F

F


Fx, Fy, Fz symbols denoting resolved components of ground reaction force (anteroposterior, vertical and horizontal components respectively); Figure F1


image

Figure F1 Resolved components of ground reaction force. Fx, anteroposterior; Fy, vertical; Fz, horizontal. This article was published in Neale’s Disorders of the Foot, Lorimer, French, O’Donnell, Burrow, Wall, Copyright Elsevier, (2006).


facet smooth area on bone denoting articulation with adjacent bone, tendon, ligament or bursa


facies characteristic facial appearance associated with a particular condition


moon facies round reddened face, greasy skin with acne and facial hair characteristic of Cushing’s disease or long-term, high-dose steroid medication

myasthenic facies drooping eyelids, down-turned or drooping mouth, inability to hold eyelids open or maintain a smile, and generalized weakness of facial muscles characteristic of myasthenia gravis

Parkinson’s facies expressionless, mask-like facial expression characteristic of Parkinson’s disease

facilitation see Table D2


factitial artificial or self-induced, e.g. trauma produced either unintentionally (accidentally) or deliberately (consciously or unconsciously)


factor VIII antifibrinolytic agent used to prevent or control haemorrhage in patients with haemophilia A or B


faecal–oral transmission transmission of pathological microorganisms from contaminated faeces, e.g. via hands to the mouth


faint see syncope


falls dynamic postural instability, characteristic of old age, usually carrying significant morbidity, e.g. fractures, resultant decreased quality of life and increased mortality; tendency to fall is exacerbated by systemic illnesses, general confusion, drug therapies, foot pathologies, gait alterations (e.g. slow speed, short step length, narrow stride width, varied stepping frequency, stride length variability); inappropriate footwear, loss of visual acuity, loss of balance and poor home circumstances


false negative; FN inaccurate investigative or diagnostic test response, giving a ‘no’ response where the correct response should be ‘yes’, so that potentially pathological conditions are missed (see false positive)


false plantar fascia bow strapping


false positive; FP inaccurate investigative or diagnostic test response, giving a ‘yes’ response, where the correct response should be ‘no’; pathological conditions are misdiagnosed as being present (see sensitivity; specificity)


familial feature affecting several close family members


familial dysautonomia see syndrome, Riley–Day


fan strapping soft splintage applied to immobilize a painful first metatarsophalangeal joint (1 MTPJ); longitudinal application of 2.5-cm-wide strips of non-extensible strapping across 1 MTPJ (each strap overlying its neighbour by 50% at medial side of the hallux just proximal to interphalangeal joint, and fanning out as they cross the medial aspect of the 1 MTPJ, so that straps lie adjacent to one another at the midpoint of the shaft of the first metatarsal); see Table S13


faradism interrupted low-frequency direct current (50–100 Hz; pulse rate 0.1–1 ms) surged to induce alternate contraction and relaxation of voluntary muscle; two electrodes, underlain by damp sponges, are strapped on skin overlying affected muscles and sufficient power allowed to flow to induce a sensation of tingling and create muscle activity, for approximately 10–20 minutes; used therapeutically to exercise or re-educate specific muscles in sports injury, arthritis, plantar fasciitis, flat foot, trauma or to reduce adhesions, and improve venous and lymphatic drainage; contraindicated in patients with heart conditions, pacemakers, tumours or thromboses


farmer’s lung occupational lung disease characterized by fever and dyspnoea, caused by inhalation of fungal spores from mouldy hay; a similar condition can be induced as a result of the long-term inhalation of fungal spores in dust generated by abrasion of mycotic nails


fascia sheets/layers of fibrous tissue enveloping subcuticular structures, nerves, blood vessels, muscles and muscle groups


deep fascia fibrous tissue layers overlying and separating muscle groups or other deep structures

fascia lata deep fascia of thigh, continuous with femoral periosteum and intermuscular septa; thickened laterally, forming the iliotibial tract

plantar fascia see plantar fascia

superficial fascia network of loose fibrous tissue underling and supporting skin and subdermal fatty layer

fascial groove accommodation see Table O4


fasciculation involuntary contraction or spasmodic twitching of muscle fibres, coarser than fibrillation


fasciculi cuneatus and gracilis nerve fibre tracts with spinal cord dorsal columns


fasciitis inflammation of fascia


plantar fasciitis acute or chronic inflammation of plantar fascia due to formation of microtears in response to repetitive excessive tensile forces (e.g. as in overpronating or cavoid foot); characterized by pain, acute or chronic discomfort in proximal, central or distal part of the plantar fascia, that may radiate into the Achilles tendon; see triple therapy for plantar fasciitis; Table H9

fasciotomy incision to divide fascia


fast pain see physiological pain


fasting blood glucose; FBG blood glucose level following fasting, i.e. > 14 hours without food; two consecutive FBG recordings of > 6.7 mmol/L is diagnostic of diabetes mellitus (note: some authorities consider that the cut-off point diagnostic of hyperglycaemia is 5.9 mmol/L); see random blood glucose


fat adipose tissue


fatigue fracture see fracture, fatigue; Table C18


fatty acid any long-chain monobasic organic acid derived from hydrolysis of fats


fatty mantle waterproof layer of sebum, sweat and desquamated epidermal keratin that invests the outer part of the stratum corneum


fatty streak fibrosed extracellular lipid at the intimal surface of an artery causing local stenosis and roughening; earliest manifestation of arterial or arteriolar pathology, culminating as atheroma formation, typically presenting at arterial bifurcations


feedback regulatory mechanisms in which the outcome of system activity governs the amount of further output from the system; e.g. modulation of motor activity by sensory stimuli triggered by muscle contractions


feedback loop detection system regulating activity within a hormonal system – raised hormonal output triggers the switch-off mechanism reducing release of further hormone and vice versa; a characteristic of homeostatic control


felt wool, or wool/synthetic mix of various thicknesses (2, 5, 7 mm) and compressive qualities (semicompressed, compressed) spread with adhesive mass; shaped and applied to the foot as clinical padding (or fixed to a temporary insole) to realign non-fixed joint deformity, deflect pressure from painful areas, realign areas within the foot, and act as a carrier of medicaments (see Table P2)


female athlete triad triad of disorders (abnormal eating patterns; amenorrhoea; osteoporosis) noted in young females engaged in very heavy athletic endeavour


feminization acquisition of female characteristics by the male


femoral anteversion transverse-plane deformity of proximal femur; femoral head and neck are positioned anterior relative to the body of the femur, with resultant internal leg rotation and in-toeing gait


femoral artery direct continuation of external iliac artery (lying within adductor canal) forming the principal lower-limb artery; extends from inguinal ligament to popliteal artery, and continuous with the tibial artery; branches include profunda femoris artery and descending genicular artery


femoral nerve a division of lumbar plexus; enters thigh at inguinal ligament, lateral to the femoral sheath; it divides into muscular branches (to pectineus, sartorius and quadriceps femoris) and cutaneous branches (anterior medial and lateral cutaneous nerves of thigh); its terminal branch (the saphenous nerve) supplies sensation to medial longitudinal arch of the foot


femoral neuropathy; proximal motor neuropathy; diabetic amyotrophy motor neuropathy with sensory loss within femoral nerve distribution; characterized by quadriceps atrophy persisting for up to 18 months; may present at start of insulin therapy


femoral retroversion transverse-plane deformity of proximal femur due to contracture of the external rotators of hip, causing external leg rotation and an out-toeing gait


femoral sheath funnel-shaped sheath of fascial tissue extending from the fascial lining of abdomen into the upper thigh; encases the femoral neurovascular bundle deep to the inguinal ligament


femoral triangle inverted triangular-shaped area at anterior aspect of upper thigh; bounded proximally by inguinal ligament, laterally by medial border of sartorius, medially by medial border of adductor longus; it contains (from superior to deep) skin and superficial fascia, lymphatic vessels and nodes, upper part of the great saphenous vein, femoral branch of genitofemoral nerve, branches of ilioinguinal nerve, femoral vessels and muscle tissue (adductor longus, pectineus, psoas major, iliacus)


femoral vein direct continuation of the popliteal vein, extending from the tendinous opening in adductor magnus (posterior to femoral artery) to the inguinal ligament; it contains valves to assist proximal flow of venous blood against gravity


femur thigh bone


fenbrufen non-steroidal anti-inflammatory drug used to control pain and inflammation in rheumatoid disease and other musculoskeletal disorders


fentanyl patch topically applied opioid analgesic; in control of severe central pain, with same side-effects as morphine salts


ferric iron (Fe3+)


ferric chloride solution, strong (fortis) 60% ferric solution; may be applied topically to assist closure of a bursal sinus, where there is no suspicion of infection, vascular compromise or neuropathy


ferric chloride solution, weak (mitis) 15% ferric chloride solution; may be applied topically to precipitate plasma proteins and aid control of minor skin haemorrhage (see Table A19)


ferritin water-soluble iron–protein complex, used in haemoglobin formation


ferroproteins complex iron-containing proteins, e.g. haem


ferrous iron (Fe2+)


festinant gait tottering gait, with short, rapid accelerating steps; typical of Parkinson’s disease (see Table G1)


fetal (foetal) origins hypothesis Table F1


Table F1 Risk factors for the development of peripheral arterial disease (PAD)

















































Risk factor Feature of the risk factor
Modifiable factors
Smoking Cigarette smoking is the most powerful risk factor for the development of PAD. It is dose-dependent and the risk declines within 6 months of quitting. A non-smoker is 10 times less likely to develop PAD than a smoker
Blood lipid disorders Plasma cholesterol levels of >5.2 mmol/L
Increased plasma concentrations of low-density lipoprotein (LDL) cholesterol, low plasma concentrations of high-density lipoproteins (HDLs), and higher concentrations of plasma triglycerides all correlate with increased incidence of PAD
Familial hypercholesterolaemia (affecting 1:500 in UK)
Familial combined hyperlipidaemia (affecting 1:250 in UK)
Diabetes mellitus (DM) Type 2 DM increases risk of PAD by 1.5–4.0, due to the associated hypertension, hyperlipidaemia and altered vascular reactivity
Hypertension Raised systolic blood pressure (BP) increases the risk of PAD and atherosclerosis by 4 due to endothelial injury caused by increased intra-arterial shear stresses at the blood–endothelium interface (raised systolic pressures are more predictive than raised diastolic pressures)
Obesity Central obesity is an independent risk for PAD, but also predisposes to other risk factors for PAD, such as type 2 DM, hypertension
Homocysteine Homocysteine is an amino acid that in high levels is associated with thromboembolism
Haemostatic variables Increased levels of clotting factors VII, VIIIC and fibrinogen are associated with increased risk of atherosclerosis
Sedentary lifestyle Low levels of regular activity are associated with increased risk of PAD (higher levels of activity are associated with higher levels of plasma HDL-cholesterol and reduced blood pressures and facilitate the development of the collateral circulation)
Dietary deficiencies Low levels of antioxidant vitamins (vitamins C and E) and polyunsaturated fatty acids facilitate the formation of oxidized LDLs and thus predispose to the risk of PAD
Type A behaviours (TABs) People who tend to aggression, ambitiousness, restlessness, time urgency and high anxiety tend to an increased incidence of PAD, possibly due to increased levels of circulating catecholamines
Non-modifiable or fixed factors
Age and sex Atherosclerosis is more common in males, and in postmenopausal women
Family history Atherosclerosis shows familial patterns of incidence, possibly due to genetic factors and/or lifestyle choices and patterns
Early environment Fetal origins hypothesis: adverse conditions in utero or infancy predispose to the risk of cardiovascular disease in later life (e.g. statistically, small-birth-weight babies have a higher incidence in adult life of hypertension, type 2 DM, altered plasma lipids, altered bone densities, altered stress responses, less elastic arteries, thicker-walled ventricles and ‘age’ quicker)

fetus; foetus product of conception, from 8th week of intrauterine life until point of birth


fever pyrexia: body temperature >37°C (>98.4°F)


fibre nerve cell axon and its glial envelope


myelinated fibre nerve axon enveloped by a myelin sheath and Schwann cells

unmyelinated fibre nerve axon lacking the myelin sheath, but enveloped by Schwann cells

fibril minute fibre


fibrillation fine, rapid contractions (twitching) of individual or groups of skeletal or cardiac muscle fibres


atrial fibrillation pathological replacement of normal atrial contraction by rapid, irregular twitching of atrial wall muscle tissue, with associated irregular ventricular contraction, reduced cardiac output, resultant breathlessness and reduced general tissue perfusion

ventricular fibrillation pathological replacement of normal ventricular contraction by fine, rapid, irregular fibrillation of ventricle wall muscle tissue, with associated irregular and ineffective ventricular contraction, reduced cardiac output, breathlessness and reduced general tissue perfusion

fibrin elastic, filamentous, insoluble protein formed as the endproduct of the clotting cascade; derived from plasma fibrinogen (factor I) by the action of thrombin (derived from factor II)


fibrinogen factor I; soluble plasma protein; converted by coagulation factor cascade into insoluble fibrin


fibrinolysin plasmin


fibrinolysis hydrolysis of fibrin; i.e. initiation of blood clot dissolution


fibrinolytic drugs agents used in the immediate treatment of acute myocardial infarction, but also in deep-vein thrombosis, pulmonary embolism and diabetes-related retinal embolism management; side-effects include prolonged bleeding; e.g. streptokinase


fibroadenoma benign neoplasm derived from glandular epithelium


fibroblast connective tissue cell involved in tissue repair (i.e. liberate growth factors, lay down fibroelastic matrix of connective tissues and differentiate into connective tissue cells including chondroblasts or osteoblasts)


fibroblast-derived dermal replacement; Dermagraft bioengineered wound dressing; ‘seeds’ wound bed with human, neonatal-derived fibroblasts, promoting healing


fibrocartilage cartilage with prominent collagen fibrils


fibroelastic composed of collagen and elastic fibres


fibrofatty padding; plantar fat pad reticulated adipose tissue covering the plantar weight-bearing aspect of the foot


fibroma benign neoplasm derived from fibrous connective tissue


fibromatosis formation of multiple widespread fibromas


fibromyalgia; fibrositis non-specific chronic aching, soreness and/or stiffness of otherwise normal muscle, ligamentous or joint tissues


fibromyositis chronic inflammation of a muscle with associated overgrowth of local fibrous connective tissue


fibrosarcoma malignant neoplasm derived from fibrous connective tissue


fibrositis fibromyalgia


fibrous corn long-standing hyperkeratotic skin lesion formed within skin areas subject to chronic high loading; characterized by fibrosis of underlying soft tissues, and tying down of superficial tissues to deeper structures (see Table C14)


fibrous histiocytoma see dermatofibroma


fibrous tumours in skin Table F2


Table F2 Classification of skin tumours



















































Tumour type Degree of malignancy Examples
Epidermal tumours (see Table E3) Benign
Premalignant
Malignant		 Seborrhoeic keratoses
Bowen’s disease
Basal cell carcinoma
Squamous cell carcinoma
Pigmented skin lesions Benign Freckle
Lentigo
Pigmented and potentially metastatic skin tumours Benign Congenital naevus
Acquired naevus
Speckled/lentiginous naevus
Becker’s naevus
Spitz naevus
  Premalignant Dysplastic naevus
Melanoma
  Malignant Subungual melanoma
Vascular tumours Benign Pyogenic granuloma
Glomus tumour
  Malignant Kaposi’s sarcoma
Fibrous tumours Benign Acquired fibrokeratoma
Dermatofibroma
  Malignant Dermatofibrosarcoma
Adnexal tumours Benign Eccrine poroma
Others Benign Leiomyoma (smooth muscle)
Subungual exostosis (bone)
Myxoid cyst (joint lining herniation)
Ganglion (joint fluid)
Bursitis (joint inflammation)
Piezogenic pedal papule (fat herniation)
Neurofibromatosis (nerve)

fibula most lateral of the two bones of lower leg: articulates proximally with inferior aspect of lateral condyle of tibia; distal end forms the lateral malleolus and articulates with lateral aspect of the trochlea of talus; linked throughout its length to lateral border of tibia by an interosseous ligament (see Table O5)


fibular relating to fibula (lateral) side of lower leg or foot


fibular nerve see superficial peroneal nerve


field block; regional block see anaesthesia, field block


figure-of-eight bandage crêpe bandage or strapping applied under mild tension to tarsus and ankle to (1) stabilize rearfoot complex (control inversion/eversion); (2) invert calcaneum (reduce midstance pronation and minimize tension on plantar fascia in plantar fasciitis); (3) evert calcaneum (reduce lateral ankle tension in lateral ankle sprain)


filariasis presence of filarian worms in body tissues; dead worms promote chronic granulomatous inflammation and permanent woody fibrosis, obstruction of local lymphatic vessels, dense subcutaneous scar formation and severe limb oedema (see elephantiasis; kerato pachyderma)


filler pad see tarsal platform


filmated swabs absorbent wound dressing; layers of non-woven synthetic gauze interspersed with cotton wool


filtrate liquid that has passed through a filter; the filtrate retains any suspended solids


fimbria calcium-dependent, actin-binding proteins that modulate behaviour of intracellular monofilaments


finger clubbing see clubbing of the digits


fingerprint see dermatoglyphics


‘fireside tartan’ see erythema ab igne


first aid immediate assistance rendered to a collapsed or injured individual by a passer-by, before the arrival of paramedics or other members of the health care team


first-degree nerve injury see Table N3


first layer (of the plantar structures of the foot) tissues located immediately deep to the plantar fascia


first metatarsophalangeal joint; 1 MTPJ synovial joint at the articulation of the base of proximal phalanx, head of first metatarsal, plantar aspect of head of first metatarsal and hallucal sesamoids (embedded within tendon of flexor hallucis brevis muscle); ginglymoarthrodial joint allowing both sagittal-plane hinge movement (dorsiflexion/plantarflexion) of hallux toward the dorsum of first metatarsal head, and gliding sagittal-plane movement as first metatarsal head moves through an arc in a plantarwards direction; combined ginglymoarthrodial 1 MTPJ movement ensures that, immediately before toe off, the pulp of the hallux is in ground contact and the first metatarsal is at almost 90° to the horizontal plane (see Table N6)


first pain see physiological pain


first ray column of bones and associated joints forming medial border of forefoot; i.e. medial cuneiform, first metatarsal, hallucal sesamoids, proximal and distal phalanges of hallux (see Table A6)


first-ray block see anaesthesia, first-rag block


first-ray cutout see Table O4


fish oils edible oil extracted from fish high in omega 3 fatty acids; used as dietary supplement in treatment of osteoarthritis


fissure deep epidermal cleft that penetrates to dermis; frequently painful and may become infected; may complicate fungal foot infections; treated by addressing the underlying cause


heel fissures fissuring of heel perimeter skin, associated with anhidrosis and loss of elasticity of perimeter skin (e.g. diabetes, hypothyroidism, the elderly), local fungal infection (causing loss of normal tensile skin strength), perimeter heel callus and loss of skin elasticity (e.g. overweight or clinically obese patients, compensated rearfoot and/or forefoot pronation); treated as necessary, e.g. addressing underlying systemic disease, identification and treatment of tinea pedis, reduction of local hyperkeratosis, regular application of hydrating emollients, referral for advice on weight control (see Box S2)

interdigital fissures fissures at depth of interdigital cleft between two adjacent toes; associated with skin maceration, hyperhidrosis, tinea infection or foot type characterized by excessive forefoot sagittal-plane movement (in compensation for forefoot or whole-foot varus); treated as necessary by topical astringents, antifungal preparations, orthoses

webbing fissure fissuring of plantar toe skin at its junction with plantar webbing; associated with dyshidrotic (hyperhidrotic or anhidrotic) skin and/or tinea pedis; treated by addressing dyshidrosis and/or use of antifungal preparations

fistula abnormal opening or canal between a hollow organ and the body surface


fits see epilepsy


fixation stabilization of bone following surgery or fracture


external fixation use of rigid casts or insertion of transdermal pins from an external metal framework or cage (see Ilizarov frame) to maintain bone fragments in correct alignment following surgical or traumatic fracture

internal fixation use of bone remodelling and positioning techniques, or insertion of pins, screws, or screws and plates to maintain bone fragments in correct alignment, following surgical or traumatic fracture

fixator muscle/muscle group, contraction of which stabilizes the origin of another muscle


flaccid flabby; lacking tone


Flagyl see metronidazole


flank side


flap mass or tongue of tissue, vascularized by a pedicel (stem)


flare diffuse skin redness, due to vasomotor reaction; characteristic of inflammation or infection


flared heel see buttressed heel


flask strapping; butterfly strapping non-extensible strapping, applied under tension over first metatarsal joint, to minimize joint movement and reduce pain in hallux limitus, or temporarily realign a reducible hallux abductovalgus deformity


flat foot see pes planus


flea bites small localized erythematous pruritic papules, caused as an inflammatory reaction to bite of Pulex irritans, often occurring on the lower legs of people whose household pets are infested with fleas


‘fleck’ fracture see fracture, avulsion


flexed toe see toes, flexed


flexion joint movement, causing the flexor aspects of the body parts it connects to move towards one another


flexor a muscle bringing about joint flexion


flexor accessorius; quadratus plantae third-layer intrinsic foot muscle


origin from medial and lateral margins of plantar aspect of calcaneum

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