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Introduction

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Houston Rockets center Yao Ming has elected to have extensive surgery on his fractured left foot … After consultation with a battery of doctors, Yao, 28, has decided to undergo a bone graft to heal the existing fracture and have his arch surgically lowered to reduce the stress on his foot.

ESPN NBA news reporting Yao Ming’s navicular stress fracture management plan. July 18, 2009. Yao Ming announced his retirement from basketball, July 8, 2011.

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Many practitioners consider the foot a difficult region to treat, largely because the anatomy seems rather complex (Figs 40.1, 40.2). If the foot is considered in its three distinct regions (Fig. 40.1)—the rear foot (calcaneus and talus), the midfoot (the cuneiforms and navicular medially, the cuboid laterally), and the forefoot (the metatarsals and phalanges)—the bony anatomy is greatly simplified. Soft tissue anatomy can be superimposed on the regional division of the foot (Figs 40.2ce).

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Figure 40.1

The regions of the foot—rear foot, midfoot and forefoot

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Figure 40.2

Anatomy of the foot

(a) Lateral view of the bones of the foot

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(c) Dorsal view of the soft tissues of the foot

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(d) Plantar view of the soft tissues of the foot—first layer

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In keeping with this anatomical division of the foot, clinical assessment of foot pain is most conveniently considered in three anatomical regions (Fig. 40.1):

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  • heel pain (arising from the rear foot)

  • midfoot pain

  • forefoot pain.

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Rear foot pain

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The most common cause of rear foot (inferior heel) pain is plantar fasciitis. A lay term for this condition is “heel spur(s).” This condition occurs mainly in runners and the older adult, and is often associated with a biomechanical abnormality, such as excessive pronation or supination. In non-athletic populations, limited ankle dorsiflexion range of motion and high body mass index (BMI) should be considered predisposing factors.1 Another common cause of heel pain is the fat pad syndrome or fat pad contusion. This is also known as a “bruised heel” or a “stone bruise.”

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Less common causes of heel pain are stress fracture of the calcaneus ...

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