therapeutic foot care certificate program part i: online ... · therapeutic foot care certificate...

Therapeutic Foot Care pCertificate Program

Part I: Online Home Study PProgram

1

Anatomy And Terminology Of The Lower Extremity

Joan E Edelstein MA PT FISPOJoan E. Edelstein, MA, PT, FISPO

Associate Professor of Clinical Physical TherapyAssociate Professor of Clinical Physical Therapy

Director of the Program in Physical Therapy

Columbia University, College of Physicians and y, g ySurgeons, New York, NY

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• Learning ObjectivesAt th C l i f thi P P ti i tAt the Conclusion of this Program, Participants Should Be Able to:1 Identify Structure and Function of the Foot and1. Identify Structure and Function of the Foot and

Lower Extremity2. Describe Anatomical Positioning of the Foot and

Lower ExtremityLower Extremity3. Understand Basic Medical Terminology 4 Identify Major Blood Vessels and Nerves in the4. Identify Major Blood Vessels and Nerves in the

Foot And Lower Extremity

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T d• Planes of the Body

• Body Positions

• Tendons

• Ligaments

• Joint Movements• Bones

• Blood Vessels

• Nerves• Bones• Muscles

• Nerves• Medical Terminology

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Planes Of The Body

Frontal / Coronal

Sagittal

Transverse / HorizontalTransverse / Horizontal

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Planes Of The Body

F t l C l Pl• Frontal or Coronal Plane

Associated Movements- Abduction

Add ti- Adduction

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Planes Of The Body

• Sagittal Plane• Sagittal PlaneAssociated Movements

- Flexion

Extension- Extension

- Hyperextension

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Planes Of The Body

• Transverse or Horizontal PlaneAssociated Movements- Arm and Leg

• Internal or Medial Rotation• External or Lateral Rotatione a o a e a o a o

- Foot• External Rotation or• External Rotation or

Supination • Internal Rotation or

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Internal Rotation or Pronation

Body Positions

• Anterior / PosteriorAnterior / Posterior

• Superior / Inferior

• Proximal / Distal

D / Pl t• Dorsum / Plantar

• Longitudinal / Transverseg

• Medial / Lateral

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Body Positions

• Anterior – Posterior

PosteriorPosterior

10AnteriorAnterior

Body Positions

• Anterior – Posterior

PosteriorPosterior

Anterior

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Body Positions

• Superior – Inferior

SuperiorSuperior

InferiorInferior

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Body Positions

• Proximal – Distal

ProximalProximal

DistalDistal

ProximalProximal

DistalDistal

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Body Positions

• Proximal – Distal

ProximalDistal

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Body Positions

• Plantar – Dorsal

DorsalDorsal

15PlantarPlantar

Body Positions

• Dorsal – Plantar

Dorsal

Plantar16

Plantar

Body Positions

Longit dinal• Longitudinal

Transverse

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Body Positions

• Medial – Lateral

Medial

RL

18Lateral

Joint Movements

• Normal Joint MovementsAbduction / AdductionFlexion / ExtensionPlantarflexion / DorsiflexionEversion / InversionInternal Rotation / External RotationPronation / Supination p

• Abnormal PositionValgus / Varus

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Valgus / Varus

Joint Movements

• Abduction – Adduction

20Abduction Adduction

Joint Movements

• Abduction – Adduction

21Abduction Adduction

Joint Movements

• Flexion – Extension

22Flexion Extension

Joint Movements

• Plantarflexion – Dorsiflexion

DorsiflexionDorsiflexion

PlantarflexionPlantarflexionPlantarflexionPlantarflexion

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Joint Movements

• Inversion – Eversion

Inversion Eversion24

Inversion Eversion

Joint Movements

• Eversion

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Joint Movements

• Inversion

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Joint Movements

• Inversion – Eversion

27Eversion Inversion

Joint Movements

• External Rotation – Internal Rotation

28External Internal

Joint Movements

• Pronation – SupinationTri-plane Motion (Oblique Plane)

Pronation– Pronation• Eversion (Transverse)• Dorsiflexion (Sagittal)( g )• Abduction (Frontal)

– Supination• Inversion (Transverse)• Plantarflexion (Sagittal)• Adduction (Frontal)

Supination Pronation

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Adduction (Frontal)

Joint Movements

• Valgus – Varus

Valgus Varus30

Valgus Varus

Joint Movements

• Valgus / Varus

Valgus Varus31

Valgus Varus

Medical Terminology

Motor Sense: Movement

Position Sense: ProprioceptionPosition Sense: ProprioceptionInternal Sensation

E ilib i– Equilibrium– Tendon

J i t– Joint– Muscle

Vi32

– Viscera

Medical Terminology

External Sensation

• Sight • TouchLight Touch• Hearing

• Taste

Light Touch

Deep Touch• Taste

• SmellHot

Cold

Pain

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Medical Terminology• Osteo

Bone (e.g. Osteomyelitis: Infection of the Bone)• Arthro

Joint (e.g. Arthritis: Inflammation of the Joints)• MyoMyo

Muscle (e.g. Myocyte: Muscle Cell)• Neuro

N ( N th Di d f th N )Nerve (e.g. Neuropathy: Disorder of the Nerves)• Arterio

Artery (e.g. Arteriosclerosis: Blockage of an Artery)• Phlebo

Vein (e.g. Phlebitis: Inflammation of a Vein)• Dermo

34Skin (e.g. Dermatology: Study of the Skin)

Medical Terminology• Valgus

Angular Deformity where the Limb Distal to theAngular Deformity where the Limb Distal to the Deformity Points away from the Midline (e.g. Genu Valgum: “Knock-kneed”)

• Varus• VarusAngular Deformity where the Limb Distal to the Deformity Moves Closer to the Midline (e.g. Genu V “B l d”)Varum: “Bow-legged”)

• PlanusFl t ( P Pl Fl t F t )Flat – (e.g. Pes Planus: Flat Foot )

• CavusHollow (e g Pes Cavus: Exaggeration of Normal Arch)

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Hollow – (e.g. Pes Cavus: Exaggeration of Normal Arch)

Medical Terminology

• HyperGreater than (e g Hypertension – Blood Pressure GreaterGreater than (e.g. Hypertension Blood Pressure Greater Than Normal)

• HypoLess than (e g Hypotension – Blood Pressure Less thanLess than (e.g. Hypotension – Blood Pressure Less than Normal)

• -ItisRefers To Inflammation (e g Sesamoiditis – Inflammation ofRefers To Inflammation (e.g. Sesamoiditis – Inflammation of the Sesamoid Bones)

• -OsisCondition Or Process (e g Hyperhidrosis Condition ofCondition Or Process (e.g. Hyperhidrosis – Condition of Excessive Sweating

• -AlgiaPain (e g Metatarsalgia Metatarsal Pain)

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Pain (e.g. Metatarsalgia – Metatarsal Pain)

Anatomy Of The Foot

• Bones• Bones

• Muscles• Nerves

• Blood Vessels• Tendons

• Blood Vessels

• Skin• Ligaments

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Anatomy Of The Foot

• Basic Foot Anatomy26 Bones

One fourth of All the Bones in the Human– One-fourth of All the Bones in the Human Body are Located in the Feet

33 Joints33 Joints

19 Muscles

107 Ligaments

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Bones Of The Foot

Forefoot• Forefoot• Phalanges• Metatarsals• Metatarsals

• Midfoot• Lesser Tarsus

• Rearfoot•Tarsus

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Tarsus

Bones Of The Foot• Malleoli

Lateral Malleolus– Most Lateral Portion of Distal Fibula

Medial Malleolus– Most Medial Portion of Distal Tibia

• Tarsus - The Seven Bones that Comprise the Hind and Mid Portions of the Foot

Hi df tHindfoot– Talus– Calcaneus – The Largest Bone in Foot

Midfoot– Navicular, Also Known as Scaphoid (Medial Side)

3 Cuneiforms (Medial Side)

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– 3 Cuneiforms (Medial Side)– Cuboid (Lateral Side)

Bones Of The Foot

• ForefootFive Metatarsals– Head of First – Palpable– Head of First – Palpable

• Two Sesamoid Bones Beneath Head of First Met

Base of Fifth Palpable– Base of Fifth – Palpable

Fourteen Phalanges– Two In Hallux

– Three In Each of the Other Four Toes

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Bones Of The Foot• Distal Phalanges

• Pro imal Phalanges• Proximal Phalanges

• Metatarsals

• Cuneiforms

• Cuboid• Cuboid

• Navicular

• Talus

• Calcaneus42

• Calcaneus

Muscles

• MuscleTough Elastic Tissue that Makes Body Parts Move

Skeletal Muscles are Attached to Bones by Tendons

Intrinsic Muscles are those which have Both their Origin and Insertion within the Same Body St t (i th F t)Structure, (i.e., the Foot)

Extrinsic Muscles are those which Originate in Another Body Structure than the InsertionAnother Body Structure than the Insertion

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Muscles Of The Lower Extremity

Extensor Digitorum Longusg g

ORIGIN Upper two thirds of anterior shaft of fibula, interosseous membrane and superior tibiofibular joint

INSERTION Extensor expansion of lateral four toesp

ACTION Extends toes and extends foot at ankle

NERVE Deep peroneal nerve (L5, S1)

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Extensor Hallucis Longus

ORIGIN Middle half of anterior shaft of fibula

INSERTION Base of distal phalanx of great toe

ACTION Extends big toe and foot. Inverts foot and tightens subtalar joints

NERVE Deep peroneal nerve (L5, S1)

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Gastrocnemius

ORIGIN Lateral head: posterior surface of lateral condyle of femur and highest of three facets on lateral condyle. medial head: posterior surface of femur above medial condyle

INSERTION Tendo calcaneus to middle of three facets on posteriorTendo calcaneus to middle of three facets on posterior aspect of calcaneus

ACTION Plantarflexes foot. Flexes kneePlantarflexes foot. Flexes knee

NERVE Tibial nerve (S1, 2)

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Peroneus Brevis

ORIGIN Lower two-thirds lateral shaft of fibula

INSERTION Tuberosity of base of 5th metatarsal

ACTION Plantarflexes and everts foot. Supports lateral longitudinal arch

NERVE Superficial peroneal nerve (L5, S1)

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Peroneus Longus

ORIGIN Upper two-thirds of lateral shaft of fibula, head of fibula and superior tibiofibular jointp j

INSERTION Plantar aspect of base of 1st metatarsal and medial cuneiform, passing deep to long plantar ligament, p g p g p g

ACTION Plantarflexes the ankle and everts the foot. Supports lateral longitudinal and transverse archesg

NERVE Superficial peroneal nerve (L5,S1)

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Tibialis Anterior

ORIGIN Upper half of lateral shaft of tibia and interosseous membranemembrane

INSERTION Inferomedial aspect of 1st medial cuneiform and base of 1st metatarsalmetatarsal

ACTION Dorsiflexes the ankle and inverts the foot. Holds up medial longitudinal arch of footlongitudinal arch of foot

NERVE Deep peroneal nerve (L4, 5)

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Tibialis Posterior

ORIGIN Upper half of posterior shaft of tibia and upper half of fibula between medial nerve crest and interosseous border, and interosseous membrane

INSERTION Tuberosity of navicular bone and all tarsal bones (except talus) and spring ligament

ACTION Plantarflexes the ankle and inverts the foot. Supports medial l it di l h f f tlongitudinal arch of foot

NERVE Tibial nerve (L4, 5)

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( )

Tendons And Ligaments

• Tendon Tough, Flexible, Fibrous, Connective Tissue That Connects Skeletal Muscles to Bones

• LigamentLigament Tough, Fibrous, Connective Tissue That Holds Tendons in Place Stabilizes JointsHolds Tendons in Place, Stabilizes Joints, and Connects Bone to Bone

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Tendons and Ligaments Of The Foot

• Ankle LigamentsAnkle LigamentsMedial Collateral– Also Known As Deltoid Ligament; Resists Foot

Eversion

Lateral Collateral– Resists Foot Inversion; Frequently Sprained

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Tendons Of The Lower Extremity

53Achilles Tendon


• Extensor Digitorum Longus Tendon

Superior Anterior

• Extensor Hallucis Longus TendonTendon

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• Extensor Hallucis Longus• Extensor Hallucis Longus Tendon

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• Tibialis Posterior Tendon• Tibialis Posterior Tendon

• Achilles Tendon

• Tibialis Anterior Tendon

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Nerves and Vessels• Nerves

Cordlike Fibers that Transmit Sensory and Motor InformationCordlike Fibers that Transmit Sensory and Motor Information Between the CNS and the Body

• Blood VesselsSmall Tube-like Structures which Transport Blood and Nutrients within the Body

ArteriesArteries– Carry Blood away from the Heart

Veins– Carry Blood to the Heart

CapillariesS ll t V l th t P id N t i t t th C ll d R t

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– Smallest Vessels that Provide Nutrients to the Cells and Return Waste Materials to the Veins

Nerves Of The Lower Extremity

• Tibial NerveTibial NervePrimary Nerve that Innervates the Posterior Portion of the Lower Extremity and the Sole of the Footthe Foot

• Common Peroneal Nerve

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• Common Peroneal NerveCommon Peroneal NervePasses the Head of the Fibula then Bifurcates to the Deep and S fi i l B hSuperficial Branches

• Superficial Peroneal NerveI t th L t l LInnervates the Lateral Lower Extremity Muscles

• Deep Peroneal NervepInnervates the Anterior Lower Extremity Muscles

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• Superficial Peroneal Nerve

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Blood Vessels Of The Lower Extremity

• Peroneal ArteryPeroneal Artery

• Anterior Tibial Artery

• Posterior Tibial Artery

• Dorsalis Pedis Arteryy

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Blood Vessels Of The Lower Extremity• Posterior Tibial Artery

Supplies the Posterior• Anterior Tibial Artery

Supplies the AnteriorSupplies the Posterior Compartment of the Leg Pulse Palpated Immediately Posterior to the Medial

Supplies the Anterior Compartment of LegTerminates as the Dorsalis PedisPosterior to the Medial

Malleolus• Peroneal Artery

Pedis

• Dorsalis Pedis ArteryContinuation of the Anterior

Runs along Fibula of Lower Leg and Supplies Ankle Region Nerve Network

Tibial Artery; Supplies the Dorsum of the FootPulse Palpated On Dorsumg

Lower Branch of Posterior Tibial Artery

Pulse Palpated On Dorsum for Between the Tendons of the Extensor Hallucis Longus And Extensor

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Longus And Extensor Digitorum Longus

Blood Vessels Of The Lower Extremity

Posterior Tibial Arter• Posterior Tibial Artery

• Anterior Tibial Artery

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Skin

• Largest Organ of the B dBody

• Protects Inner Structure of the Body

• Provides Sensations

• Two LayersEpidermisEpidermis

Dermis

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