Forefoot Injuries in Athletes: Integration of the Movement System

Abstract

Despite the prevalence of forefoot related problems in athletes, there are few comprehensive summaries on examination and intervention strategies for those with forefoot related symptoms. While many factors may contribute to pathology and injury, the presence of abnormal foot alignment can negatively affect lower extremity biomechanics and be associated with injuries. Physical therapists may use the characteristics associated abnormal pronation or abnormal supination to describe the movement system disorder and serve as a guide for evaluating and managing athletes with forefoot pathologies. Athletes with an abnormal pronation movement system diagnosis typically demonstrate foot hypermobility, have decreased strength of the tibialis posterior muscle, and present with a medially rotated lower extremity position. Athletes with abnormal supination movement system diagnosis typically demonstrate foot hypomobility, decreased strength of the fibularis muscles, and a laterally rotated lower extremity position. Interventions of manual therapy, taping, strengthening exercises, and neuromuscular reeducation can be directed at the identified impairments and abnormal movements. The purpose of this clinical commentary is to integrate a movement system approach in pathoanatomical, evaluation, and intervention considerations for athletes with common forefoot pathologies, including stress fractures, metatarsalgia, neuroma, turf toe, and sesamoiditis. By applying a prioritized, objective problem list and movement system diagnosis, emphasis is shifted from a pathoanatomical diagnosis-based treatment plan to a more impairment and movement focused treatment.

Elite Tennis Players Experiencing High-Arched Supination and Cuboids Dropped Foot Syndromes in Daily Normal Gait

“…An elevated MLA affects the foot’s supination alignment, whereas a lowered one is associated with its pronation [ 19 ]. Therefore, abnormal MLA function can affect lower extremity biomechanics and contribute to podiatric diseases [ 20 ]. For example, an athlete with an abnormally supinated foot may be more prone to metatarsal stress fractures because a more rigid foot is less able to attenuate weight-bearing stresses [ 20 ].…”

“…Therefore, abnormal MLA function can affect lower extremity biomechanics and contribute to podiatric diseases [ 20 ]. For example, an athlete with an abnormally supinated foot may be more prone to metatarsal stress fractures because a more rigid foot is less able to attenuate weight-bearing stresses [ 20 ]. Furthermore, a supinated foot can also be reminiscent of the cuboid syndrome, which is most likely to occur in athletes who engage in sports such as ballet, basketball [ 21 ], rugby [ 22 ], tennis, and running [ 23 ].…”

Bipedal Static Supination and Dynamic Forefoot Loading Characteristics in Taiwanese College Badminton Players: A Cross-Sectional Study

“…The fact is well known that the arch index (AI) from footprints has been widely accepted as a reliable and relatively accurate method for determining MLA and arch height [ 17 , 18 , 19 , 20 ]. A static posture of the MLA is also a reliable method for evaluating dynamic foot function to determine whether a patient has foot-specific pathologies [ 21 , 22 , 23 ] or lower extremity dysfunction that might increase the risk of injury [ 24 , 25 , 26 ].…”

Pre-planning of individualized talus implants based on computed tomography-automated segmentation

“…The feet must bear the weight of the entire body, and the talus, as a connector between the foot and leg that makes up the lower part of the ankle joint, helps to transfer pressure forces from the upper body 1 . Due to regularly arising disturbances of normal muscle and talus collapse, structural and postural abnormalities in the feet regularly strain the lumbar spine, resulting in chronic low back pain with increasing age 2 .…”