1. LOWER EXTREMITY Foot Ankle Knee Hip

2. 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

3. FOOT DIAGRAM

4. Lisfran Fx & Sesamoiditis

5. 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 1 st metatarsal Irritation due to overuse Pain with “toe off” DISLOCATIONS & SUBLUXATIONS Complete tear of all ligaments Partial tear of some or all the ligaments

6. 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

7. FOOT INJURIES NEURITIS Irritation of the nerve MORTON’S NEUROMA Pain between 3 rd & 4 th 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

8. 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

9. 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

10. 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

11. ANKLE ANATOMY MUSCLES Gastrocnemius Soleus Peroneal Group Extensor Digitiorum Tibialis Anterior Tibialis Posterior MOVEMENT Plantar Flexion PF & Eversion Extend Toes Inversion Eversion

12. 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

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

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

15. 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

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

18. 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

19. KNEE MUSCULATURE QUADRICEPS HAMSTRINGS

20. 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

21. 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 1 st over stretching 2 nd partial tears 3 rd complete tear of tissue RUPTURE Patellar Tendon Rupture unable to extend lower leg

22. 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

23. 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

24. 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

25. 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