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