Download Clinical Manifestations Vertebral Column Disorder: Manifestations

Clinical Manifestations
Vertebral Column
Disorder:
Spina Bifida
Scoliosis
Kyphosis
Lordosis
Herniation of Intervertebral Discs
Manifestations
Failure of the two sides of the
vertebral arches to fuse; open
vertebral canal
Abnormal lateral curvature of the
vertebral column; involves the right
and left sided curvature and rotation
of one vertebra upon another
Abnormal curvature of the vertebral
column in the thoracic region,
producing a hunchback deformity
Abnormal curvature of the vertebral
column in the lumbar region
producing a swayback deformity
A tear can occur within the annulus
fibrosis through which the gelatinous
material of the nucleus pulposus can
track and eventually impinge upon
neural structures
Shoulder Joint, Scapular & Pectoral Muscles
Injury
Site of Injury
How does
this occur?
Associations
Misc.
Most
commonly
Clavicle Fracture
fractured
bone
Results in
Commonly
Shoulder
elevation
Dislocation of
associated with
Acromioclavicular separation as
and upward
Acromioclavicular
rupture of the
joint
a result of
subluxation
Joint
coracoclavicular
direct trauma
of the
ligament
clavicle
Rare;
Dislocation of
Dislocation
Sternoclavicular
Sternoclavicular
is typically in
joint
Joint
the ventral
direction
Deviation of the
proximal
Fracture of the
Distal to the
segment
Humerus
deltoid tuberosity
laterally by the
deltoid and
supraspinatous
Junction of the
middle and lateral
thirds
Fracture of the
Humerus
Proximal to the
Deltoid tuberosity
Rotator Cuff
Occur in violent
or repeated
abduction above
90 degrees
Acute fall on
the
outstretched
hand
*Shoulder
Dislocation
Anterior shoulder
(constitute 90% of
all shoulder
dislocations)
Posterior = 10%
Traumatic
impact on
abducted and
laterally
rotated arm
and extended
forearm
Subacromial
Bursitis
Subacromial
Bursa (located
inferior to the
Inflammation
presents with
localized
and the distal
segment
superomedially
by the pull of
the triceps,
biceps and
coracobrachialis
Deviation of the
proximal
segment
medially
(adducted) by
the pull of the
Pec. Major and
Teres major and
displacement of
the distal
segment
laterally and
superiorly by
the pull of the
Deltoid
Produces
rupture of one
or more of the
Rotator
rotator cuff
cuff
muscles; Pain = tendonitis =
limited ability
elderly
to abduct the
arm
When the arm is
abducted and
Initially the
laterally rotated dislocated
the subscapular
humeral
muscle moves
head
upward
assumes
removing the
subglenoid
needed
position
muscular
and then it
protection from
may take
the anterior
subcoracoid
surface of the
position
joint
Associated with
supraspinatus
tendonitis or
acromion)
Paralysis of
Serratus Anterior
Serratus Anterior
pain and
tenderness
upon
abduction
from 50 to
130 degrees
Results in
protrusion of
the inferior
angle of the
scapula
(WingedScapula) –
becomes
prominent on
protraction
tear
Axilla and Brachium
Site of Injury
Anterior Brachium – Biceps Brachii
Manifestation
Long head may rupture in swimmers and
baseball players as a result of tendonitis
and when forceful flexion occurs against
excessive resistance
Antebrachium & Elbow Joint
Injury
Fracture of Medial
Epicondyle of the Humerus
Cause
Lateral epicondylitis (tennis
elbow)
Occurs secondary to chronic
and repeated flexion;
usually follows prolonged
rotary motion of the
forearm
Constant pull on the origin
of the extensor muscles
Supracondylar Fracture of
the Distal End of the
Humerus
Displacement of the
proximal segment is most
likely to cause rupture of
the brachial artery and
injury to the radial and
median nerves
Valgus angle between distal
end of humerus and
proximal ends of the radius
and ulna
Fractures of the Head and
Affect
Cause damage to the ulnar
nerve
Inflammation of the origin
of the common extensor
muscle and occasionally
of the extensor carpi
radialis brevis; pain is felt
over the lateral humeral
epicondyle and at the
elbow
The triceps would pull the
distal fragment
posteriorly, while the
proximal segment would
be displaced anteriorly by
the biceps brachii and
coracobrachialis
Occurs as a result of prior
trauma
Occurs upon a fall on
Associated with painful
Neck of Radius
outstretched hand with
forearm flexed and partially
pronated
Fractures of the Radial
Body
Radial shaft fractures are
nearly always associated
with displacement due to
muscular pull
A fracture line Proximal to
the insertion of the pronator
teres and distal to the
insertion of the biceps
brachii
The proximal segment
supinates and the distal
fragment pronates
A fracture line distal to the
insertion of the pronator
teres
The proximal segment
remains in situ by the
contraction of the biceps
and pronator quadratus
*Colles Fracture
Occurs in traumatic fall on
an outstretched hand as a
result of slipping or tripping
Mallet or Baseball Finger
Results from hyperflexion
of the distal interphalangeal
joint and avulsion of the
long extensor tendon at its
attachment to the base of
the distal phalanx
DeQuervain’s
Tenosynovitis
Repetitive use; wringing;
Pain over the thumb and
wrist; positive Finkelstein’s
test
supination; severe
fractures are frequently
accompanied by posterior
dislocation of the elbow
joint
Associate with complete
transverse fracture of
distal part of radius
Distal fragment protrudes
proximally and dorsally
causing shortening of the
lateral part of the hand,
giving the appearance of
*DINNER FORK
DEFORMITY due to the
reversed relationship
between the distal end of
the radius and ulna
Ulnar styloid process is
usually avulsed
Median nerve may be
injured
Commonly occurs when a
finger is jammed against a
base pad.
Cannot extend the distal
interphalangeal joint and
the affected finger
resembles a mallet
Stenosing tenosynovitis of
the Abductor Pollicis
Longus (APL) and
Extensor Pollicis Brevis
(EPB) distal to the styloid
process of the radius
Intersection Syndrome
Bursitis “Student’s elbow
Subtendinous Olecranon
Bursitis
Bicipital Bursitis
Dislocation of the Elbow
Joint
Inflammatory Condition
- 1st extensor department
- APL/EPB
- Radial wrist extensors
- ECRB/ECRL
- Squeakers Syndrome
Inflammation of the
subcutaneous olecranon
bursa. Occurs as a result of
trauma to the elbow as a
sequel to fall or repeated
and sustained excessive
pressure
Results from friction
between the triceps and
olecranon subsequent to
repeated flexion and
extension
Occurs between the radial
tuberosity and the biceps
brachii tendon.
Posterior dislocation occurs
as a result of
hyperextension or direct
blow to the elbow joint that
forces the ulna posteriorly
and the distal end of the
humerus anteriorly through
the fibrous capsule
Pain is pronounced during
flexion.
Produces pain upon
pronation
Associated with rupture of
the ulnar collateral
ligament, fracture of the
head of radius, coronoid or
olecranon process of the
ulna, and ulnar nerve palsy
Elbow Dislocation
2nd most common injury;
Posterolateral Rotatory
Hyperextension
LCL complex injury;
MCL is often injured
Stable in flexion; reduce in
extension
Pulled Elbow
Characterized by
subluxation of the radial
head through the annular
ligament
Occurs as a result of
sudden jerk on the arm of
a child
Anatomy of the Hand
Injury & Site
Cause
Scaphoid Fracture
A fall on the outstretched
hand
Wrist sprain as a result of
hyperextension injury
Effect
Swelling and tenderness
occur over the anatomic
snuffbox; may lead to
avascular necrosis because
of frequent transection of
*Colle’s Fracture – fracture
of the distal end of the
radius
Lunate – rarely fractures;
commonly dislocates
Hamate
*Carpal Tunnel Syndrome
Most common neuropathy
of the hand
Gamekeeper’s Thumb
(Skiers Thumb)
Jersey Finger
Dupuytren’s Contracture
(Palmar Fibromatosis)
the nutrient artery
The fractured distal
segment displaces dorsally
and the hand assumes
Fall on outstretched,
DINNER FORK
extended and abducted hand
appearance;
Distal end of the ulna and
scaphoid may fracture
Dislocated lunate produces
Fractures = direct trauma to
shortening of the 3rd
the adducted wrist
metacarpal bone and
Dislocation = fall on the
paresthesia in the
dorsiflexed hand
cutaneous area of the
median nerve
Hamulus of the hamate and
pisiform bone forms the
canal of Guyon – a common
site of ulnar nerve
entrapment –
HANDLEBAR neuropathy
Characterized by
A unilateral condition
acroparasthesia; nocturnal
affecting the dominant
pain; atrophy of thenar
hand; occurs in pregnancy,
muscles; ape-hand
heart failure, Colle’s
configuration; opposition
fracture
and thumb abduction are
commonly affected
Minor tear or rupture of the
ulnar collateral ligament of
the MCP joint of the thumb;
Patient experiences pain
Fracture of the base of
on the ulnar side of the
proximal phalanx due to
joint and inability to grip
acute radial abduction may
also occur
The FDP maximally
contracts while the finger
Closed avulsion of the
is forcibly extended by
insertion of Flexor
acceleration of the
Digitorum Profundus (FDP)
opposing
player; pain and
tendon on the 5th or 4th digit
inability to flex the DIP
joint of the injured finger
Characterized by
The fifth and fourth digit
progressive painless
assume flexed positions at
thickening of the medial
the MP and PIP joints by
bands of the palmar
the pull of the shortened
aponeurosis
aponeurotic bands
Volkmann’s Ischemic
Contracture
Fibrosis of the muscles of
the forearm as an end result
of ischemic necrosis
Caused by tight cast at the
elbow or tourniquet on the
upper arm
FDP and FDS muscles are
shortened leading to wrist
flexion contracture and
clawing of the fingers;
passive extension of the
fingers usually produces
pain in the forearm;
Pain, swelling, pallor,
pulselessness, and
paralysis
Mallet Finger
Deformity that results from
rupture of the extensor
digital expansion that
attaches to the base of the
distal phalanx
Avulsion fracture of the
base of the distal phalanx
and dislocation of the DIP
joint may occur
Chronic case of mallet
finger, spasticity and
malunion of the fracture of
the middle phalanx
Drooping of the DIP joint
and extensor imbalance in
the affected finger:
Characterized by
hyperextension of the PIP
joint, flexion of the
metacarpal and DIP joints
Swan Neck Deformity
Head and Neck
Disorder
Craniosynostosis
Scaphocephaly (abnormally elongated
skull)
Brachycephaly (abnormally broad skull)
Acrocephaly
Craniofacial dystosis
Trauma to Scalp
Bell’s Palsy
Dislocation or Hardening of TMJ or
Manifestation
Premature closure of one or more of the
cranial sutures
Premature closure of the sagittal suture
allows growth of the skull parallel to the
sagittal suture
Premature closure of the coronal suture
Skull that results from premature fusion
of the coronal and lambdoid sutures
Premature closure of all sutures and is
associated with hydrocephalus
May cause extravasated blood to enter the
loose connective layer and seeps
anteriorly toward the orbit and eye
producing “black eye”
The loose CT layer communicates with
emissary veins allowing for a route of
spread of infection from the extracranium
to the cranial cavity
Paralysis of the buccinator muscle leading
to accumulation of food between the
cheek and teeth
This can injure the auricotemporal nerve
Fracture
Epidural Hematoma
Mandibular Nerve Palsy
Neck Wounds
Torticollis (Wryneck)
Exudates posterior to the Prevertebral
Fascia
*Thoracic Outlet Syndrome
and causes pain that radiates to the ear
and external acoustic meatus
Temporary loss of consciousness; lucid
intervals; ICP increase – Papilloedema;
uncal herniation; oculomotor nerve palsy
(fixed-dilated pupil); acute epidural
hematoma exhibits convexity toward the
brain in CT scan
Deviation of the mandible; atrophy of
muscles of mastication; hyporeflexia
(Jaw-jerk reflex)
Neck wounds require the platysma to be
sutured with skin to enhance healing and
prevent large scar formation
Spasmodic contracture of the SCM that
produces twisting of the neck and slanting
of the head away from the affected side;
results commonly from fibroma pre or
postnatally; excessive pull on the head of
infant during delivery may damage the
SCM and produces torticollis; children
with chronic trochlear nerve palsy may
develop compensatory torticollis as a
result of constant bending of the neck;
dystonia involving the cervical muscles
also produces torticollis; irritation of the
spinal accessory nerve may also produce
torticollis
Exudates as a result of TB, osteomyelitis,
cancer or epidural metastasis may spread
to the posterior neck, axilla, and posterior
mediastinum, guided by the fascial
continuation
Could result in pseudotumor, anterior
cervical disc herniation, etc.
- Constellation of neurovascular
manifestations associated with the root of
the neck
- Occurs in individuals with cervical rib,
healed clavicular fracture, abnormalities
associated with the insertions of the
anterior scalene muscle
- Fibrosis at the point of insertion of the
anterior scalene can result in compression
of the subclavian artery and inferior trunk
of the brachial plexus (Scalene anticus
*Thoracic Outlet Syndrome
syndrome)
- 90% of patients primarily present with
neurogenic symptoms due to compression
of the inferior trunk that include fatigue of
the forearm muscles, paresthesia in the
medial arm, intermittent or constant neck
and shoulder pain. Hand pain is primarily
restricted to the medial one and half of the
hand
- Vascular manifestations include
diminished radial pulse, pallor, coolness,
and sensitivity to cold temperatures, and
ischemic pain
- Hyperabduction of the arm may
exacerbate the symptoms and diminishes
radial pulse
- Adson’s test: diminution of radial pulse
upon rotation of the head toward the
ipsilateral side
Anterior Abdominal Wall & Inguinal Region
Disorder
Appendicitis
Portal Hypertension
Meckel’s Diverticulum
Referred Pain
Scarpa’s Fascia
Manifestation
Initial phase produces pain in the
paraumbilical area
Paraumbilical veins are distended and
commonly associated with liver
cirrhosis due to chronic alcoholism
Remnant of the vitelline duct
Assume the form of a cyst, open canal
or fibrous cord
Inflammation mimics signs and
symptoms of appendicitis
Pleural irritation as a result of
inflammation of the pleura may cause
pain sensation in the anterior
abdominal wall
Dislocation of the ribs may also
produce pain that radiates to the
abdomen
Periumbilical pain is associated with
the initial phase of appendicitis
Rupture of the urethra can result in
extravasation of blood and urine into
the superficial perineal pouch
Accumulated blood and urine within
this pouch spread into the anterior
abdominal wall guided by the
Conjoint Tendon
Processus Vaginalis
Cryptorchidism
***Hernia
Umbilical Hernia
Omphalocele
Inguinal Hernia
Indirect Inguinal Hernia
continuation of Colle’s fascia with the
Scarpa’s fascia
Attaches to the pubic crest posterior
to the superficial inguinal ring,
providing a natural barrier that
prevents the occurrence of inguinal
hernias
Failure of the processus vaginalis to
close allows part of a viscera to
protrude through the deep inguinal
ring and follow the course of the
inguinal canal to the superficial
inguinal ring, producing INDIRECT
inguinal hernia
Maldescent of the testis; assume
abdominal, inguinal, femoral and
perineal testis
Refers to protrusion of viscera or part
of viscera through a weak area which
normally does not traverse
Herniation may occur through the
inguinal canal, lumbar trigone,
femoral canal, or the umbilicus or as a
postsurgical complication
Protrusion of the herniated sac
through the umbilicus
Physiologic herniation that occurs
around the 6th week of development
Involves herniation of intestine that
returns into the abdominal cavity
around the 10th week
Retention of the herniated intestine
beyond the 10th week leads to the
formation of omphalocele
Refers to protrusion of a viscera or
part of a viscera from the superficial
inguinal ring• Indirect inguinal
hernia denotes a hernial sac that
follows the entire course of the
inguinal canal from the deep inguinal
ring to the superficial inguinal ring
Direct Inguinal hernia or it passes
only through the superficial inguinal
ring without pursuing the hernia
Indirect inguinal hernial sac
Protrudes through the area lateral to
Direct Inguinal Hernia
Direct Inguinal Hernia
Femoral Hernia
the inferior epigastric vessels and
descends to the scrotum in the male
and major labium in the female
Indirect inguinal hernia is common in
all ages and both sexes
Hernial sac
Passes through the superficial
inguinal ring only
May pass medial, lateral to or through
the conjoint tendon
Hernial sac that pierces the conjoint
tendon will be covered by the
peritoneum as well as the conjoint
tendon
Direct inguinal hernia occurs
through Hesselbach's (inguinal)
triangle, which is bounded medially
by the rectus abdominis, laterally
by the inferior epigastric vessels,
and inferiorly by the inguinal
ligament
Direct inguinal hernia is less common
than indirect inguinal hernia, usually
affecting men over age 40, and is rare
in women Hernial sac rarely extends
to the scrotum and generally
protrudes anteriorly
Protrudes inferior to the pubic
tubercle through the space between
the lacunar ligament and the femoral
vein
Pubic tubercle acts as a bony
landmark between the site of inguinal
and femoral hernia Femoral hernias
are more common in females due to
the shape of the pelvis
Gluteal Region & Posterior Thigh
Disorder/Injury
Head of Femur (Neck Fracture
Coxa Vara
Coxa Vulga
Manifestation
Prone to avascular necrosis when the
subcapital femoral neck fracture
occurs
(90-110 degrees): Occurs in
adduction injuries, Slipping of the
epiphysis & osteomalacia
(150-160 degrees): occurs abduction
Femoral Neck Fractures
Fractures of the Femoral Body:
Proximal Fracture
Fractures of the Femoral Body:
Middle Third Femoral Fracture
Fractures of the Femoral Body:
Distal Third
Anterior Hip Dislocation
fractures
Advanced age, Osteoporosis and
Impaction fractures
Subcapital fracture-IntracapsularTranscervical (Mid neck) -capsular
arteries
Both types are associated with
delayed healing and subsequent
avascular necrosis
Distal segment overrides the proximal
segment- leads to shortening of the
lower extremity
Trochanteric/ Intertrochanteric
Fractures occur in direct traumaFavorable outcome
1. Upper segment is abducted (lesser
gluteals), Flexed (iliopsoas) and
laterally rotated (gluteus maximus,
piriformis, obturator internus, gemelli
& quadratus femoris)
2. Lower segment move medially by
the action of the adductors
Associated with shortening of the
limb
- Proximal segment displaces laterally
and anteriorly by gluteus maximus
and medius as well as the quadriceps
femoris
- Distal segment is pulled medially
and posteriorly by the action of the
gastrocnemius
Fracture of the distal third is rare.
1. Proximal segment moves medial
and anterior to the distal segment by
the pull of the adductors and
quadriceps
2. Distal segment displaces
posteriorly by the gastrocnemius; may
injure the popliteal artery
Femoral head dislocations are
fairly uncommon
Anterior dislocation forms 10-15%
of hip dislocations. Usually
associated with acetabular fracture
subsequent to trauma
In anterior dislocation the femoral
Posterior Hip Dislocation
Gluteus Maximus Palsy
Ischial Bursitis (Weaver’s Buttock)
Trochanteric Bursitis
Lesser Gluteal Muscles Palsy
Pulled Hamstrings
Pes Anserine Bursitis (site of Pes anserinus
muscles)
head dislocates medial to the
Iliofemoral ligament, and moves close
to the Obturator foramen, inferior to
the pubis
Occurs when the thigh is adducted
and flexed and medially rotated- tear
in the acetabular labrum and
Ligamentum teres femoris; Femoral
head rests upon the ischium
• Loss of thigh extension
• Inability to climb stairs
• Atrophy of the Gluteus
maximus
• Loss of contour of the buttock
Inflammation of the ischial bursa
between the ischial tuberosity and
gluteus maximus
Occurs as a result of prolonged sitting
on hard surface
Inflammation of the bursa between
the greater trochanter and the gluteus
maximus
Occurs as a result of repetitive
contraction of the gluteus maximus:
Climbing stairs or running on a
elevated treadmill
Refers to paralysis of the Gluteus
Medius and Minimus
Results in tilting of the pelvis toward
the unsupported side when the foot is
off the ground during walking
(Positive Trendelenburg Sign)
Tearing or avulsion of the hamstrings
from the ischial tuberosity, and is
associated hematoma
Incidence of pes anserine bursitis is
higher among obese middle-aged
women. This prevalence of women
may be because of the broader female
pelvis and greater angulation of the
leg at the knee, placing additional
stresses on these structures
Anterolateral Leg & Knee Joint
Disorder/Injury
Osgood-Schlatter Disease
Manifestation
Tibia could be the site of OsgoodSchlatter disease that affects age (10-
Fractures of the Tibia
Fractures of the Tibia
March Fractures (Tibia Fracture)
Bumper Fractures
Spiral Fracture
Neck of Fibula
Potts Fracture
Osteochondritis
Patella
Genu Valgum
Genu Varum
15) due excessive pull of the patellar
ligament on the tibial epiphysis
Fractures that involve the nutrient
canal compromise union of the
fractured fragments
Fractures and rickets commonly occur
at the narrowest area of the tibial
body (junction of middle and lower
1/3)
Long walk; sudden turning of the
body when the foot is fixed
Direct trauma; anterior or posterior
fall can also cause tibial fracture
Severe torsion during skiing and
impact of ski boots applied to the tibia
Prone to fracture; encircled by the
common peroneal nerve
Distal third of the shaft of fibula is
most likely to fracture as a result of
slipping while the foot is rigidly held
in everted position, the tibia is
internally rotated and the talus is
pressed against the fibula
Osteochondritis occurs frequently,
roughens the articular surface and
produce pain. Fragments may cast off
into the joint cavity, leading to painful
internal derangement that locks the
knee (inability to fully extend the
knee)
Patellar fractures- usually simple
transverse type
Patellar dislocation-uncommon
(knock knee): less common, may
occur as a result of:
1. abnormal down growth of the
medial femoral diaphysis. Self
correct by the age of 9 year
2. complication of poliomyelitis or
Rickets
In this condition the foot is laterally
deviated, everted and flattened
(talipes valgus)
(bow-leg) occurs in toddlers and is
self correcting. Persistence of the
condition is seen in tibial
Bakers Cyst or Popliteal Cyst
Tibial (Medial) Collateral Ligament
Fibular (Lateral) Collateral Ligament
Anterior Cruciate Ligament
Posterior Cruciate Ligament
Medial Mensicus
Lateral Meniscus
Tibialis Anterior Overuse
Anterior Compartment Syndrome
Peroneus (Fibularis Longus)
osteochondrosis. Rickets should be
ruled out
Herniation and synovial effusion seen
in rheumatoid or degenerative disease
Ruptures when violent abduction
strain is applied
Tears occur in violent adduction force
applied to the extended knee
Complete tear may endanger the
common peroneal nerve
Torn by violent hyperextension of the
knee, anterior dislocation of the tibia
on femur or posterior dislocation of
femur on the tibia
Tears when the tibia dislocates
posteriorly on the femur with the knee
flexed
Ruptures in conjunction with the
tibial collateral and the anterior
cruciate ligament (unhappy triad)
when the flexed knee is forcible
abducted and externally rotated
It may be torn by a severe strain that
involves adduction and internal
rotation
Overuse produces shin splints
An acute increase in pressure in the
anterior compartment of the leg
Bleeding or edema in this
compartment causes severe ischemic
changes to muscles, and compression
of the nerves and blood vessels
Patients exhibit pain, pallor in the
anterior leg
Diminished or complete loss of pedal
pulse
Treatment- Fasciotomy
Torn in forceful and sudden inversion
Posterior Leg
Disorder/Injury
Injury to the Common Fibular (peroneal) nerve
Manifestation
Paralysis of all muscles in the anterior
and lateral compartments
Foot-drop
High stepping gait
Foot & Ankle Joint
Disorder/Injury
Manifestation
Lateral Collateral Ligament
Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament
Ankle Sprain
Eversion sprains (Potts fracture)
Talus Fracture
Calcaneous Fracture
Cuboid & Cuneiform
Metatarsals:
Limits inversion and plantar flexion
Commonly injured ligament
weakest, prone to rupture in ankle
inversion when the foot is plantar
flexed
strongest, resists anterior
displacement of fibula; avulsed in
dislocation
can be torn in severe sprains, lateral
ankle disability occurs when
concomitant tear involves the
calcaneofibular and the anterior
talofibular ligaments
Sprains of ankle are the most
common trauma affecting the ankle
joint
Tear of a ligament with a concomitant
fracture is known as a sprain fracture
Most sprains are of inversion type
with a concomitant tear of the lateral
collateral ligament (calcaneofibular
and anterior talofibular ligaments)
Eversion sprains with a possible tear
or avulsion of the medial collateral
(deltoid) ligament may be associated
with pull off the medial malleolus and
fracture of the distal end of the fibula
as a result of downward and lateral
displacement of the talus against the
lateral malleolus (Pott’s fracture)
Fractures of the talus occur in violent
dorsiflexion of the foot against the
anterior edge of the distal tibia
Body fractures occur as a result of
jumping from height
Falls from height drives the talus
downward against the calcaneus and
produce calcaneal compression
fractures
Skin over the posterior surface of the
calcaneus is a common site of
decubiti
Fractures of the cuboid and
cuneiforms seldom occur because of
their protected position
Fatigue (stress, march) fractures in
5th metatarsal more prone to fracture
Phalanges
Metatarsophalangeal joints
Tarsal Joints
Hallux Valgus
Pes Planus (flat-foot)
Pes Cavus (claw foot)
the metatarsals occur in young adults
unaccustomed to vigorous physical
activity and are radiographically
invisible until healing calus appears
Phalangeal fractures are very
common and usually results from
violent crushing or stubbing injuries
First metatarsophalangeal joint is
commonly affected in gout
Restricted movement of the second
metatarsal bone at the MP joint makes
it prone to stress (fatigue) fractures in
strenuous activities
Mid (transverse) tarsal joint- consists
of the talocalcaneonavicular and
calcaneocuboid, allows inversion and
eversion- subject to torsion injuries
Talocalcaneonavicular Joint supported by the plantar
calcaneonavicular (spring) ligamen
Refers to lateral deviation and
deformation of the great toe at the MP
Joint and is associated with:
1. Short first metatarsal bone
2. Ill-fitting pointed shoes
3. aggravated by the pull of the flexor
and extensor hallucis longus muscle
1. Depressed or collapsed longitudinal
arch
2. Talus shifts medially between the
calcaneus and navicular bones
3. Supporting ligaments and muscles
are permanently stretched
occurs as a result of muscle
imbalance, e.g. secondary to
poliomyelitis