Download lower extremity

LOWER EXTREMITY
Foot
Ankle
Knee
Hip
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
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
Lisfran Fx & Sesamoiditis
FOOT INJURIES

SPRAIN
Stretch or tear of a ligament in foot
Midfoot most common
Stress test-twist foot

TENDON RUPTURES
Same 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




2 TIBIAL FIBULAR


Anterior TaloFibular
Posterior Talofibular
Calcaneofibular
Anterior & Posteror
Stabilizer
1 MEDIAL-Inversion

Deltoid

BONES


HINGE JOINT
TIBIA


FIBULA


Medial Malleolus
Lateral Malleolus
TALUS
ANKLE ANATOMY
True Ankle Joint
Muscles of the Ankle
ANKLE ANATOMY

MUSCLES






Gastrocnemius
Soleus
Peroneal Group
Extensor Digitiorum
Tibialis Anterior
Tibialis Posterior

MOVEMENT






Plantar Flexion
Plantar Flexion
PF & Eversion
Extend Toes
DF & Inversion
Eversion
ANKLE INJURIES

SPRAINS


FRACTURES


Any tear in ligament
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
 Calcaneofibular
 Posterior Talofibular
 Peroneal Tendon
 Tibiofibular (severe)


DORSIFLEXION


Tibiofibular
EVERSION

Deltoid
MOI

Fractures
Plantar Flexion & Inversion
 Land on uneven surface


Contusions
Direct blows
 Improperly fitted shoes


Tendon Ruptures-Achilles
>age 30
 Abrupt starts & stops

ANKLE SPECIAL TESTS

ROM


STRENGTH


Resistance
ANTERIOR DRAWER & TALAR TILT


Can it move appropriately
Ligament Instability-ATF
THOMPSON TEST

Squeeze 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
http://www.youtube.
com/watch?v=RTV
5Yo3E7VQ
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
PCL due to hyperflexed or posterior force w/bent knee
LCL due to medial (VARUS) force

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