Fractures: Results from direct trauma or overuse. There are two types of fracture: acute fractures, due to a compressive, rotational, tensile or crushing force, and stress fractures, which are a more prolonged stressor due to malalignment or a biomechanical abnormalitie.

Fractures of the foot and toes include:

Fore foot: - Phalanegeal,  Metatarsal Fractures

Mid foot:  - Cuneiform, Cuboid, Navicular Fractures

Hind foot: -Talus, Calcaneous (Heel) Fractures

Assessment:-Look for swelling, redness, open wounds, crepitus and deformity.

                                 - Use uninjured foot as comparison.

                                 - Palpate for pulses, instability and tenderness.

                                 - Test motor and sensory functions.

                        - Percussion/ Tap test

                        - Capillary refill

Treatment:    - Rest

                                - Avoid strenuous activity

                                - Casting, splinting, stiff-soled shoe.

                                - Surgery, especially if a piece of bone is badly displaced.

Plantar Fasciitis: The inflammation of the plantar fascia located on the bottom of the foot. Occurs as severe pain in the heel. Due to overuse with too much weight bearing and not having enough arch support.

Assessment: - Palpate inflammation of plantar fascia.

                          - Check range of motion of foot.

                          - Tinel's sign to check that there is no tarsal tunnel syndrome with it.

Treatment:     - NSAID's to decrease inflammation.

                          - Taping

                          - R.I.C.E. : rest, ice, compression and elevation.

                          - Arch support inserts.

Tarsal Tunnel Syndrome: Due to compression of the posterior tibial nerve within the tarsal tunnel. May be associated with acute trauma, plantar fasciitis, fracture,  dislocation or inflammation.  Those with arthritis or diabetes may be more likely to get it.

Assessment: -Tenderness in tarsal tunnel area when palpated.

                         - Range of motion may be limited due to pain.

                         - Tinel sign would work to assess if it is nerve

                            inflammation.

Treatment:    - Rest and ice.

                         - Orthotics

                         - Immobilizaton

                         - NSAID's for inflammation.

                         -Surgery

MTP Joint Sprain: Due to sudden blunt force such as stubbing your toe. Causes pain and swelling.

Assessment: - Valgus and Varus testing of MTP joint, has great flexibility and pain.

                          - Decreased range of motion in hallux.

Treatment:     - Rest, Ice, Compression, Elevation.

                          - Soft shoes.

                          - Taping.

Hallux Rigidus: Is a form of degenerative athritis, or the wearing down of cartilage in a joint located at the joint at base of the big toe (Hallux). This wearing down of the cartilage leads to stiffness and pain. Leads to swelling and decreased mobility (walking, running) due to pain. Occurs in individuals with abnormalities or differences in biomechanics that change the way they walk. In addition, it can be acquired by overuse of the hallux or injury to it such as stubbing your toe.

Assessment: -Test range of motion of big toe

                          - Look for abnormanilities in appearance.

                          - X-Ray to see if athritis is present.

 

Treatment:     -Different shoes with a large toe area

                                  - NSAIDs to reduce inflammation

                                  - Orthotic devices

                                  - Physical Therapy

Hallux Valgus: Is a condition where there is a deformity in the big toe, due to its irregular placement.  The big toe, in this case, is deviated outwards where a bulge or bunion is seen.  A bunion is a painful swelling of a fluid-filled sac that forms at the base of the big toe.  This bulging or bunion is formed by the angle that is made between the first metatarsal which is deviated medially.  The big toe is thus, pulled laterally, or toward the toes of the ipsalateral foot.   Usually casued by the use of pointed high heel shoes, and can be linked with family history.

Assessment: Sharp pain at the joint, with limited range of motion.  Irritation of the bunion, with increased swelling in the in the area, will cause a widening of the foot and thus more pain.

Treatment:  To understand and treat the cause which can usually be from poor shoe wear or family history.  If shoes are causing the Hallux Valgus find appropriate and comfortable shoes.  This pathology is irreversible as long as the metatarsal has not been put on the sesamoid bones.  If this is not the case, surgery will be done to correct the big toes placement.

Sesamoiditis: Bruising and inflammation of sesamoid bones located beneath the hallux. It causes a very sharp pain much like stepping on a tack. Occurs in runners, mostly people who overpronate due to high arches.

Assessment: - Sharp pain when touched and inflammation of sesamoid bones.

Treatment:     - Simply to change your shoes to a softer sole so that there is less impact, or cut a hole where the sesamoid bones are.

Arch Pathologies: Typically a congenital defect but may be a result of trauma or disease. Intervention is only considered if the condition results in other biomechanic pathology leading to discomfort.

Pes Planus (Flat feet): This is the lowering of the medial longitudinal arch and results in changes affecting all planes of the foot, especially the subtalar and calcaneocuboid joints. The navicular drops and the talus tilts medially. Pes planus may be classified as flexible or rigid. In flexible flatfoot, an arch is present while the foot is not weight bearing and while standing tip-toed but is absent during weight bearing. This is common in children due to increased laxity of ligaments and underdevelopement of muscles which support the arch. Adults with congenitle laxity may therefore also display supple pes planus.  Rigid pes planus is the absence of the arch  during  non-weight bearing and may be due to tarsal coalation.  Tarsal coalition is a union between two or more tarsal bones from bone, fibrous or cartilaginous material and which reduces eternal rotation about the ankle. Pes planus may also result from injury to a structure which supports the arch such as the medial longitudinal ligament, plantar fascia, plantar ligaments, spring ligament, or tibialis anterior and posterior ligaments. Pes planus may increase the individuals liklihood of suffering from metatarsal stress fractures, ACL tears, and lower limb and back musculoskeletal problems. 

Assesment: -Test severity of of arch drop using navicular drop test or the Feiss' line test

                                 from non-weight bearing to weight bearing stance.

 -X-ray to determine bone alignment

Treatment:   -Orthotic shoe

                        -Surgery for talsal coalation

Pes Cavus (High arches): Frequently a congenital foot defect as a soft tissue deformity involving the plantar fascia or a bone deformity but may also result due to a peroneus longus versus tibialis anterior muscle imbalance or a motor neuron lesion. Claw toe is often associated with pes cavus. General stiffness and impaired shock absorbtion result from pes cavus and there is a predisposition to MT, femoral, and tibial stress fractures.

 Assesment: -Visual assesment

                        -X-ray to determine bone alignment

                                -ROM

                        -Neorological exam

Treatment:   -Symptomatic approach

                        -Soft orthotics to provide shock absorbtion and support

                        -Surgery to release bony and soft tissue