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Q1: What are the three main structural units of the foot?
The foot comprises three units: the hindfoot, formed by the calcaneus and talus bones; the midfoot, containing the navicular, cuboid, and three cuneiform bones; and the forefoot, consisting of five metatarsal bones and toe phalanges connected by metatarsophalangeal joints. These structures work together to provide flexibility, shock absorption, and support for ambulation.
Q2: Why is the plantar fascia important in foot structure?
The plantar fascia is a fibrous tissue band running from the heel to the forefoot that supports the foot's arch. It plays a critical role in weight bearing and maintaining foot structure. Tenderness at the proximal plantar fascia indicates plantar fasciitis, a common foot condition affecting patients who place stress on their feet.
Q3: What should you look for during foot inspection?
During inspection, examine both feet for asymmetry, swelling, ecchymoses, and deformities. Check skin and nails for calluses, corns, ulcers, fungal infections, and Tinea Pedis, which causes redness and peeling between toes. Compare findings between sides and inspect shoes for abnormal wear patterns to identify potential structural or functional problems.
Q4: What does palpation of the metatarsal heads reveal?
Palpating between the third and fourth metatarsal heads can reveal Morton's Neuroma, a thickening of nerve tissue causing tenderness and numbness. Squeezing the metatarsal heads together accentuates pain if this condition is present. Palpation also assesses the dorsalis pedis pulse to detect peripheral arterial disease.
Q5: How do you test foot abduction and adduction range of motion?
To test foot abduction, grasp the patient's calcaneus with one hand and push the forefoot laterally; normal range is approximately 5 degrees. For adduction, push the forefoot medially with the same technique, also achieving about 5 degrees maximum range. Always compare both feet and note any limited motion or pain during these maneuvers.
Q6: What nerves are tested during foot sensory examination?
Sensory testing evaluates the sural nerve at the lateral foot border, the deep peroneal nerve in the web space between the first and second toe, and the superficial peroneal nerve on the foot dorsum. Assessment also includes dermatomes of the plantar aspect. Testing pathways and peripheral nerve distribution helps identify neurological deficits affecting foot sensation.
Q7: Which muscles are assessed during foot strength testing?
Strength testing evaluates the extensor halluces longus muscle (peroneal nerve innervation) for great toe extension and the flexor halluces longus muscle (tibial nerve innervation) for great toe flexion. Lesser toe testing assesses the flexor digitorum brevis muscle and extensor digitorum brevis muscle, innervated by L4-S1 nerve roots, using resisted isometric movements.