Exam IV Flashcards
3 divisions of the foot
- forefoot
- midfoot
- hindfoot
Bones of the foot
- Talus
- Calcaneus
- Navicular
- Cuboid
- cuneiforms
- Sesamoid (2)
Fcns of the arches
- assist in supporting the body
- Absorb shock
- Provide space for vessels/nerves/muscles to pass
Interlongitudinal arch
serves for mov’t
-originates along medial border of the calcaneus and extends forward to dist. head of 1st meta tarsal
-Calcaneus->talus->navicular->1st cunieform-> 1st metatarsal
Main supporting ligament = plantarcalcaneonavicular
Outerlogitudinal arch
serves for support
- lat aspect of the foot
- Calcaneus -> cuboid -> 5th metatarsal
- much lower and less flexible than inner arch*
Ant. Metatarsal Arch
Shaped by distal heads of metatarsals
Transverse arch
extends across trans tarsal bones, primarily cuboid/cuneiform
-forms 1/2 dome which gives protection to soft tissue and increase mobility
4 arches of the foot
- Interlogitudinal
- Outerlongitudinal
- Ant. Metatarsal Arch
- Transverse Arch
Fibula
non weight bearing
- distal portion = lat. mallelous
- extends entire length of talus
Tibia
primary weight bearing bone
- dist. portion = med malleolous
- extends 1/3 length of the talus
Ligaments (Lateral Aspect) of ankle
- Ant. tibiofibular
- Post. tibiofibular
- Ant. talofibular
- Calcaneofibular
- Post. talofibular
Ligaments involved in a “high” ankle sprain
- Ant tibiofibular
2. Post tibiofibular
3 most common ligaments sprained (ankle)
- Ant talofibular
- Post talofibluar
- calcaneofibular
Medial ligaments of ankle
- Detoild ligaments
- 3 aspects/portions
4 compartments of the lower leg
- Ant. compartment
- Lat compartment
- Superficial Post Compartment
- Deep Post Compartment
Muscles of Ant Compartment of lower leg
- Tibialis ant
- Extensor Hallicus Longus
- Extensor Digitorum Longus
Actions of Tibialis Ant.
- Dorsi flex
2. invert
Actions of Extensor Hallicus Longus
- Dorsi Flex
2. Extend big toe
Actions of Extensor digitorum longus
- dorsi flex
2. extend toes
Muscles of the Lat Compartment of Lower leg (Peroneal Retinaculum)
- Peroneus Longus
- Peroneus Brevis
- Preoneus Tertius
Actions of the Peroneus Longus
- eversion
2. Plantar flex
Actions of Peroneus Brevis
- eversion
2. Plantar flex
Actions of Peroneus Tertius
- eversion
2. Dorsi flex
Muscles of the Superficial Post. Compartment of the lower leg
- Gastrocnemius (2 heads)
- Soleus
- Plantaris
Peroneal Retinaculum
Holds tendons at ankle
Actions of gastrocnemius
- Flex knee
2. Plantar flex
Actions of soleus
- plantar flex
Actions of Pantaris
- Plantar flex
Muscles of Deep post. cmpartment of lower leg
- Tibialis post.
- Flexor Hallicus longus
- Flexor digitorum longus
Flexor retinaculum
holds tendons behind med. malleolus
Actions of Tibialis Post.
- Plantar flex
2. inversion
Actions of Flexor Hallicus longus
- Plantar Flex
2. Flex big toe
Actions of Flexor Digit. Longus
- Plantar Flex
2. flex toes
Achilles Tendon
common tendon of the gastrocnemius /soleus; united distally w/ plantaris to form tendon.
- inserts into post. calcaneus
- 2 busae
- superficial retrocalcaneal bursa
- Deep retrocalcaneal bursa
Superficial retrocalcaneal bursa
b/t skin and achilles tendon
Deep retrocalcaneal bursa
b/t achilles tendon andBuni calcaneus
Bunion
Thickening of bursa (medial to 1st MP jt)
- normally Hallus Valgus causses bunions
- S/Sx: swelling, redness and pain
- Causes: Shoes too narrow/sjort, hereditary (?)
- Tx: Ice, US, Rest, Reposition toes w/ braces/tape
Hallux Valgus
Deformity of the 1st metatarsal jt caused by vlagus (lat) mov’t of the big toe
-normally causes bunions to from
Turf Toe
1st MP jt. sprain
- hyperextension of the great toe
- Causes: Turf (hard), improperly fitting shoes, shoes too flexible (not enough support)
- Tx: Ice, tape toe in neutral position, better shoes to prevent hyper extension.
Arch Conditions
painful arches usually result from:
- improper fitting shoes
- overweight
- excessive activities on hard surfaces
- overuse
- faulty posture
- fatigue
Ant. Meta Tarsal arch condition
when supporting lig/muscles lose their ability to retain the metatarsal heads in a dome- like shape, placing pressure on nerves/vessels and added stress on meta tarsals
-Tx. Ice, rest, whirl pool exercises, metatarsal pads, reposition arch and set muscles at ease, orthotics, properly fitted shoes.
Inner longitudinal arch condition
when supporting muscles/ ligs lose their ability to retain the meta tarsal heads in a dome like shapeplacing pressure on nerves/vessels and added stress on meta tarsals
- Tx. Ice, rest, whirl pool exercises, metatarsal pads, reposition arch and set muscles at ease, orthotics, properly fitted shoes
- longitudinal arch tape support and strengthen foot flexors*
Shin splints (S/SX)
result from fallen inner longitudinal arch
S/SX
-local pain and irritation to bones and soft tissues in the mid 1/3
Continues to disable athlete as long as they are active
Plantar Fasciitis (Heel spurs)
inflammation of the PF
Tx: rest, ice, strech, US
Inversion Sprains
- 80 to 85% of all ankle sprains
- 1st lig affected: Ant tallofib
- 2nd lig affected: Calcaneofib
- 3rd lig affected: PTF/ Ant. Tib-fib
Eversion sprain
15% of ankle sprains
- occurs less freq. b/c
- anatomy of ankle jt (fib extends further than tib)
- Strong deltoid ligament
- injury
- sprain delt lig
- avulsion of med. malleolus b/c lig may be stronger than bone
Shin Splints Prevention
- Properly fitting shoes
2. Run on soft ground
Shin Splints causes
- Lack of conditioning
- Running on hard ground
- Change of athletic shoes
- weak/flat longitudinal arch
Shin Splints Tx
- Ice Massages
2. Exercises (Pick up marbles/ towel with toes)
Ankle Eversion stress test
stress delt lig by moving calcaneus and talus into eversion
Ankle Side to Side mov’t of Talus (Lig stability test)
tests for weakening of the mortise
- move calcaneus and talus from side to side a 1
- if mortise is widened, the talus will be able to move sideways making a thud as it hits the fib
Ankle Ant. Drawer test
- Good test
- Ankle in slight planter flex
- Pull calcaneus forward out of “chest”
- excessive fwd mov’t indicates ATF damage
Talac Tilt/ Inversion Test
attempt to tilt talus into inversion
- pure inversion: tests CF
- Plantar flex and invert: tests ATF
Mild Grade 1 Ankle Sprain
- may walk normally
- little to no pain
- tenderness @ site
- little to no swelling
- 3 to 7 day recovery
- strengthen muscles across jt.
Mild Grade 2 Ankle Sprain
- Sx same as mild but more intense
- will be able to bear weight, but not walk
- more painful than mild when in stress
- Abnormal ROM
- 2 to 4 week recovery
Severe Grade 3 Ankle Sprain
- Complete loss of fcn
- spasms restricts ROM
- cannot bear weight
- abnormal motion in at least one ROM
- 6 to 8 week recovery
- excessive discoloration/swelling almost immediately.
Ligaments of the Knee
- Medial Capsular lig (deep)
- Medial Collateral lig (superficial)
- Lateral capsular lig (deep)
- Lateral Collateral lig (superficial)
- Anterior Cruciate lig
- Posterior Cruciate lig
Medial meniscus
- “C” shaped
- consists of ant portion (body)
- post segment (horn)
- attaches to medial capsular lig (not moveable)
- outer edge is thicker than inner
Lateral meniscus
- “O” shaped
- moveable b/c it does not attach to lateral capsular lig
Fcns of the menisci
- Deepen knee jt. (creating a more stable articulation)
- Absorb shock
- lubricate jt.
- Share load in weight bearing
Muscles and Action of Quadriceps
- Vastus Medialis
- Vastus intermedius
- Vastus lateralis
- Rectus Femoris
Flexes hip and extends the knee
Muscles and Action of the Hamstrings
- Semitendinosous
- Semimembranosus
- Biceps Femoris
Flex knee and extend the hip
Muscles and Actions of the Pes Anserine Group
- Sartoris
- Gracillis
- Semitendinosus
flexes the knee
IT Band
Orig: Illiac crest as Tensor Fascia Lata
insert: Gerdy’s tubr.
- important lat stabilizer
- symptomatic in runners
Valgus/Varus Knee stress test
- Done at 0 and 20-30 degress flex
Looks for laxity in MCL and LCL
-stability expected at 0 degrees if isolated tear
Anterior Drawer test (Knee)
- Tests ACL and (MCL or LCL)
- 50% reliable b/c
1. menisci have door stopper effect
2. hamstring contraction
Posterior Drawer Test (Knee)
Tests PCL
Tibia drops back
posterior sag test
Lachman Test (knee)
-most reliable
-90% effective
Test knee at 10-15 flex
McMurray Test (knee)
- usually checked last
- tests menisci
- use femur to “palpate” catilage
- loading/unloading different port of menisci
Apley’s Compression
- tests mensici (90 flex)
- Forces menisci to bear weight
Mechanisms of injury to the MCL
Caused by VALGUS force
-can lead to O’Donaghue’s Triad*
O’Donaghue’s Triad
- MCL
- ACL
- Medial Meniscus
Mechanisms of injury to the LCL
-Caused by VARUS stress
-Less common
Can cause damage to:
1. Bicep Femoris
2. IT band damage
Mechanisms of injury to the ACL
- IR of lower leg, ER of femur and upper body
- Er of lower leg and IR of femur
- Deceleration
- Hyperextension
- Force which drives the knee forward when flexed (getting tackled from behind)
Mechanisms of injury to the PCL
- Forced is appplied to ant. tibia while knee is flexed at 90, tibia is forced back.
Knee Dislocation
- patella dislocates laterally
- true knee dislocation is b/t femur and tibia
- arteries and nerves at risk for being impinged/compressed, potential amputation risk
Meniscal Injuries (tears)
- if meniscus is repaired by being sown back up, must wait to bear weight
- if torn meniscus is just cut out, can weight bear as soon as comfortable
Chondromalacia Patella
softening of articular cartilage on the post aspect of the patella
Patella Femoral Pain Syndrome
-patella does not stay in groove, has tendency to ride over lat condyle of the femur due to contracting quad muscles.
IT Band Friction Syndrome
- during flexion and ext. IT band maybe irritated by the lat. femoral condyle and cause:
1. extreme pain
2. loss of stabilization - irritated by snapping over the lat condyle
Osgood Schlatter’s disease
- disorder to tibial tubr.
- pain/swelling/pt. tenderness
- caused by kneeling/jumping/ running/ direct trauma
- TX: decrese activity/ice/rest/grad return
- usually occurs in young girls and boys (8-13/10-15)
Osteochondritis Dissecans
condition is which the area of the bone undergoes changes which result in a loose peice of bone w/in a jt. Caused by: -direct trauma -Impairment of blood -Hereditary (some)
Illiopsoas Group (hip Flexors)
- Illiacus
- Psoas major
- Psoas Minor
* TRUE GROIN STRAIN*
Adductor Group
- Adductor Brevis
- Adductor Longus
- Adductor Magnus
common groin strain
Hip dislocations
Mechanism: flexed, add, and IR
- femur dislocates posteriorly
- do not attempt to reduce
Legg (Calve) Perthe’s Disease
- Osteochrondritis
- caused by avascular disturbance that diminishes blood flow to the head of the femur
- femoral head degenerates
- Pt. has disruption in blood supply/nutrition
Hip pointer
-slang expression for any inflammation of the crest of the illium resulting from trauma
-extremely painful
-caused by direct trauma
Muscles involved:
1.iliacus
2.satoris
3.tensor fascia lata
3.gluteal muscles
4.lat dorsi
5.obliques
