Chapter 14 The Foot and Toes

CHAPTER 14
The Foot and Toes
OVERVIEW

Sports injuries occur frequently to the foot. The complicated anatomy requires a
great deal of strength, flexibility, and coordinated movement. Complaints about foot
injuries by athletes call for careful physical examination.
Common acute injuries are heel and instep bruises, arch strains, and sprains of
the midfoot, forefoot, and great toe. Fractures can occur to all areas of the foot.
Chronic and overuse foot conditions can lead to stress problems in the lower
extremities due to overcompensation. Common chronic problems occur to the
arches of the foot, toes, and forefoot. These problems include deformities such as
hammer or clawed toes, bony outgrowths, heel bursitis, heel spurs, tendinitis, and
stress fractures.
Those individuals that work with athletes should be well aware of potential foot
problems and should be capable of identifying, ameliorating, or preventing them
whenever possible.

LEARNING OBJECTIVES
After studying Chapter 14, the student should be able to:
Identify the bony anatomy of the foot.
Explain the steps taken in the assessment of the foot.
Identify the four arches of the foot.
Identify the muscles acting on the foot and describe their functions.
Identify those injuries in the foot that need immediate physician referral.
Identify steps that can be taken to minimize foot injuries.
Explain the causes of various foot injuries seen commonly in athletes and the
appropriate care for those injuries.
Describe the appropriate care for injuries incurred in the foot.

KEY TERMINOLOGY

Bunion painful deformity of the head of the first metatarsal which can cause
deformity of the great toe
Exostosis - Benign bony outgrowths that protrude from the surface of a bone and
usually are capped by cartilage
Hallux valgus deformity Malalignment of the great toe from a bunion that
moves the toe laterally and may cause overlap of the second toe
Jones fracture - Fracture at the base of the fifth metatarsal
March fracture - A stress fracture of the second metatarsal
Metatarsalgia - A general term used to describe pain in the ball of the foot
Mortons Neuroma Enlargement of the plantar nerve between the 3 rd and 4th
metatarsal heads
Mortons toe - A condition where the first metatarsal is abnormally short
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Chapter 14 The Foot and Toes

Neuroma Enlargement of a nerve

Pes planus - Flattening of the medial longitudinal arch
Pes Cavus Having a high medial longitudinal arch
Severs Disease Chronic inflammation of Achilles tendon at the attachment on
calcaneous
Subungual Hematoma Blood accumulated underneath a toenail

DISCUSSION QUESTIONS
1. What bones make up the foot? How are they arranged and what motions are
allowed between them?
2. What are the various arches of the foot? What are their functions?
3. What are the steps in evaluating a foot injury?
4. How can foot injuries be prevented?
5. What are some common injuries to the foot that frequently occur in athletes?
How would you care for these?
6. Where do sprains, dislocations, and fractures commonly occur in the foot?
Discuss their symptoms and signs and how they can be cared for.

CLASS ACTIVITIES
1. Have students pair up to identify and palpate the bony landmarks, ligamentous
structures, and muscle tendons associated with the foot as they are discussed in
class.
2. In groups of two, have students powder their bare feet then walk on a dark floor
or mat. Have each student measure their partner's stride length and stride
width. Have them note the weight-bearing pattern of the foot to find out if they
are neutral, pronated, or supinated.
3. Invite an individual from an athletic shoe store in town to discuss the different
types of shoes.

WORKSHEET ANSWERS
Matching
1.
2.
3.
4.
5.

i
h
d
j
g

6. c
7. f
8. e
9. b
10. a

11.
12.
13.
14.
15.

f
g
c
d
h

16. b
17. e
18. a

Short Answer
19.Ice is applied initially and if possible the athlete should not step on the heel for
24 hours. If pain has subsided by the third day, the athlete may resume
moderate activity. A heel cup or protective doughnut can be used to help with
protection of area.
20.Pain in the anterior medial heel at attachment of the plantar fascia to the
calcaneus that eventually moves more centrally into the middle of the plantar
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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
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Chapter 14 The Foot and Toes

fascia. Heel pain in weight bearing, upon rising in the morning, or after sitting
for prolonged periods of time. After a few steps, the pain lessens. Pain
intensifies when the toes and forefoot are forcibly dorsiflexed.
21.Base of the fifth metatarsal (Jones fracture)
22.May be associated with a depressed or flattened transverse arch, wearing shoes
that are pointed, too narrow, too short, or have high heels.

23.Soak the toe in hot water for 20 minutes (2-3 times a day). Insert a piece of
cotton under the edge of the nail and lift it from the soft tissue. Continue until
the nail has grown out sufficiently to be trimmed straight across. One may also
cut a notch in the toenail, toward the infected side, so the nail will grow more
towards the middle. If the ingrown toenail becomes infected, refer immediately
to MD.
24.Due to the poor blood supply to the area a non-union may occur.
Listing
25.Wearing at least 1 layer of socks.
26.Wearing shoes that are the correct size and in good condition
27.Applying materials such as petroleum jelly to reduce friction
28.Severe intermittent radiating pain from distal metatarsal heads to the tips of
toes
29.Pain is often relieved when the foot is not bearing weight
30.Hyperextension of the toes on weight bearing can increase the symptoms
31.Wearing shoes with a narrow toe box or high heels can increase symptoms
32.Metatarsal arch
33.Transverse arch
34.Medial longitudinal arch
35.Lateral longitudinal arch
Essay
36-39.RICE followed by appropriate therapy, reduction of weight bearing, and
exercise rehabilitation. All exercises and weight bearing should be pain free.
Arch tapings may be used to allow for earlier pain-free weight bearing.
40-44.See Focus Box 14-1, pg. 353.

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Chapter 14 The Foot and Toes

NAME ______________________________
SECTION__________

CHAPTER 14 WORKSHEET
The Foot and Toes
MATCHING: Select the structure and match it with the appropriate name.
_____ 1. Calcaneus
_____ 2. Cuboid
_____ 3. Cuneiforms
_____ 4. Fibula
_____ 5. Metatarsals
_____ 6. Navicular
_____ 7. Phalanges
_____ 8. Sesamoid
bones
_____ 9. Talus
_____10. Tibia
MATCHING: Match the condition with the correct response.
______
______
______
______
______
______
______
______

11.
12.
13.
14.
15.
16.
17.
18.

March fracture
Bunion
Blister
Mortons toe
Pump bump
Plantar fasciitis
Soft corn
Turf-toe

a. Sprain of the metatarsophalangeal

joint of great toe
b. Characterized by pain over the
medial heel
c. Results from shearing forces on
the skin
d. Characterized by a short first
metatarsal
e. Usually forms between the fourth
and fifth toes
f. Stress fracture to the second
metatarsal
g. Hallux valgus deformity of the
great toe
h. Retrocalcaneal bursitis

SHORT ANSWER: Answer the following questions with a brief response.

19.How would you manage a bruised heel?
20.What signs and symptoms are present with plantar fasciitis?
21. Where does the most common acute fracture of the foot occur?

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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 14 The Foot and Toes

22. What is the cause of a hallux valgus deformity?

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manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 14 The Foot and Toes

23. How would you manage an ingrown toenail?

24. What complication can occur with a Jones fracture?
LISTING: List three ways excessive callus accumulation can be prevented.
25.
26.
27.
List the signs of Mortons neuroma.
28.
29.
30.
31.
List the four arches of the foot.
32.
33.
34.
35.
ESSAY:
36-39. Explain how you would manage a longitudinal arch strain.

40-44. Explain how to manage a torn blister.

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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.