Foot

19 Foot

Orientation and general presentation (Figs 19.1 & 19.2)

The bony foot consists of seven tarsal bones, five metatarsals and the phalanges. The tarsus consists of the following bones: talus (1), calcaneus (2), navicular (3), cuboid (4), medial cuneiform (5), intermediate cuneiform (6) and lateral cuneiform (7). The five metatarsal bones (M1–M5) support the digital rays via the metatarsophalangeal joints (FM1–FM5). The calcaneus presents a large posterior surface (FCC) with one medial (FCM) and one lateral (FCL) edge, and a prominent tubercle, the sustentaculum tali (FST), on its medial aspect. On its lateral aspect, the calcaneus shows an oblique ridge, the peroneal trochlea (FPT), which should not be confused with the insertion of the calcaneofibular ligament (8), located more posteriorly and dorsally (both FPT and [8] show variable individual development; FPT is usually the most developed). The greater apophysis (FGA) is the anterior part of the bone. The pulley-shaped articular surface of the talus, or trochlea (9), is superior. Anteriorly, the talus shows both a neck (FNK) and a head (FHE). The navicular presents a large tubercle (FNT) on its medial aspect. The basis of the fifth metatarsal bone supports a sharp tuberosity (FMT).

Figure 19.1 Foot bones (3D model).

Entire foot: A lateral view; B medial view; C superior view.

Figure 19.2 Foot bones (anatomic specimens).

Entire foot: A lateral view; B medial view; C superior view. D Isolated calcaneus: medial view. E Calcaneus, talus and navicular bone: medial view. Isolated calcaneus: F posterior view; G lateral view. (Metallic material visible in A–C was used to keep the various foot bones in a physiologic position.)

Foot/Calcaneus – posterior surface (FCC, FCM, FCL)[R,L] H|Anim

Landmarks FCC, FCM, FCL

The posterior face of the calcaneus can be described as a square with four edges (see Figs 19.1 & 19.2). Both medial and lateral edges are palpated.

Subject lying: The subject is lying prone, with the foot slightly extended and at rest.

Subject standing: The palpator kneels next to the subject’s foot, which is in neutral position. The subject is asked to put his or her bodyweight on the limb that is not being palpated.

Slightly pinch both lateral and medial edges of the calcaneal tendon between your thumb and middle finger, respectively.

Then follow the edges distally until you reach the the calcaneus (blue arrows).

The upper ridge of the posterior face of the calcaneus is difficult to palpate with accuracy because of the insertion of the calcaneal (Achilles) tendon.

The distance between FCL and FCM may be overestimated, depending on the development of soft tissue in this area.

Move your fingers further until their pulp centers reach the center of both lateral (FCL) and medial (FCM) edges of the calcaneus.

FCC is located by pushing your forefinger centrally between the thumb and middle finger.

Observe the calcaneus bone from a medial view. Select the center of the medial calcaneal edge (FCM).

Repeat the selection from a lateral view to select the lateral calcaneal edge (FCL).

Then observe the calcaneus from a posterior view. FCC is located on the posterior surface at the center of a horizontal line between FCL and FCM.

Foot/calcaneus – Sustentaculum Tali (FST)[R,L] H|Anim

Landmark FST

The sustentaculum tali is a prominent tubercle at the medial aspect of the calcaneus (see Figs 19.1 & 19.2). It also supports the medial part of the anteromedial joint surface of the talus. It is located on the border joining the superior and medial surfaces of the calcaneus.

Subject lying: The subject is lying supine, foot at rest.

Subject standing: The palpator kneels next to the subject’s foot, which is in neutral position. The subject is asked to put his or her bodyweight on the limb that is not being palpated.

Start with the forefinger from TAM (see p. 148).

Move distally (blue arrow) in the direction of the medial border of the foot.

The tubercle located about one fingerwidth distally and towards TAM is the posterior edge of the sustentaculum tali.

Leave the index finger on this point, and move the thumb anteriorly and distally to the anterior edge of the sustentaculum (about one fingerwidth).

The mid-point between the two fingers is FST.

Observe the foot from a medial view. Select the center of the sustentaculum tali.

Then observe the foot from an inferior view. Make sure that the located point is on the most prominent aspect of the sustentaculum tali.

Foot/Navicular – Tuberosity (FNT)[R,L]

Landmark FNT

The navicular tuberosity is a prominence located on the medial aspect of the navicular bone, pointing towards the sole of the foot (see Figs 19.1 & 19.2). It receives one of the insertions of the tibialis posterior muscle.

Subject lying: The subject is lying supine, foot at rest.

Subject standing: The palpator kneels next to the subject’s foot, which is in neutral position. The subject is asked to put his or her bodyweight on the limb that is not being palpated.

From FST (see p. 164), move anteriorly (towards the toes; blue arrow).

The first bony prominence you meet is the navicular tuberosity. Select its tip.

Manual palpation tip

• Ask the subject to perform an inversion of the foot to feel the tension of the tibialis posterior tendon (green arrow), which runs towards the navicular tuberosity after passing behind the medial malleolus.

• The direction of the tendon will lead you to FNT.

Observe the foot from a medial view (slightly posterior). Locate the center of the navicular tuberosity.

Then, observe the foot from an inferior view. Check that the selected point is the most medial point of the navicular tuberosity.

Tags: Color Atlas of Skeletal Landmark Definitions Guidelines for Repr

Sep 9, 2016 | Posted by admin in MANUAL THERAPIST | Comments Off

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