THE FOOT

319-351-1112

•    Establish protocol with the physician.

–  Bones, ligaments, musculo-tendinous attachments. 

–  Pathologies with all anatomy depending on the mechanism of injury.

Begin distal to proximal.

•    Great toe

–  Direct hit to great toe in field hockey

–  Posteriorly directed force at great toe

–  F.O.  Full footplate with toe cap

•    Turf toe

–  Carbon graphite insert to decrease extension of great toe

–  Rocker bottom shoe on involved side with accommodating lift on contralateral side

–  Possible bilateral F.O. to support midfoot

•    Toe fractures

–  Possible NWB acutely

–  Carbon graphite insert

–  Lift on shoes with toe roll

•     Mechanics of decreasing extension of toes

–  Second class lever

–  Plantar directed force at metatarsal heads

–  40% of  plantar force is loaded at first metatarsal head

–  15% of load is dispersed equally per lateral 4 metatarsal heads to equal 60% of load

–  Occurs only in straight line running

–  Which sports employ straight running?

–  As body moves laterally, the ground reaction forces increase dramatically at the first metatarsal head

•    Sesamoid injuries

–  Sesamoiditis is chronic once diagnosed

–  Provide accommodating F.O. with relief at first metatarsal head

–  Provide support to lateral 4 metatarsals

–  Good support to shaft of first ray

–  Caution for skin breakdown at medial longitudinal arch

•    Metatarsalgia

–  Pain at metatarsals

–  Provide F.O. with metatarsal pad

–  Bear plantar directed force to a broad area proximal to metarsal heads

•    Metatarsal fractures

–  Diagnose with X-ray and bone scan for stress fractures

–  Walking boot with F.O. to support metatarsals

–  Casting

–  Surgical intervention, i.e. Jones fracture with f/u orthotic mgt. via UCBL with rocker bottom shoe and accommodating lift on contralateral

•    Midfoot sprains

–  NWB depending on severity of sprain

–  Walking boot with MLA support

–  Possible UCBL for return to activity

–  Flexible vs. rigid driven by diagnosis

•    Navicular fracture

–  Surgical intervention

–  Casting

–  Boot with F.O.

–  Posterior leaf spring AFO

–  UCBL

–  F.O.

•    Talo-Navicular injuries

–  OCD secondary to high impact

–  As treatment progresses provide good MLA support

–  Rigid or semi-rigid secondary to diagnosis

•    Subtalar joint

–  Possible immobilization depending on severity

–  Walking boot with accomodating F.O. with hind foot, mid foot and forefoot control

–  Trailing with semi-rigid F.O. in sport specific shoe

•    Calcaneal injuries

–  Fat pad contusions

–  Multidurometer F.O.

–  F.O. with negative heel

–  F.O. with cushioned heel and firm arch

–  Rockerbottom shoe to decrease pressure at heel strike

•    Retro calcaneal bursitis

–  Heel elevation

–  Reduce pressure at heel counter of shoe with accommodative padding

•    Plantar Fasciitis

–  Good MLA support to reduce stress on P.F.

–  Change direction of stress, i.e. strap for tennis elbow or ChoPat strap for patellar tendonitis