LOWER EXTREMITY

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LOWER EXTREMITY

• Foot
• Ankle
• Knee
• Hip

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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

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FOOT DIAGRAM
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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

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Lisfran Fx Sesamoiditis
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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

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FOOT INJURIES

• NEURITIS Irritation of the nerve
• MORTONS 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

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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

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FOOT INJURIES

• INGROWN TOENAIL
• Toenail grows in the skin
• soak toe
• cut V in top edge of nail
• ATHLETES FOOT
• Fungal infection-rash, blisters, itching
• Treatment-OTC powder creams
• Prevention-clean dry socks
• no bare feet

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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

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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

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ANKLE ANATOMY

• True Ankle Joint

• Muscles of the Ankle

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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

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MOI

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

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MOI

• Fractures
• Plantar Flexion Inversion
• Land on uneven surface
• Contusions
• Direct blows
• Improperly fitted shoes
• Tendon Ruptures-Achilles
• gtage 30
• Abrupt starts stops

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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

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KNEE JOINT

• BONES
• Femur CONDYLES
• Patella
• Tibia TIBIAL TUBEROSITY
• Fibula
• MENISCUS
• CARTILIDGE shock absorbers

• LIGAMENTS
• Collateral
• Cruciate
• Patellar
• TENDONS
• Quadriceps

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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?vRTV5Yo3E7VQ

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KNEE MUSCULATURE

• QUADRICEPS

• HAMSTRINGS

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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

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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

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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

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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 _at_ 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

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KNEE INJURY

• OSGOOD-SCHLATTER
• Irritation off tibia _at_ 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

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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