the midsupport phase, resulting in a strain to the arch.3 Such a strain may appear suddenly, or it may develop slowly over a considerable length of time. It should be added that some people have a congenital pes planus or pes cavus (high arch) that does not cause pain. pes planus 2024828 Downloaded (pees planis) 1:18 PFlat feet.IP is 149.150.236.147 Your Chapter 14: The Foot and Toes, Page 13 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility Signs of Injury As a rule, pain is experienced only when running is attempted and usually appears just below the medial malleolus and the posterior tibial tendon, accompanied by swelling and tenderness along the medial aspects of the foot. Prolonged strain will also involve the calcaneonavicular Cause of Injury Longitudinal arch strain is usually caused by subjecting the musculature on the plantar surface of the foot to unaccustomed stresses and forces when coming in contact with hard playing surfaces. In this condition, there is a flattening or depression of the longitudinal arch (pes planus) while the foot is in the midsupport phase, resulting in a strain to the arch.3 Such a strain may appear suddenly, or it may develop slowly over a Access Provided by: considerable length of time. It should be added that some people have a congenital pes planus or pes cavus (high arch) that does not cause pain. pes planus (pees planis) Flat feet. Signs of Injury As a rule, pain is experienced only when running is attempted and usually appears just below the medial malleolus and the posterior tibial tendon, accompanied by swelling and tenderness along the medial aspects of the foot. Prolonged strain will also involve the calcaneonavicular ligament and first cuneiform with the navicular. The flexor muscle of the great toe (flexor hallucis longus) often develops tenderness as a result of overuse in compensating for the stress on the ligaments. Many people have what appears to be a flat foot or a fallen longitudinal arch with no associated symptoms or pain whatsoever. In these cases, the rule that should always be followed is "If it's not broken, don't try to fix it" (Figure 14–12). FIGURE 14–12 Fallen medial longitudinal arch. ©William E. Prentice As long as an existing condition in the foot is not causing pain, don't try to fix it. Care The management of a longitudinal arch strain involves immediate care consisting of POLICE (see Chapter 8) followed by appropriate therapy and reduction of weight bearing. Weight bearing must be performed painfree. Arch taping might be used to allow earlier painfree weight bearing. Fractures and Dislocations of the Toes (Phalanges) Cause of Injury Fractures of the phalanges may be incurred by kicking an object, stubbing a toe, or dropping a heavy object on the toes. Signs of Injury Generally, fractures and dislocations of the phalanges are accompanied by swelling and discoloration. If the fracture is to the proximal phalanx of the great toe or to the distal phalanx and also involves the interphalangeal joint, the injury should be referred to a physician. Fractures and dislocations of the toes can be caused by kicking an object or stubbing a toe. 14–2 Critical Thinking Exercise A field hockey player complains of swelling, tenderness, and aching in the head of the first metatarsophalangeal joint of her left foot. On inspection, the great toe is deviated laterally. ? What is this condition commonly called, and why does it occur? Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 14 / 26 Care If the break is in the bone shaft, adhesive tape is applied. However, if more than one toe is involved, a cast may be applied for a few days. As a rule, ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility 3 or 4 weeks of inactivity permit healing, although tenderness may persist for some time. A shoe with a wide toe box should be worn; in cases of great– toe fracture, a stiff sole should be worn. Fractures and dislocations of the toes can be caused by kicking an object or stubbing a toe. Access Provided by: 14–2 Critical Thinking Exercise A field hockey player complains of swelling, tenderness, and aching in the head of the first metatarsophalangeal joint of her left foot. On inspection, the great toe is deviated laterally. ? What is this condition commonly called, and why does it occur? Care If the break is in the bone shaft, adhesive tape is applied. However, if more than one toe is involved, a cast may be applied for a few days. As a rule, 3 or 4 weeks of inactivity permit healing, although tenderness may persist for some time. A shoe with a wide toe box should be worn; in cases of great– toe fracture, a stiff sole should be worn. Dislocations of the phalanges are less common than fractures. If one occurs, it is usually a dislocation of the proximal joint of the middle phalanx. The mechanism of injury is the same as for fractures. Reduction is usually performed easily, without anesthesia, by a physician. Bunions (Hallux Valgus Deformity) Cause of Injury A bunion, also referred to as an exostosis, is a painful deformity of the head of the first metatarsal.27 A bunion involves bony enlargement of the head of the first metatarsal that progresses to the point at which the great toe becomes malaligned and moves laterally toward the second toe, sometimes to such an extent that it eventually overlaps the second toe, creating what is called a hallux valgus deformity (Figure 14–13).19 This type of bunion may also be associated with a depressed or flattened transverse arch. Often, the bunion occurs from wearing shoes that are pointed, too narrow, too short, or have high heels. A tailor's bunion or bunionette occurs on the fifth metatarsal head and causes the little toe to angulate toward the fourth toe. FIGURE 14–13 A hallux valgus deformity with a bunion. (top) ©William E. Prentice Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 15 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility angulate toward the fourth toe. FIGURE 14–13 Access Provided by: A hallux valgus deformity with a bunion. (top) ©William E. Prentice 14–3 Critical Thinking Exercise A soccer player complains of intermittent pain in the region between the third and fourth toes of the left foot. Pain, along with tingling and numbness, seems to radiate from the base to the tip of the toes during weight bearing. ? What condition usually causes these symptoms, and how can it be managed? Signs of Injury A bunion is one of the most frequent painful deformities of the great toe. As the bunion is developing, there is tenderness, swelling, and enlargement, with calcification of the head of the first metatarsal. Poorly fitting shoes increase the irritation and pain. Care Shoe selection plays an important role in the treatment of bunions. Shoes of the proper width cause less irritation to the bunion. Night splints have been recommended to correct the position of the great toe in skeletally immature patients but are not effective in the skeletally mature patient. Protective devices such as some type of doughnut pad over the bunion help disperse pressure, and tape can also be used. If the condition progresses, a special orthotic device may help normalize foot mechanics and significantly reduce the symptoms and progression of a bunion. Surgery to correct the hallux valgus deformity is very common during the later stages of this condition.19 Morton's Neuroma Cause of Condition A neuroma is a mass occurring in the common plantar nerve. It occurs most commonly between the third and fourth metatarsal heads, where the nerve is the thickest because it is receiving both branches from the medial and lateral plantar nerves (Figure 14–14).1 Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 16 / 26 FIGURE 14–14 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility A Morton's neuroma usually occurs between the third and fourth metatarsal heads. the hallux valgus deformity is very common during the later stages of this condition.19 Morton's Neuroma Access Provided by: Cause of Condition A neuroma is a mass occurring in the common plantar nerve. It occurs most commonly between the third and fourth metatarsal heads, where the nerve is the thickest because it is receiving both branches from the medial and lateral plantar nerves (Figure 14–14).1 FIGURE 14–14 A Morton's neuroma usually occurs between the third and fourth metatarsal heads. neuroma Enlargement of a nerve. Signs of Condition The athlete complains of severe intermittent pain radiating from the distal metatarsal heads to the tips of the toes; the pain is often relieved when the foot is not bearing weight.24 The athlete complains of a burning numbness in the forefoot that is often localized to the third web space and radiating to the toes.1 Hyperextension of the toes on weight bearing, as in squatting, stair climbing, or running, can increase the symptoms. Wearing shoes with a narrow toe box or high heel can increase the symptoms. Care Either a metatarsal bar (see Figure 14–11) is placed just proximal to the metatarsal heads, or a teardropshaped pad is placed between the heads of the third and fourth metatarsals in an attempt to have these toes splay apart with weight bearing (Figure 14–15).19 Shoe selection also plays an important role in treatment of neuromas. A shoe that is wide in the toe box area should be selected. FIGURE 14–15 A teardropshaped pad placed between the third and fourth metatarsal heads will spread them apart during weight bearing, taking pressure off the neuroma. ©William E. Prentice Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 17 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility FIGURE 14–15 A teardropshaped pad placed between the third and fourth metatarsal heads will spread them apart during weight bearing, takingAccess pressure off the Provided by: neuroma. ©William E. Prentice Turf Toe Cause of Injury Turf toe is a hyperextension injury resulting in a sprain of the great toe, either from repetitive overuse or trauma.22 Typically, these injuries occur on unyielding synthetic turf, although they can occur on grass also.21 Many of these injuries occur because artificial turf shoes often are more flexible and allow more dorsiflexion of the great toe. Some shoe companies have addressed this problem by adding steel or other materials to the forefoot of their turf shoes to stiffen them. A sprain of the great toe can also occur from kicking some nonyielding object.13 Care Flat insoles that have thin sheets of steel under the forefoot are available. When commercially made products are not available, a thin, flat piece of thermoplastic material may be placed under the shoe insole or may be molded to the foot. Taping the toe to prevent dorsiflexion may be done separately or in addition to one of the shoestiffening suggestions (refer to Figure 10–14). In less severe cases, the athlete can continue to play with the addition of a rigid insole. With more severe sprains, 3 to 4 weeks may be required for pain to subside to the point at which the athlete can push off on the great toe.21 Calluses Cause of Condition Foot calluses may be caused by shoes that are too narrow or too short. Calluses that develop from friction can be painful because the fatty layer loses its elasticity and cushioning effect. The excess callus moves as a gross mass, becoming highly vulnerable to tears, cracks, and, ultimately, infections.17 It is not uncommon for blisters to develop underneath a callus. Care Athletes who are prone to excess calluses should be encouraged to use an emery callus file after each shower. Massaging small amounts of an emollient such as skin lube or Aquaphor or vaseline into devitalized calluses once or twice a week after practice may help maintain some tissue elasticity. The coach may have the athlete decrease the calluses' thickness and increase their smoothness by sanding or pumicing. NOTE: Great care should be taken not to remove the callus totally and the protection it affords at a given pressure point. Athletes whose shoes are properly fitted but who still develop heavy calluses commonly have faulty foot mechanics that may require special orthotics. Special cushioning devices such as wedges, doughnuts, and arch supports may help to distribute the weight on the feet more evenly and thus reduce skin stress. Excessive callus accumulation can be prevented by (1) wearing at least one layer of socks, (2) wearing shoes that are the correct size and in good condition, and (3) routinely applying materials such as petroleum jelly to reduce friction. Blisters Cause of Injury As a result of shearing forces acting on the skin, blisters develop in which fluid accumulates below the outer skin layer. This fluid may be clear or bloody. Soft feet, coupled with this shearing skin stress, can produce severe blisters. The application of a skin lubricant can protect the skin against abnormal friction. Wearing socks with no folds or wrinkles can protect the athlete with sensitive skin or the one who perspires excessively.17 Wearing the correctsize shoe is essential. Shoes should be broken in before being worn for long periods. Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The 14–4 Critical Foot and Thinking Toes, Exercise Page 18 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility A football player who both practices and plays on artificial turf complains of pain in his right great toe. Cause of Injury As a result of shearing forces acting on the skin, blisters develop in which fluid accumulates below the outer skin layer. This fluid may be clear or bloody. Soft feet, coupled with this shearing skin stress, can produce severe blisters. The application of a skin lubricant can protect the skin against abnormal friction. Wearing socks with no folds or wrinkles can protect the athlete with sensitive skin or the one who perspires Provided by: 17 excessively. Access Wearing the correctsize shoe is essential. Shoes should be broken in before being worn for long periods. 14–4 Critical Thinking Exercise A football player who both practices and plays on artificial turf complains of pain in his right great toe. ? What type of injury frequently occurs to the great toe when competing on artificial turf? Care If a blister or hot spot arises, the athlete has several options: (1) Cover the irritated skin with a frictionproofing material, such as skin lubricant; (2) cover the blister with an adhesive bandage; or (3) apply a doughnut pad that surrounds the blister. When caring for a blister, there is always a possibility of infection from contamination. Any blister that appears to be infected requires medical attention. In sports, two approaches are generally used to care for blisters. The conservative approach is that a blister should not be contaminated by cutting or puncturing but should be protected from further insult by a small doughnut until the initial irritation has subsided (Figure 14–16). However, the pressure of the fluid inside the blister can often be extremely painful and in some cases debilitating. Puncturing may be necessary to allow the athlete to continue to play or practice but should be done only by athletic trainers or physicians. Focus Box 14–1 details the technique for opening a blister. Conservative care of blisters is preferred when there is little danger of tearing or aggravation through activity. A product called Second Skin by Spenco is widely used on blisters to provide a protective coating. FIGURE 14–16 A blister should be padded using a felt doughnut pad to take pressure off and provide relief. ©William E. Prentice FOCUS BOX 14–1 Downloaded Caring for a 2024828 torn blister1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 19 / 26 ©2024 McGraw 1. Cleanse the Hill. All and blister Rights Reserved.tissue surrounding Terms withofsoap Useand Privacy water;Policy Notice rinse with Accessibility an antiseptic. 2. If the blister is open, drain the fluid using a sterile gauze pad. Access Provided by: FOCUS BOX 14–1 Caring for a torn blister 1. Cleanse the blister and surrounding tissue with soap and water; rinse with an antiseptic. 2. If the blister is open, drain the fluid using a sterile gauze pad. 3. Apply antibiotic ointment under and around the loose skin; cover the area with a sterile dressing. 4. Apply a doughnut pad around the blister. 5. Change the dressing daily and check for signs of infection. 6. Within 2 or 3 days, or when the underlying tissue has hardened sufficiently, remove the dead skin by trimming as close as possible to the perimeter of the blister. ©juliardi/Getty Images Corns Cause of Condition The hard corn is the most serious type of corn. It is caused by the pressure of improperly fitting shoes, the same mechanism that causes calluses. Hammertoes and hard corns are usually associated; the hard corns form on the tops of the deformed toes. The soft corn is the result of a combination of wearing narrow shoes and excessive foot perspiration (Figure 14–17).17 FIGURE 14–17 ( A ) Hard corns appear on the top of a toe and are usually associated with hammertoes. (B) Soft corns usually appear between the fourth and fifth toes. (A) ©William E. Prentice; (B) Courtesy of Dr. Howard Kashefsky, Podiatry, University of North Carolina Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 20 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility FIGURE 14–17 ( A ) Hard corns appear on the top of a toe and are usually associated with hammertoes. (B) Soft corns usually appear between the fourth and fifth toes. Access Provided by: (A) ©William E. Prentice; (B) Courtesy of Dr. Howard Kashefsky, Podiatry, University of North Carolina Signs of Condition The soft corn usually forms between the fourth and fifth toes. A circular area of thickened, white, macerated skin appears between and at the base of the toes. There also appears to be a black dot in the center of the corn. Both pain and inflammation are likely to be present. Symptoms are local pain and disability, with inflammation and thickening of soft tissue. Care When caring for a soft corn, the best procedure is to have the athlete wear properly fitting shoes, keep the skin between the toes clean and dry, and decrease pressure by keeping the toes separated with gel or foam toe caps, cushions, or tubules. To treat a hard corn, the athlete should soak feet daily in warm, soapy water to soften the corn. To alleviate further irritation, the corn should be protected by a small felt or sponge rubber doughnut. Ingrown Toenails Cause of Condition An ingrown toenail is a condition in which the leading side edge of the toenail has grown into the soft tissue nearby, usually resulting in severe inflammation and infection (Figure 14–18).28 FIGURE 14–18 Ingrown toenail. Courtesy of Dr. Howard Kashefsky, Podiatry, University of North Carolina Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 21 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility Cause of Condition An ingrown toenail is a condition in which the leading side edge of the toenail has grown into the soft tissue nearby, usually resulting in severe inflammation and infection (Figure 14–18).28 Access Provided by: FIGURE 14–18 Ingrown toenail. Courtesy of Dr. Howard Kashefsky, Podiatry, University of North Carolina Signs of Condition The classic signs of infection are swelling, heat, aching, redness, and accumulation of pus. Care It is important that the athlete's shoes be of the proper length and width because continued pressure on a toenail can lead to serious irritation or cause it to become ingrown. In most cases, ingrown toenails can be prevented by trimming the nails correctly.28 The nail must be trimmed straight across and not curved so that its margins do not penetrate the tissue on the sides. Also, the nail should be left sufficiently long that it is clear of the underlying tissue but should be cut short enough that it is not irritated by either shoes or socks. Focus Box 14–2 details the care for an ingrown toenail. FOCUS BOX 14–2 Managing the ingrown toenail 1. Soak the toe in hot water (110°F to 120°F) (43.3°C to 48.8°C) for approximately 20 minutes, two or three times daily. 2. When the nail is soft and pliable, use forceps to insert a wisp of cotton under the edge of the nail and lift it from the soft tissue. 3. Continue this procedure until the nail has grown out sufficiently to be trimmed straight across. An ingrown toenail can easily become infected. If this occurs, the athlete should be immediately referred to a physician for treatment. ©juliardi/Getty Images Blood Under the Toenail (Subungual Hematoma) Cause of Injury Blood can accumulate under a toenail as a result of the toe being stepped on, of dropping an object on the toe, or of kicking another object. Repetitive shearing forces on toenails, as may occur in the shoe of a longdistance runner, may also cause bleeding into the nail bed. In any case, blood that accumulates in a confined space underneath the nail is likely to produce extreme pain and can ultimately cause loss of Downloaded 14–19).9 1:18 P Your IP is 149.150.236.147 2024828 the nail (Figure Chapter 14: The Foot and Toes, Page 22 / 26 ©2024 McGraw FIGURE 14–19 Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility A subungual hematoma is blood accumulating under the nail. ©William E. Prentice Access Provided by: Cause of Injury Blood can accumulate under a toenail as a result of the toe being stepped on, of dropping an object on the toe, or of kicking another object. Repetitive shearing forces on toenails, as may occur in the shoe of a longdistance runner, may also cause bleeding into the nail bed. In any case, blood that accumulates in a confined space underneath the nail is likely to produce extreme pain and can ultimately cause loss of the nail (Figure 14–19).9 FIGURE 14–19 A subungual hematoma is blood accumulating under the nail. ©William E. Prentice Signs of Injury Bleeding into the nail bed may be either immediate or slow, producing considerable pain. The area under the toenail assumes a bluishpurple color, and gentle pressure on the nail greatly exacerbates pain.9 Care An ice pack should be applied immediately, and the foot should be elevated to decrease bleeding. Within the next 12 to 24 hours, the pressure of the blood under the nail should be released by drilling a small hole though the nail into the nail bed.9 If available, a hightemperature cauterizing pen can be used to burn this hole. This drilling must be done under sterile conditions and is best done by either a physician or an athletic trainer. It is not uncommon to have to drill the nail a second time, because more blood is likely to accumulate. SUMMARY The human foot must function both to absorb forces and to provide a stable base of support during walking, running, and jumping. The 26 bones in the foot are held together by an intricate network of ligaments and fascia and are moved by a complex group of muscles. Foot injuries may be prevented by selecting appropriate footwear and using various orthotic devices inserted into the shoe to protect the foot from abnormal forces, stresses, and strains. A pump bump develops from chronic retrocalcaneal bursitis on the back of the heel. Plantar fasciitis is pain in the anterior medial heel, usually at the attachment of the plantar fascia to the calcaneus. Orthotics, in combination with stretching exercises, can significantly reduce pain. A Jones fracture is a fracture of the neck of the fifth metatarsal that often results in delayed healing. The most common stress fracture in the foot involves the second metatarsal (march fracture). Metatarsal and longitudinal arch sprains are best treated by inserting appropriate support pads into the shoes. A bunion is a deformity of the head of the first metatarsal, in which the large toe assumes a hallux valgus position. Downloaded 2024828 1:18 P Your IP is 149.150.236.147 To treat Chapter a Morton's 14: The neuroma, Foot and Toes, a metatarsal bar is placed just proximal to the metatarsal heads, or a teardropshaped pad is placed between the Page 23 / 26 heads of the third and fourth metatarsals in an attempt to have these toes splay apart with ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility weight bearing. Turf toe is a hyperextension injury resulting in a sprain of the great toe. The most common stress fracture in the foot involves the second metatarsal (march fracture). Metatarsal and longitudinal arch sprains are best treated by inserting appropriate support pads into the shoes. Access Provided by: A bunion is a deformity of the head of the first metatarsal, in which the large toe assumes a hallux valgus position. To treat a Morton's neuroma, a metatarsal bar is placed just proximal to the metatarsal heads, or a teardropshaped pad is placed between the heads of the third and fourth metatarsals in an attempt to have these toes splay apart with weight bearing. Turf toe is a hyperextension injury resulting in a sprain of the great toe. The foot within the shoe can sustain forces that produce calluses, blisters, corns, or ingrown toenails. SOLUTIONS TO CRITICAL THINKING EXERCISES 141 These complaints are most typically associated with plantar fasciitis, which can be treated with a combination of vigorous stretching of the gastrocnemius and soleus muscles and the Achilles tendon, stretching the plantar fascia in the arch, using a heel cup, arch taping, and using an orthotic with increased arch support. 142 This condition is a bunion or hallux valgus deformity. It is associated with wearing shoes that are too pointed, narrow, or short. It may begin with an inflamed bursa over the metatarsophalangeal joint. It can be associated with a depressed transverse arch or a pronated foot. 143 Most likely the athlete has a Morton's neuroma. A metatarsal bar or a teardropshaped pad applied in the correct position on the sole of the foot can help to spread the metatarsal heads apart and take pressure off the neuroma, reducing the symptoms. 144 A sprain of the great toe is often referred to as turf toe. It results from a hyperextension of the great toe and usually occurs in athletes playing on artificial turf. REVIEW QUESTIONS AND CLASS ACTIVITIES 1. Briefly describe the anatomy of the foot. 2. In evaluating an acute condition in the foot region, what general observations can be made? 3. What measures can be taken to prevent foot injuries? 4. What is the relationship between a pump bump and retrocalcaneal bursitis? 5. What is a Jones fracture, and why does it take so long to heal? 6. How is it possible for a heel bruise to lead to plantar fasciitis? 7. How are stress fractures of the second metatarsal managed? 8. Discuss how various arch sprains can be treated. 9. What injuries might result from wearing shoes that are too tight? 10. How does a Morton's toe differ from a Morton's neuroma? 11. How would you care for a chronic case of turf toe? 12. What is the recommended procedure in caring for a blister on the foot? RECOMMENDED REFERENCES 1. Adams, I. 2010. Morton's neuroma. Clinics in Podiatric Medicine and Surgery 27(4):535–545. [PubMed: 20934103] 2. Anderson, J., & Stanek, J. 2013. Effect of foot orthoses as treatment for plantar fasciitis or heel pain. Journal of Sport Rehabilitation 22(2):130–136. [PubMed: 23037146] Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The 3. Anderson, Foot Foot M. 2013. and Toes, and ankle sports medicine. Journal of Orthopedic and Sports Physical Therapy 43(10):762–763. Page 24 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility 4. Anderson, R. 2010. Management of common sportsrelated injuries about the foot and ankle. Journal of the American Academy of Orthopedic Surgeons 18(10):546–556. RECOMMENDED REFERENCES 1. Adams, I. 2010. Morton's neuroma. Clinics in Podiatric Medicine and Surgery 27(4):535–545. [PubMed: 20934103] Access Provided by: 2. Anderson, J., & Stanek, J. 2013. Effect of foot orthoses as treatment for plantar fasciitis or heel pain. Journal of Sport Rehabilitation 22(2):130–136. [PubMed: 23037146] 3. Anderson, M. 2013. Foot and ankle sports medicine. Journal of Orthopedic and Sports Physical Therapy 43(10):762–763. 4. Anderson, R. 2010. Management of common sportsrelated injuries about the foot and ankle. Journal of the American Academy of Orthopedic Surgeons 18(10):546–556. 5. Blitch, T. 2009. Clinical practice guidelines: Diagnosis and treatment of forefoot disorders (Sections 1–4). Journal of Foot and Ankle Surgery 48(2):230–272. 6. Boutefnouchet, T. 2014. Metatarsal fractures: A review and current concepts. Trauma 16(3):147–163. 7. Brukner, P. 2016. Foot pain: Sports injuries. In P. Brukner, & B. Carlsen (eds.), Clinical sports medicine , 5th ed. Sydney: McGrawHill. 8. Cornwall, M. 2013. Evaluation of foot mobility and orthotic intervention. Journal of Orthopedic and Sports Physical Therapy 43(3):A6–7. 9. Dean, B., Becker, G., & Little, C. 2012. The management of the acute traumatic subungual haematoma: A systematic review. Hand Surgery 17(1):151– 154. [PubMed: 22351556] 10. Feinblatt J. 2014. Plantar fasciitis/fasciosis. In T. Philbin (ed.), Sports injuries of the foot: Evolving diagnosis and treatment. New York, NY: Springer. 11. Ferguson, K., & McGlynn, J. 2015. Fifth metatarsal fractures: Is routine followup necessary? Injury 46(8):1664–1668. [PubMed: 26052051] 12. Fields, K. 2010. Prevention of running injuries. Current Sports Medicine Reports 9(3):176–182. [PubMed: 20463502] 13. Garras, D. 2014. Turf toe. In T. Philbin (ed.), Sports injuries of the foot: Evolving diagnosis and treatment. New York, NY: Springer. 14. Goff, J. 2011. Diagnosis and treatment of plantar fasciitis. American Family Physician 84(6):676–682. [PubMed: 21916393] 15. Granata, J., 2014. Fractures of the fifth metatarsal. In T. Philbin (ed.), Sports injuries of the foot: Evolving diagnosis and treatment. New York, NY: Springer. 16. Hertel, J., & Fraser, J. 2017. Utilization of physical therapy intervention among patients with plantar fasciitis in the United States. Journal of Orthopaedic & Sports Physical Therapy 47(2):49–55. 17. Hsu, A. 2012. Topical review: Skin infections in the foot and ankle patient. Foot and Ankle International 33(7):612–619. [PubMed: 22835400] 18. Hunt, K. 2013. Foot and ankle injuries in sport. Clinics in Sports Medicine 32(3):525–557. [PubMed: 23773880] 19. Hunter, S., Prentice, W., & Zinder, S. 2015. Rehabilitation of ankle and foot injuries. In W. Prentice (ed.), Rehabilitation techniques in sports medicine and athletic training , 6th ed. Thorofare, NJ: Slack. 20. Lohrer, H., & Nauck, T. 2014. Retrocalcaneal bursitis but not Achilles tendinopathy is characterized by increased pressure in the retrocalcaneal bursa. Clinical Biomechanics 29(3):283–288. [PubMed: 24370462] 21. Mann, R. A. 2007. Great toe disorders. In D. Porter (ed.), Baxter's The foot and ankle in sports. St. Louis, MO: Mosby. 22. McGraw, E. 2008. Turf toe. Coach & Athletic Director 77(7):34. 23. McKinney, F. 2012. The sporting foot and ankle: An introduction to sportspecific foot and ankle injuries. SportEx Dynamics 34:10–14. 24. Metzl, J. 2008. Morton's neuroma: A common cause of foot pain. Triathlete 293:30. Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 25 / 26 25. Mills,McGraw ©2024 K. 2010.Hill. FootAllorthoses and gait: A systematic Rights Reserved. review Terms of Use and metaanalysis Privacy of literature Policy Notice pertaining to potential mechanisms. British Journal of Accessibility Sports Medicine 44(14):1035–1046. [PubMed: 19996330] 22. McGraw, E. 2008. Turf toe. Coach & Athletic Director 77(7):34. Access Provided by: 23. McKinney, F. 2012. The sporting foot and ankle: An introduction to sportspecific foot and ankle injuries. SportEx Dynamics 34:10–14. 24. Metzl, J. 2008. Morton's neuroma: A common cause of foot pain. Triathlete 293:30. 25. Mills, K. 2010. Foot orthoses and gait: A systematic review and metaanalysis of literature pertaining to potential mechanisms. British Journal of Sports Medicine 44(14):1035–1046. [PubMed: 19996330] 26. Norris, C. 2017. Plantar fasciitis: A pain in the heel. CoKinetic Journal 7(1):14–20. 27. Ng, M. 2016. A revolutionary way to approach correction of deformity—Hallux valgus (bunion). Physiotherapy 102:e192. 28. Park, D., & Singh, D. 2012. The management of ingrowing toenails. British Medical Journal 344:e2089. [PubMed: 22491483] 29. Richter, R. 2011. Foot orthoses in lower limb overuse conditions: A systematic review and metaanalysis. Journal of Athletic Training 46(1):103– 106. [PubMed: 21214358] 30. Rosenbaum, A. 2014. Plantar heel pain. Medical Clinics of North America 98(2):349–352. 31. Thevendran, G. 2013. Fifth metatarsal fractures in the athlete: Evidence for management. Foot and Ankle Clinics 18(2):237–254. [PubMed: 23707176] 32. Werd, M., & Knight, L. 2017. Athletic footwear and orthoses in sports medicine. New York, NY: Springer. ANNOTATED BIBLIOGRAPHY Altchek, D. 2012. Foot and ankle sports medicine. Baltimore, MD: Wolters Kluwer, Lippincott, Williams & Wilkins. More than 40 specialists in orthopedic surgery, podiatry, physiatry, physical therapy, and athletic training contributed to this book's contents, making it a comprehensive and practical resource for the treatment of foot and ankle sports injuries. Philbin, T. 2014. Sports injuries of the foot: Evolving diagnosis and treatment : NY: New York, Springer. This book focuses on sports injuries of the foot and succeeds in both covering the most common injuries and reviewing the gamut of how to treat these common injuries from office to operating room to rehabilitation. Porter, D., & Schon, L. 2007. Baxter's The foot and ankle in sports. St. Louis, MO: Mosby. A complete medical text on all aspects of the foot and ankle. It covers common sports syndromes, anatomical disorders in sports, unique problems, shoes, orthoses, and rehabilitation. Vonhof, J. 2016. Fixing your feet: Prevention and treatment for athletes. Birmingham, AL: Wilderness Press. This comprehensive resource covers footwear basics, prevention, and treatments along with clear diagrams, photos, and charts that demonstrate techniques and solutions. Werd, M., & Knight, L. 2017. Athletic footwear and orthoses in sports medicine. New York, NY: Springer. This practical resource provides a concise and logical approach to prescribing footwear that will maximize performance and minimize injury in athletes. This second edition includes an expanded section on running footwear and additional sportsspecific recommendations. WEBSITES American Podiatric Medical Association: www.apma.org Provides a variety of information on foot and ankle injuries, from the APMA. Foot Injuries Foot Disorders MedlinePlus: www.medlineplus.gov Foot pain Causes Mayo Clinic: www.mayoclinic.org/symptoms/footpain/basics/causes/sym20050792 Downloaded 2024828 1:18 P Your IP is 149.150.236.147 Chapter 14: The Foot and Toes, Page 26 / 26 ©2024 McGraw Hill. All Rights Reserved. Terms of Use Privacy Policy Notice Accessibility

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