Work- and athletic-related injuries are two of the most common
areas from which foot injuries arise. Work-related injuries vary
widely in the body area injured; one study estimates that 20% of
all injuries in the U.S. occur in the workplace, with 60% involving
injury to the musculoskeletal system; 10% of these are
foot and ankle injuries.1 Medical costs and wages
lost are two of the primary reasons that timely and appropriate
care of foot-related work injuries is so crucial.2 Foot
and ankle sport-related injuries are also extremely common and returning
the athlete to his or her sport demands the utmost attention.3 Motor
vehicle crash patients with a foot or ankle injury had a higher
injury severity score than those without these injuries.4 Many
of these patients will likely seek their initial care in the ED
and early intervention is essential.
The foot is divided into three sections: the hindfoot, the midfoot,
and the forefoot. Chopart joint separates the hindfoot from the
midfoot. Lisfranc joint divides the midfoot and the forefoot. Although
bones are not the only components of the foot, they are the focus
of the following discussion. 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 274-1). Several ligaments and muscles
aid these bones in the multiple movements the foot can engage in,
including eversion, inversion, adduction, and abduction. The construction
of the foot serves as the foundation for many of the dynamic movements
the rest of the body engages in.
A. Diagram of normal bony anatomy of the
foot. B. Radiograph of normal bony alignment of the
foot. (B. Courtesy of Robert DeMayo, MD.)
For the neurovascular supply of the foot, the popliteal artery gives
rise to several branches: the anterior tibial artery, with its branch
the dorsalis pedis supplying the dorsal aspect of the foot; the posterior
tibial and peroneal arteries supply the sole (Figure
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; ...
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