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Chapter 14: The Foot and Toes

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©William E. Prentice

OBJECTIVES

When you finish this chapter you will be able to:

  • Briefly describe the anatomy of the foot.

  • Explain the process of injury assessment for the foot.

  • Formulate steps that can be taken to minimize foot injuries.

  • Identify the causes of various foot injuries commonly seen in athletes.

  • Describe the appropriate care for injuries to the foot.

INTRODUCTION

Many activities involve some elements of walking, running, jumping, and changing direction. The foot is in direct contact with the ground, and the forces created by these athletic movements place a great deal of stress on the structures of the foot. Consequently, the foot has a high incidence of injury.11

The function of the foot is critical in walking, running, jumping, and changing direction. In one instant, the foot must act as a shock absorber to dissipate the ground reaction forces. In the next instant, it must become a rigid lever that propels the body forward, backward, or to the side.30

FOOT ANATOMY

Bones

The human foot must function both to absorb forces and to provide a stable base of support during walking, running, and jumping. It contains 26 bones (7 tarsal, 5 metatarsal, and 14 phalangeal) that are held together by an intricate network of ligaments and fascia and moved by a complex group of muscles (Figure 14–1). The tarsal bones that form the ankle include the talus and calcaneus. The navicular, cuboid, and three cuneiform bones form the instep of the foot.

FIGURE 14–1

Bony structure of the foot. From Van De Graaff, K., Human anatomy, 6th ed. Dubuque, IA: McGraw Hill, 2002.

An illustration of the skeletal structure of the foot shows the medial and lateral structures with various parts annotated. The bones of the foot are divided into three zones namely the tarsal bones, the metatarsal bones, and the phalanges. The tarsal bones consist of seven short bones located in the proximal region of the foot. They are arranged in proximal and distal rows. Calcaneus or the heel bone lies at the back of the foot below the three bones that make up the ankle joint. Talus is located between the calcaneus and the fibula and tibia in the lower leg. The cuboid bone is short in the lateral part of the foot, located on the distal row of the tarsal bones and it is the main bone of the mid-foot. The medial cuneiform is situated at the medial side of the foot, anterior to the navicular bone and posterior to the base of the first metatarsal. The intermediate cuneiform is situated between the other two cuneiform bones and articulates with the navicular posteriorly, the second metatarsal anteriorly, and with the other cuneiforms on either side. Lateral cuneiform occupies the center of the front row of the tarsal bones, between the intermediate cuneiform medially, the cuboid laterally, the navicular posteriorly, and the third metatarsal in front. Navicular is located on the medial aspect of the foot, next to the cuboid bone, anterior to the head of the talus, and posterior to the cuneiform bones. The metatarsal bones are the bones of the forefoot that connect the distal aspects of the cuneiform bones and cuboid bone to the base of the five phalanges of the foot. The first metatarsal is located on the side of the big toe, medially. The fifth metatarsal is arranged on the side of the little toe, laterally. The phalanges are the bones that make up the toes of the foot. Three phalanges are present on each toe, except the big toe, which possesses only two. The proximal phalanx is the toe bone that is closest to the metatarsals. The middle phalanx is positioned between the tip of the toe and the proximal phalanx. The distal phalanx is located at the tip of a toe.
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Ligaments

Arches of the Foot

The foot is structured, by means of ligamentous and bony arrangements, to form several arches. The arches assist the foot in supporting the body weight and in absorbing the shock of weight bearing. There are four arches: the medial longitudinal, the lateral longitudinal, the metatarsal, and the transverse (Figure 14–2).

FIGURE 14–2

Arches of the foot: (A) Metatarsal and transverse arches. (B) Medial longitudinal arch. (C) Lateral longitudinal arch. ©William E. Prentice

The plantar view of the skeletal structure of the foot shows the metatarsal and transverse arches of the foot. The metatarsal arch is the primary transverse arch, running across the foot just behind the ball of the foot. The transverse arch is located in the coronal plane of the foot. It is formed by the metatarsal bases, the cuboid, and the three cuneiform bones. A medial view of foot shows a medial longitudinal arch composed of first three metatarsals, cuneiforms, navicular, talus, and calcaneus bones of foot. The lateral view of foot shows a lateral longitudinal arch which is flatter than 2 arches and composed of calcaneus, cuboid, and last 2 metatarsals.
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The metatarsal arch is shaped by the distal heads of the metatarsals. The arch stretches from the first to the fifth metatarsal. The transverse arch extends across the cuboid and intermediate cuneiform and forms a half dome. The medial longitudinal arch originates along the medial border of the calcaneus and extends forward to the distal head of the first metatarsal. The main supporting ligament of the ...

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