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LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of this chapter the student should be able to demonstrate the following competencies and proficiencies concerning the foot and ankle:

  • Have a basic knowledge and understanding of the anatomy

  • Understand normal arthrokinematics and osteokinematics

  • Describe and understand the gait cycle

  • Understand normal biomechanics of the foot and ankle

  • Recognize pathomechanics and its relation to dysfunction at the foot and ankle

  • Have a general understanding of common foot and ankle disorders

  • Have a common understanding of surgical procedures used to address foot and ankle disorders

  • Design a rehabilitation plan with the understanding of surgical precautions

  • Implement a rehabilitation plan including proper stretching, strengthening, proprioception, and exercise technique in accordance with principles of basic exercise

  • Perform manual treatment techniques including basic stretching, joint mobilization, and soft tissue mobilization

  • Demonstrate and educate the patient on a comprehensive home exercise program

  • Demonstrate and understand the use of orthotic intervention in the treatment of foot and ankle pathology

  • Utilize adjunct treatment interventions such as pain control modalities, bracing, taping, and neuromuscular electrical stimulation

ANATOMY OF THE FOOT AND ANKLE

The foot is an amazingly complex structure that readily adapts to a variety of terrains and mechanical stresses. The foot is composed of 28 bones (including the two sesamoids in the tendon of the flexor hallucis brevis), at least 29 boney articulations, and a great number of supporting ligaments (Fig. 14-1).1 Functionally, the foot is divided into upper and lower functional units. The upper functional unit comprises the talus and lower leg. The lower functional unit includes the calcaneus and the rest of the foot. The foot is also divided into forefoot, midfoot, and rearfoot components.2 The rearfoot consists of the talus and calcaneus, and the midfoot consists of the navicular, cuboid, and cuneiform bones. The forefoot comprises the metatarsals and phalanges.

Figure 14-1.

A schematic diagram of the bones and subdivisions of the foot.

The foot contains two arches: the longitudinal and the transverse arch. The longitudinal arch (Fig. 14.2) is described as an arc based posteriorly at the calcaneus and anteriorly at the metatarsal heads. The arch is continuous both medially and laterally through the foot. Because the longitudinal arch is higher medially, it is usually the side of reference.3

Figure 14-2.

The medial longitudinal arch of the foot with its associated ligamentous support. (The plantar ligaments are projected through from the lateral side of the foot.) Reprinted from Levangie, PK, Norkin, CC: Joint Structure & Function: A Comprehensive Analysis, ed 4. Philadelphia, FA Davis, 2005, p.465, with permission.

The transverse arch is also a continuous structure, being most prominent at the level of the anterior tarsals and gradually becoming less ...

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