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LOWER EXTREMITY

LOWER EXTREMITY. Foot Ankle Knee Hip. 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

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LOWER EXTREMITY

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  1. LOWER EXTREMITY Foot Ankle Knee Hip

  2. 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 ANATOMY

  3. FOOT DIAGRAM

  4. FOOT INJURIES • FRACTURES Any break in a bone LISFRAN FX- midfoot STRESS FX- 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. MUSCLES Tibialis Anterior Gastrocnemius Soleus Peroneal Group Tibialis Posterior MOVEMENT Dorsiflexion Plantar Flexion Plantar Flexion PF & Eversion Eversion ANKLE ANATOMY

  11. 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

  12. MOI • PF or INVERSION (85% of all sprains) • Anterior Talofibular • Calcaneofibular • Posterior Talofibular • Peroneal Tendon • Tibiofibular (severe) • DORSIFLEXION • Tibiofibular • EVERSION • Deltoid

  13. MOI • Fractures • Plantar Flexion & Inversion • Land on uneven surface • Contusions • Direct blows • Improperly fitted shoes • Tendon Ruptures-Achilles • >age 30 • Abrupt starts & stops

  14. ANKLE SPECIAL TESTS • ROM • Can it move appropriately • STRENGTH • Resistance • ANTERIOR DRAWER & TALAR TILT • Ligament Instability-ATF • THOMPSON TEST • Squeeze calf to see ankle movement from Achilles Tendon

  15. BONES Femur CONDYLES Patella Tibia TIBIAL TUBEROSITY Fibula MENISCUS CARTILIDGE shock absorbers LIGAMENTS Collateral Cruciate Patellar TENDONS Quadriceps KNEE JOINT

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

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