Foot and ankle injuries

• Hindfoot - talus and calcaneus
• Midfoot - navicular, cuboid and cuneiforms
• Forefoot - 5 metatarsals and 14 phalanges
• Medial sesamoid bones of foot are prone to stress fractures
• Plantar aponeurosis of foot

  • contributes towards longitudinal arch
  • tension is increased during toe off
  • stores energy during stance phase
  • unleashes energy during push off
• Pes planus (flat feet) - most significant cause is underactive tibialis posterior muscle
• Higher heeled tight narrow shoes can make bunions worse
• Shoes that are too high, tight, loose or without enough support can cause unwanted stress on the feet, ankles, lower leg, hip and spine. This ongoing pressure can cause pain and injuries that may limit or prevent participation in work, sports, and hobbies.
• An ideal shoe has a square or wide toe box, with a heel two inches or lower.
• The higher the heel, the greater the pressure on the pad under the ball of the foot
• Over time, wearing high heels with narrow toe boxes can cause the foot to take the shape of the shoe, creating deformities like hammer toes and corns
• Bimalleolar ankle fracture is usually due to more severe inversion or supination forces
• History taking ankle injury

  • history of sign and symptoms
  • onset and mechanism of injury
• Examining ankle injuries

  • colouration, wounds, haematomas, old scars or obvious gross deformities
  • careful palpation: bones, muscles, arteries
  • check sensory and motor nerves of foot
  • assess ligament damage
  • X-rays, ultrasonography, capillary refill
• Hallux valgus (bunion) - valgus strain on 1st metatarsophalangeal joint
• Causes of bunion

  • tight fitting or high heeled shoes, especially among women
  • arthritis could trigger it
• Treatment of bunion

  • more spacious shoes
  • reducing standing time
  • foot pads to relieve pressure
  • anti-inflammatory drugs (NSAIDs) like ibuprofen
• Walking barefoot creates better toe alignment than pointed shoes
• Surgery is recommended for severe hallux valgus (bunion) - joint fusion, tendon transfer or portion of joint removed to improve alignment
• Hammer toe

  • dorsiflex metatarsophalangeal joints
  • plantarflex interphalangeal joints
• Major causes of hammer toe

  • tight fitting shoes
  • 2nd toe longer than big toe
  • due to loss of action of lumbricals
  • lumbricals
  • flex MTP
  • extend IP
• Treatment for hammer toe

  • more spacious shoes
  • foot pads to relieve pressure
  • foot exercises
  • severe cases surgery - joint fusion, tendon transfer or portion of joint removed to improve alignment
• Clubfoot (talipes equinovarus) is usually first seen soon after birth. Presents with strong plantarflexion and inversion posture.
• Clubfoot - overdominance and tightness of

  • deep posterior leg muscles
  • posterior - medial ligaments, capsules and tendons
  • resulting in strong plantarflexion and inversion
• Plaster of paris is usually used to realign bones and soft tissue in clubfoot. Plaster forces ankle towards dorsiflexion and eversion