Deformity observed includes: increased height of the longitudinal archesmetatarsal heads are lower than hindfootplantarflexion and splaying of forefootclaw toes

function is limited owing to altered arthrokinematics resulting in limited ability to absorb forces through foot

PT intervention includes;education emphazing limitation of high impact sports (i.e., long distance running and ballet); use of proper footwear and orthotic fitting.

Pes planus (flat foot)

normal in infant and toddler feet

Deformity observed includes:decreased height of the medial longitudinal arch

decreased ability of foot to provide a rigid lever for push off during gait as results of altered arthrokinematics

PT intervention include: emphasis on patient education ,use of proper footwear and orthotic fitting.

Talipes equinovarus (club foot)

two types: postural and talipes equinovarus

an abnormal development of the head and neck of talus as the result of heredity or neuromuscular disorders i.e., myelomeningocele

deformity observed includes:plantarflexed, adducted and inverted foot postural

deformity observed includes, has three components- plantarflexion at talocrural joint- inversion at subtalar, talocalcaneal, talonavicular, calcaneocuboid joints- supination at midtarsal joints

PT intervention includes:manipulation following by casting or splinting for postural conditions

PT intervention includes:requires surgical intervention to correct deformity followed by casting

Equinus

deformity observedplantarflexed foot

compensation due to limited dorsiflexion includes subtalar or midtarsal pronation

PT intervention includes:flexibility exercises of shorted structures within footjoint mobilization to joint restrictions identified in examinationstrengthening to instrinsic and extrinsic foot musclesorthotic management

Hallux valgus

deformity observed includes:medial deviation of head of first metatarsal from midline of bodymetatarsal and based of proximal first phalanx moves mediallydistal phalanx the moves laterally

Normal metatarsophalangeal angle

8° - 20°

PT intervention includes: early orthotic fitting and patient education

PT intervention includes:later management requires surgery followed by flexibility exercises to restore normal functionstrengthening exercises and possible joint mobilization to identified restrictions

Metatarsalgia

etiology mechanical: tight triceps surae group and/or achilles' tendon, collapse of transverse arch, short first ray, pronation of forefoot

structural changes in transverse arch possibly leading to vascular and /or neural comprosmise in tissues of forefootchanges in foot wear

complaint frequently heard is: pain at 1st, and 2nd. metatarsal heads after long periods of weight bearing

PT intervention includes:correction of biomechanical abnormality (improving flexibility of triceps surae), modalities to decrease paineducation about selection of footwear

Metatarsus adductus

etiology: congenital, muscle imbalance, or neuromuscular diseases such as polio

two types; rigid and flexible

rigid results : medial sublaxation of tarsometatarsal jointshindfoot is slightly in valgus with navicular lateral to head of talus

flexible is observed as adduction of all 5 metatarsal at the tarsometatarsal joints

PT intervention strengthening and regaining proper alignment of foot (i,e., through the use of orthoses)

Charcot-Marie-Tooth disease

peroneal muscular atrophy that affects motor and sensory nerves, may begin in childhood or adulthood

initially affects muscles in lower leg and foot, but eventually progresses to muscles of hands and forearm

slow progressive disorder that has varying degrees of involvement depending on degree of genetic dominance

PT intervention: no specific treatment to prevent since it is an inherited disorder, intervention centers on preventing contractures/skin breakdown and maximizing patient's function capacity to perform activitiespatient education and training regarding braces and ambulatory devices

Plantar fascitis

etiology is usually mechanical: chronic irritation of plantar fascia from excessive pronation, limited ROM of 1st MTP and talocrural joint, tight triceps suraeacute injury from excessive loading of footrigid cavus foot

results in microtears at attachment of plantar fascia

differentiated from tarsal tunnel syndrome by a negative Tinel sign

PT interventionregaining proper mechanical alignmentmodalities to reduce pain and inflammationflexibility of the planter fascia for pes cavus foot, and triceps suraejoint mobilizations to identified restrictions, night splintsstrengthening of invertors of foot

Rearfoot varus

Subtalar varus, Calcaneal varusEtiology: Abnormal mechanical alignment of tibia, shortened rearfoot soft tissues, or malunion of calcaneous

Deformity observed: rigid inversion of calcaneous when subtalar joint is in neutral.PT Intervention- Regaining proper mechanical alignment- Improving flexibility of shortened soft tissues- Orthotic fiiting and patient education regarding selection of footwear

Rearfoot valgus

Etiology: Abnormal mechanical alignment of the knee (genu valgum) , or tibial valgus

Reafoot valgus

Deformity observed: eversion of calcaneus with a neutral subtalar joint.- owing to increased mobiltiy of hindfoot, fewer musculoskeletal problems develop from this deformity than occurs with rear foot varus- PT Intervention- Regaining proper mechanical alignment- Improving flexibility of shortened soft tissues- Orthotic fiiting and patient education regarding selection of footwear

Forefoot varus

Etiology: Congenital abnormal deviation of head and neck of talusDeformity observed: Inversion of forefoot when subtalar joint is in neutral.PT Intervention- Regaining proper mechanical alignment- Improving flexibility of shortened soft tissues- Orthotic fiiting and patient education regarding selection of footwear

Forefoot valgus

Etiology: Congenital abnormal DEVELOPMENT of head and neck of talusDeformity observed: eversion of forefoot when the subtalar joint is in neutralPT Intervention- Regaining proper mechanical alignment- Improving flexibility of shortened soft tissues- Orthotic fiiting and patient education regarding selection of footwear

Hallux Valgus (bunion)