Foot injuries occur most commonly in work and athletic environments.1 Work-related foot injuries can be associated with substantial medical costs and lost wages.2 Sport-related foot and ankle injuries require care so the athlete can return to the demands of the sport as quickly as possible.3 Motor vehicle crash patients with a foot or ankle injury typically have a higher injury severity score than those without such injuries.4
The foot is divided into three sections: the hindfoot, the midfoot, and the forefoot. The Chopart joint separates the hindfoot from the midfoot. The Lisfranc joint divides the midfoot and the forefoot. The hindfoot is comprised of the talus and the calcaneus. The midfoot encompasses the medial, middle, and lateral cuneiforms; the navicular; and the cuboid. The tarsus refers to the bones of the hind and midfoot. The forefoot includes the metatarsals and the proximal, middle, and distal phalanges (Figure 1). Ligaments and muscles enable foot movements of eversion, inversion, adduction, and abduction.
A. Diagram of normal bony anatomy of the foot. B. Radiograph of normal bony alignment of the foot. [Panel B courtesy of Robert DeMayo, MD.]
Vascular supply of the foot originates from branches of the popliteal artery: the anterior tibial artery, with its branch the dorsalis pedis supplying the dorsal aspect of the foot; and the posterior tibial and peroneal arteries supplying the sole (Figure 2).
A. Arteries of the dorsum of the foot. B. Vessels and nerves of the sole of the foot. a. = artery; aa. = arteries; Abd. hall. = abductor hallucis; Ant. lat. = anterior lateral; Ant. med. = anterior medial; br. = branch; brev. = brevis; dig. = digitorum; Flex. = flexor; Lat. = lateral; Med. plant. = medial plantar; n. = nerve; nn. = nerves; Post. = posterior; Quad. = quadratus; Superf. = superficial; trans. = transverse.
The sural, saphenous, peroneal, and lateral plantar nerves innervate the foot for both motor and sensory function and originate in branches from the sciatic and femoral nerves.
Ask about the mechanism of injury and direction of force. Obtain key information, including ability to bear weight after the injury, prior injury or surgery to the area, and any other potential injuries. Because it requires great force to fracture the foot, other injuries can coexist, and foot pain can distract from other serious injuries.
The foot examination does not necessarily begin with the foot, but with the entire lower extremity on the affected side. Examine the hip, ...