@joepamps
Affectations of the
Ankle and Foot
————————————
Flexible Flat Foot
● Children
○ Absence of medial longitudinal arch
○ Treatment:
■ None
■ Raise medial border of heels of
shoes 3 mm
■ Shoe with long counter and
Thomas Heel
● Adult
○ Asymptomatic flatfoot - No treatment
○ Severe - stiffness and pain during weight
bearing
○ Unilateral, acquired
○ Middle aged or older adults
○ Rupture of posterior tibial tendon
Claw Foot
● Abnormally high longitudinal arch (cavus foot)
associated with clawing of toes
● DF of MTP jt. And PF of IP jt.
● Contracted plantar fascia
● Etiology:
○ Associated with nervous system
disorders
○ Peroneal muscular atrophy
○ Myelomeningocele
○ Poliomyelitis
○ Imbalance in motor power of intrinsic
and extrinsic muscle of the foot
● Symptoms:
○ Fatigue with exercise and tender calluses
beneath the metatarsal heads and over
the proximal IP jt.
● Treatment:
○ Simple stretching of fascia and Achilles
tendon
○ Wearing proper shoes
○ Metatarsal pads/bars (relieve stress on
the anterior portion of the foot)
Kohler’s Disease
● Osteonecrosis of the navicular bone
● Uncommon
● Insidious onset childhood (4-6 y.o)
● Discomfort and lumping
● Spontaneous recovery
● Idiopathic
● Contributing factor - trauma
● (+) Tenderness and slight thickening over the
affected navicular bone
● Treatment:
○ Longitudinal arch support
○ Activity restriction
Metatarsalgia
● Pain in region of MT heads
● Abnormal distribution of weight on forefoot
● Etiology:
○ Pain beneath the MT heads
○ Everted/abducted foot
○ Foot with high longitudinal arch
■ 30 y.o.
○ Female > Male
● Causes:
○ Muscular weakness due to excessive
weight bearing
○ Tight short high heeled shoes
● Clinical Picture:
○ Burning cramping pain in the anterior
part of the foot (under middle MT heads)
○ Pain in standing and walking
 @joepamps

○ Pain seldom when shoes are off ○ Rest

○ (+) tenderness beneath the fourth MT ○ Adhesive tape
head ○ Master cast
● Treatment: ○ Anterior arch pad
○ Support that decrease pressure beneath ○ Excessive walking is unadvised
the MT heads
○ Strengthening of the muscles of the foot Freiberg's Disease
and ankle through corrective exercise ● Gradual development of the generative changes
○ Should wear thick sole with adequate in the head of 2nd MT bone
width at the toes ● Degeneration of 2nd metatarsal
○ Support the longitudinal arch and narrow ● Uncommon
counter
○ Small felt/ rubber pads behind the MT ● < adolescence
○ Hot compress / contrast baths and ● Disturbance of circulation = ischemic necrosis
corrective foot exercise ● Thickening and tenderness over the affected MT
head
Morton’s Toe ● Disturbance of circulation
● A type of metatarsalgia ● Trauma a contributing factor
● Characterized by sudden attacks of sharp pain ● Pain during weight bearing
● Web space of 3rd and 4th toes are commonly ● Treatment:
involved ○ Plaster foot
● Unilateral ○ Anterior arch pad
● Female > male ○ Surgery
● Burning sensation radiating to adjacent toes with
paraesthesia and numbness Hallux Valgus
● Immediate removal of shoes and massage of ● Lateral angulation of the big toe in the MTP jt
toes ● Enlargement of the medial side of the head of
● (+) Tenderness 1st MT bone
● Enlargement of neuroma: repeated trauma of the ● (+) Formation of bursa and callus bunion
nerve by the MT heads
● Treatment: ● Etiology:
○ Metatarsals and arch support ○ Familial
○ Excision of the enlarge segment of the ○ Female > male
nerve (safe and effective procedure, ● Treatment
treatment of choice) ○ Wear properly fitting shoes
○ Sleep with pad separating 1st and 2nd
March Fx / Fatigue Fx toes
● Fracture of 2nd / 3rd MT shaft -repeated stresses ○ Surgery if (+) pain
on accustom amount of walking
● Fx: Complete or incomplete
● Sxs: Minimal at a time of fracture
● Pain and swelling comes first (1 to 2 before
showing up on x-ray)
● Treatment:
 @joepamps

Hallux Varus Intoeing

● Medial angulation of the great toe at the MTP ● Pigeon toe
joint ● Habitual turning in of the feet on walking
● Causes: ● MC Cause: Medial torsion of the Tibia
○ Congenital ● Treatment:
○ Trauma ● Infants and young children should not be allowed
○ Muscle imbalance (paralysis of Adductor to spend too much time in sleeping and sitting
hallucis) with LE in IR.
● Tx: ● Corrects spontaneously
○ Surgical release in medial side of the toe ● Pt. ed. - Toes pointed out
○ Osteotomy of MT head ● Severe - Denis Browne Splint

Out-Toeing
● Cause:
○ External tibial torsion
○ Forefoot abduction
○ Retroversion of femoral neck
● Treatment:
Toe Deformities ○ Denis Browne Splint
● Hammer Toe ○ Slight degrees of out-toeing
○ DF of MTP jt.
○ PF of PIP jt.
○ (+) Tender corns and calluses on toe
○ Over activity et tightness of long flexor
tendons/pressure of a short narrow shoe
on the end of a long toe
● Claw Toe
○ Hyperextension of MTP jt.
○ Flexion of PIP and DIP
● Mallet Toe
○ Flexion of DIP
● Treatment: Diabetic Foot
○ Simple manipulation ● Ulceration or infection leading to gangrene or
○ Wide toes shoes amputations
● Vascular and neurologic
● Doppler ultrasound evaluation
● Treatment:
○ Prophylactic care
■ Always wearing shoes
○ Patient ed.