Transcript lower extremity

LOWER EXTREMITY
Foot
Ankle
Knee
Hip
FOOT ANATOMY
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BONES
TARSALS
Calcaneus
Talus
Cuniforms (3)
Cuboid
Navicular
METATARSALS
#1-5
PHALANGES
#1-5
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ARCHES
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LONGITUDINAL
metatarsal heads - heel
TRANSVERSE
medial-lateral midfoot
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PLANTAR FASCIA
connective tissue on bottom of
the foot
FOOT DIAGRAM
FOOT INJURIES
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FRACTURES
Any break in a bone
LISFRAN FX- midfoot (distal 2-4 metarsals, cuniforms)
MOI-crush injury; rotation while planar flexed
STRESS FX- MOI-over use, RMI
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SESAMOIDITIS
Bone imbedded into tendon of 1st metatarsal
Irritation due to overuse
Pain with “toe off”
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DISLOCATIONS & SUBLUXATIONS
Complete tear of all ligaments
Partial tear of some or all the ligaments
Lisfran Fx & Sesamoiditis
FOOT INJURIES
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SPRAIN
Stretch or tear of a ligament in foot
Midfoot most common
Stress test-twist foot
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TENDON RUPTURES
Same as above
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TENDONITIS
overstretching or overuse
PRICE immediate care
stretching & conditioning
FOOT INJURIES
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NEURITIS Irritation of the nerve
MORTON’S NEUROMA
Pain between 3rd & 4th metarsals & toes
Due to ill-fitting toes
TARSAL TUNNEL SYNDROME
Compression of nerves in ankle
Can cause burning or shooting pain in foot
Usually due to wearing high heels, cowboy boots, etc
FOOT INJURIES
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BURSITIS
Between achilles tendon & talus
Pain-point tenderness, plantar flexion & toe off
PLANTAR FASCITIS
inflammation of tisue on sole of foot
repeated stress
pain increased with heel raises
PRICE immediate care
Stretching arch & calf muscles
HEEL SPUR
Extra calcium build up at the heel
FOOT INJURIES
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INGROWN TOENAIL
Toenail grows in the skin
soak toe
cut “V” in top edge of nail
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ATHLETE’S FOOT
Fungal infection-rash, blisters, itching
Treatment-OTC powder & creams
Prevention-clean & dry socks
no bare feet
ANKLE ANATOMY
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LIGAMENTS
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3 LATERAL-Ever
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2 TIBIAL FIBULAR
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Anterior TaloFibular
Posterior Talofibular
Calcaneofibular
Anterior & Posteror
Stabilizer
1 MEDIAL-Inversion
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Deltoid
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BONES
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HINGE JOINT
TIBIA
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FIBULA
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Medial Malleolus
Lateral Malleolus
TALUS
ANKLE ANATOMY
True Ankle Joint
Muscles of the Ankle
ANKLE ANATOMY
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MUSCLES
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Gastrocnemius
Soleus
Peroneal Group
Extensor Digitiorum
Tibialis Anterior
Tibialis Posterior
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MOVEMENT
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Plantar Flexion
Plantar Flexion
PF & Eversion
Extend Toes
DF & Inversion
Eversion
ANKLE INJURIES
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SPRAINS
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FRACTURES
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Any tear in ligament
Any break in bone
STRAINS
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Any tear in tendon or
muscle
Gastrocnemius
Soleus
Peroneals
Tibialis Anterior &
Posterior
MOI
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PF or INVERSION (85% of all sprains)
Anterior Talofibular
 Calcaneofibular
 Posterior Talofibular
 Peroneal Tendon
 Tibiofibular (severe)
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DORSIFLEXION
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Tibiofibular
EVERSION
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Deltoid
MOI
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Fractures
Plantar Flexion & Inversion
 Land on uneven surface
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Contusions
Direct blows
 Improperly fitted shoes
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Tendon Ruptures-Achilles
>age 30
 Abrupt starts & stops
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ANKLE SPECIAL TESTS
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ROM
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STRENGTH
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Resistance
ANTERIOR DRAWER & TALAR TILT
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Can it move appropriately
Ligament Instability-ATF
THOMPSON TEST
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Squeeze calf to see ankle movement from
Achilles Tendon
KNEE JOINT
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BONES
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Femur CONDYLES
Patella
Tibia TIBIAL TUBEROSITY
Fibula
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MENISCUS
CARTILIDGE shock
absorbers
LIGAMENTS
Collateral
Cruciate
Patellar
TENDONS
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Quadriceps
KNEE MUSCULATURE
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Quadriceps
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Vastus Medialis
Oblique
Vastus Intermedius
Vastus Lateralis
Rectus Femoris
Lower Leg Muscles
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Tibialis Anterior
Poplitieal Muscle
Plantaris Muscle
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Hamstrings
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Biceps Femoris
SemiTendious
SemiMembranosis
http://www.youtube.
com/watch?v=RTV
5Yo3E7VQ
KNEE MUSCULATURE
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QUADRICEPS
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HAMSTRINGS
KNEE INJURIES
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FRACTURES
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PATELLA rare
TIBIA & FIBULA more common
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Caused by repeated stress or direct blow
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AVULSION FRACTURE ligament tears off bone
TAP TEST
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DISLOCATIONS/SUBLUXATION
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PATELLA Foot planted w/ forced IR
APPREHENSION TEST Move patella back & forth
KNEE INJURIES
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CONTUSION
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Direct blow
Bruising of tissue
Padding offers protection
STRAINS
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Occurs to muscles or tendons
3 DEGRESS due to quick motion w/force
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1st over stretching
2nd partial tears
3rd complete tear of tissue RUPTURE
Patellar Tendon Rupture unable to extend lower leg
KNEE INJURIES
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SPRAINS
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3 DEGRESS
Most common MCL due to lateral (VALGUS) force to knee
ACL due to torsion or anterior blow
PCL due to hyperflexed or posterior force w/bent knee
LCL due to medial (VARUS) force
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STRESS TEST
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Valgus Test-MCL stability Push on LCL to test MCL
Varus Test-LCL stability Push on MCL to test LCL
Lachman Test-anterior/posterior force on knee ACL & PCL
stability. Combo of Anterior & Posterior Drawer
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KNEE INJURY
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MENISCUS
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Rotatating & Twisting of knee
Locking/clicking of knee
Unable to fully flex or extend lower leg
STRESS TEST
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McMurray-knee fully flexed foot IR Varus stress
knee @ 90 degrees, foot IR
knee fully flexed, foot ER Valgus stress
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Apley Compression-Prone position
Knee 90 degree flexion, downward pressure on foot
with IR & ER
KNEE INJURY
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OSGOOD-SCHLATTER
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Irritation off tibia @ tuberosity
Genetic predispostion
Repeated stress (jumping) to Patellar Ligament
Creates a “bump” with pain
CHONDROMALACIA PATELLAE
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Softening of cartilage below patella
PFSS Repeated trauma, improper alignment of patella
Pain w/squats, going downstairs, stiffness from flexion
PATELLA GRIND TEST knee / inferior force on patella ask
athlete to contract Quadriceps muscles
KNEE INJURIES
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BURSITIS
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Multiple bursa sacs around knee
PrePatellar most common
Direct blow, infection, repeated stress
Pain in knee from use
TENDONITIS
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Inflamed tendon
Repeated forceful extension
Pain increases with jumping, going downstairs, knee /
Patella & Quad tendon most common