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LOWER EXTREMITY
FootAnkleKneeHip
FOOT ANATOMY
BONES TARSALS
Calcaneus
Talus
Cuniforms (3)
Cuboid
Navicular METATARSALS
#1-5 PHALANGES
#1-5
ARCHES LONGITUDINAL
metatarsal heads - heel TRANSVERSE
medial-lateral midfoot
PLANTAR FASCIA connective tissue on bottom
of the foot
FOOT DIAGRAM
Lisfran Fx & Sesamoiditis
FOOT INJURIES
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
SESAMOIDITIS Bone imbedded into tendon of 1st metatarsal
Irritation due to overuse Pain with “toe off”
DISLOCATIONS & SUBLUXATIONS Complete tear of all ligaments Partial tear of some or all the ligaments
FOOT INJURIES
SPRAIN Stretch or tear of a ligament in foot
Midfoot most common
Stress test-twist foot
TENDON RUPTURESSame as above
TENDONITIS
overstretching or overuse
PRICE immediate care
stretching & conditioning
FOOT INJURIES
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
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
INGROWN TOENAIL Toenail grows in the skin soak toe cut “V” in top edge of nail
ATHLETE’S FOOT Fungal infection-rash, blisters, itching Treatment-OTC powder & creams Prevention-clean & dry socks
no bare feet
ANKLE ANATOMY
LIGAMENTS 3 LATERAL-Ever
Anterior TaloFibular Posterior Talofibular Calcaneofibular
2 TIBIAL FIBULAR Anterior & Posteror
Stabilizer
1 MEDIAL-Inversion Deltoid
BONES HINGE JOINT TIBIA
Malleolus
FIBULA Malleolus
TALUS
ANKLE ANATOMY
MUSCLES Gastrocnemius Soleus Peroneal Group Extensor Digitiorum Tibialis Anterior Tibialis Posterior
MOVEMENT Plantar Flexion Plantar Flexion PF & Eversion Extend Toes Inversion Eversion
ANKLE INJURIES
SPRAINS Any tear in ligament
FRACTURES Any break in bone
STRAINS Any tear in tendon or
muscle Gastrocnemius Soleus Peroneals Tibialis Anterior &
Posterior
MOI
PF or INVERSION (85% of all sprains)Anterior Talofibular CalcaneofibularPosterior TalofibularPeroneal TendonTibiofibular (severe)
DORSIFLEXIONTibiofibular
EVERSIONDeltoid
MOI
FracturesPlantar Flexion & InversionLand on uneven surface
ContusionsDirect blows Improperly fitted shoes
Tendon Ruptures-Achilles>age 30Abrupt starts & stops
ANKLE SPECIAL TESTS
ROMCan it move appropriately
STRENGTHResistance
ANTERIOR DRAWER & TALAR TILTLigament Instability-ATF
THOMPSON TESTSqueeze calf to see ankle movement from
Achilles Tendon
KNEE JOINT
BONES Femur CONDYLES
Patella Tibia TIBIAL TUBEROSITY
Fibula
MENISCUS
CARTILIDGE shock absorbers
LIGAMENTS Collateral Cruciate Patellar
TENDONS Quadriceps
KNEE MUSCULATURE
Quadriceps Vastus Medialis
Oblique Vastus Intermedius Vastus Lateralis Rectus Femoris
Lower Leg Muscles Tibialis Anterior Poplitieal Muscle Plantaris Muscle
Hamstrings Biceps Femoris SemiTendious SemiMembranosis
KNEE MUSCULATURE
QUADRICEPS HAMSTRINGS
KNEE INJURIES
FRACTURES PATELLA rare
TIBIA & FIBULA more common Caused by repeated stress or direct blow AVULSION FRACTURE ligament tears off bone
TAP TEST
DISLOCATIONS/SUBLUXATION PATELLA Foot planted w/ forced IR
APPREHENSION TEST Move patella back & forth
KNEE INJURIES
CONTUSION Direct blow Bruising of tissue Padding offers protection
STRAINS Occurs to muscles or tendons 3 DEGRESS due to quick motion w/force
1st over stretching 2nd partial tears 3rd complete tear of tissue RUPTURE Patellar Tendon Rupture unable to extend lower leg
KNEE INJURIES
SPRAINS 3 DEGRESS Most common MCL due to lateral (VALGUS) force to knee ACL due to torsion or anterior blow LCL due to medial (VARUS) force PCL due to hyperflexed or posterior force w/bent knee
STRESS TEST 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
KNEE INJURY
MENISCUS Rotatating & Twisting of knee Locking/clicking of knee Unable to fully flex or extend lower leg
STRESS TEST McMurray-knee fully flexed foot IR Varus stress knee @ 90 degrees, foot IR knee fully flexed, foot ER Valgus stress Apley Compression-Prone position Knee 90 degree flexion, downward pressure on foot with IR & ER
KNEE INJURY
OSGOOD-SCHLATTER Irritation off tibia @ tuberosity Genetic predispostion Repeated stress (jumping) to Patellar Ligament Creates a “bump” with pain
CHONDROMALACIA PATELLAE 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
BURSITIS Multiple bursa sacs around knee PrePatellar most common Direct blow, infection, repeated stress Pain in knee from use
TENDONITIS Inflamed tendon Repeated forceful extension Pain increases with jumping, going downstairs, knee / Patella & Quad tendon most common