1. metatarsal arch

2. transverse arch

3. medial longitudinal arch

4. lateral longiudinal arch

1. Stance Phase: support phase which starts at initial heel strike and ends at toe-off. Accounts for 60% of gait cycle. Involves weight bearing in closed kinetic chain. 

2. swing or recovery phase which represents time from toe-off to heel strike. Period of non weight bearing

(intial swing, mid swing, terminal swing)

-major cause of stress injuries due to overload 

-results in loose foot

-causes more pressure on metatarsals and tibial rotation at knee

-will not allow foot to resupinate=less powerful and less effecient force produced 

-weight absorption on 1 and 5th metatarsals and inefficient ground reaction force absorption

-limits internal rotation and can lead to inversion sprains

-tibial stress syndrome 

1. select appropriate footwear

2. correcting biomechanical structurla deficiencies through orthotics

3. practice good hygiene 

1. History: questions specific to the foot-more pain when wearing footwear, location of pain, training surfaces

2. Observations: walking paterns, color, weight bearing

3. pulses: insure proper circulation

4. morton's test

Assessed at...

1. posterior tibial: inside of ankle 

2. dorsalis pedis arteries: top of foot

-Transverse pressure applied to heads of metatarsals causing pain in forefot

-positive sign may indicate neuroma or metatarsalgia

• occurs from jump or fall, may present as posterior tibialis tendinitis
• immediate swelling, pain and inability to bear weight
• RICE, refer for X-Ray
• Non-displaced fracture immobilization and early ROM exercises when pain and swelling subside 

• Occurs due to repetitive trauma and is characterized by sudden onset in plantar-calcaneal area
• weight bearing at heel strike causes pain, pain continues following exercise.
• may require bone scan for diagnosis
• rest, non-weight bearing cardio training, gradual return to activity 

Apophysitis of the Calcaneus 

(Sever's Disease)

• Traction injury at apophysis of calcaneus, where Achilles attaches
• pain occurs at posterior heel below Achilles attachment in adolescent athletes
• pain occurs during and after activity
• best treated with ice, rest, streatching and NSAID's possibly a heel lift

Retrocalcaneal Bursitis

(pump Bump)

• inflammation of bursa beneath Achilles tendon
• result of pressure and rubbing of shoe heel 
• chronic condition that develops over time
• pain with palpation, swelling on both sides of heel cord
• RICE and NSAID's used, ultrasound to reduce inflammation, stretching Achilles, heel lifts, donut pad

• caused by sudden starts and stops or direction changes--irritation of fat pad
• severe pain in heel and is unable to withstand stress or weight
• warmth and redness over tender area
• reduce weight bearing, RICE, NSAID's, heel cup or doughnut pad

• area behind medial malleolus 
• any condition that compromses tibialis posteior, flexor hallucis longus, flexor digitorium, tibial nerve, artery or vein
• may result from previous fracture, tenosynovitis, acute trauma or excessive pronation 
• pain and paresthesia along medial and plantar aspect of foot, motor weakness and atrophy may result
• NSAID's and orthotics--possibly surgery

Tarsometatarsal Fracture Dislocation

(Lisfranc Injury) 

• Occurs when foot hyperplantarflexed without foot already plantaflexed and rear foot locked resulting in dorsal displacement of metatarsal bases
• pain and inability to bear weight, swelling
• possible metatarsal fractures, sprains of 4th and 5th tarsometatarsal joints
• key to treatment is recognition, realignment and maintaining stability
• generally requires open reduction with fixation

Pes Planus Foot

(flat foot)

• associated with excessive pronation, being overweight, excessive exercise
• pain, calcaneal eversion, bulging navicular, flattening of medial longitudinal arch or possibly NONE. 

Pes Cavus 

(High Arch foot)

• high arch, excessive supination
• poor shock absorption, heavy callus development on ball and heel of foot, ankle rolls are common
• stretch Achilles and plantar fascia

• short 1st metatarsal
• more weight bearing on 2nd toe as result 
• can impact gait
• callus development under 2nd metatarsal head
• no symptoms=no treatment
• symptoms=orthotics

• caused by increased stress on arch, flattening of foot during midsupport phase
• pain with running and jumping, sprained calcaneonavicular ligament
• immidate care, RICE, crutches 24-48 hours, no weight bearing

• common in athletes and nonathletes
• pain in proximal arch and heel
• increased tension and stress on fascia
• change from rigid supportive footwear to flexible footwear
• poor running technique, excessive pronation, running on soft surfaces, shoes with poor support
• pain in anterior medial heel along medial longitudinal arch, increased pain in morning, increased pain with dorsiflexion

• fracture of metatarsal caused by inversion and plantar flexion, direct force, or repetitive trauma
• base of 5th tarsal
• immediate swelling pain over 5th metatarsal
• surgery, internal fixation
• doesnt heal well on its own

• 2nd metatarsal fracture = MARCH fracture
• usually in 2nd 3rd and 4th 
• repeated loading on bone
• dull ache during exercise, pain at rest, progresses from diffusion to localized pain
• rest and reduced weight bearing
• gradual return to running 
• orthotics used to correct excessive pronation

Bunion

(Hallux Valgus Deformity)

• exostosis of 1st metatarsal head
• narrow shoes usually=bursa inflammation and thickness
• tender, swollen, enlarged, ambulation
• wear correct fitting shoes, orthotics, pad over 1st metatarsal, tape splint between 1st and 2nd toe, 
• bunionectomy

• repetitive hyperextension of great toe resulting in inflammation
• treat with orthotic devices--metatarsal pads, arch supports and metatrsal bars

• pain in ball of foot
• transverse arch flattened
• elevate depressed metatarsal heads, remove excessive callus build-up, stretch 

Morton's Neuroma

• Thickening of nerve sheath
• burning paresthesia and severe intermittent pain in forefoot
• teardrop pad--brings arch up and controls inflammation

• Kicking non-yielding object
• pushes joint beyond normal ROM
• immediate pain-intense and short 
• sswelling and discoloration 
• RICE, buddy taping to immobilize, 

Great Toe Hyperextension

(Turf Toe)

• hyperextension injury--sprain of 1st metatarsophalangeal joint
• may be result of single or repetitive trauma
• increase rigidity of forefoot region in shoe

• kicking, stubbing toe, stepped on
• dislocations less common than fractures
• dislocations reduced by physician, casting or buddy taping

• bone spurs on dorsal aspect of 1st meta. joint =loss of dorsiflexion
• lateral foot rolling
• forced dorsiflexion causes pain, walking is awkward due to weight on lateral aspect of foot
• stiffer shoe with large toe box, orthotics
• nsaids

• hammer: flexible deformity that becomes fixed to to contraction in joint PIP joint
• mallet: flexion contracture of DIP 
• claw: flexion of DIP joint hyperextension at MP joint
• wearing short shoes over and exended period of time
• MP DIP and PIP can be fixed
• wearing shoes with more room shave callus, use padding or tape, surgery