Lower Extremities ANMT

Isometric

Muscle contraction but no movement (doing a plank)

Flexor digitorum brevis

Muscle that flexes the toes and helps maintain balance while walking and standing.

Popliteus

Name of muscle

Peroneus Brevis (Weak Ankle Muscle)

O: distal two-thirds of lateral fibula I: tuberosity of 5th metatarsal ACTION: Everts foot, assist to plantar flex ACTIV/PERP: Prolonged immobilization, Morton's foot, high elastic socks, crossing legs when seated and flat foot S/S: Pain in the ankle and ankle weakness

Extrinsic Muscles Of the foot

Originate outside of the foot

Sartorius

"Surreptitious Accomplice" "Tailor's Muscle" LONGEST MUSCLE IN THE BODY Flexes, abducts, and laterally rotates thigh at the hip; flexes knee Assists hip flexion and knee flexion May also assist the vastus medialis, gracilis & semitendinosus in supporting the knee medially against lateral or valgus thrust in single limb balance Like the TFL, it is a flexor and abductor of the thigh, but sartorius rotates the thigh LATERALLY instead of medially. ATT: proximal to the anterior superior iliac spine and descents obliquely across front of thigh from lateral to medially to attach as a tendon to the medial of body of tibia. Symptoms: Sartorius Trps do not occur as a single muscle syndrome, but occur along with trP involvement of related muscles. Pain referred over anteromedial portion of the knee similar to pain from TrPs in vastus medialis but pain is more DIFFUSE AND SUPERFICIAL than pain deep in the knee from vastus medialis TrP pain.

Cruciate Ligaments (Cross)

* External rotation "unlocks" Cruciate * Internal rotation "locks" cruciate Lie within the articular capsule and outside the synovial cavity. They are attached to the anterior and posterior tibia and restrict the forward and backward sliding of the femur on the tibial plateaus during knee flexion and extension (and limit knee hyperextension).

Swing Phases

1. Initial swing 2. Mid swing 3. Terminal swing All are neutral

How many Bones in the foot?

14 Phalanges (distal, medial and proximal); 5 metatarsals; Navicular (medial), Cuboid, & lateral, middle and medial cuneiforms; Cuboid, Talus and Sesamoid-2.

Compartment Syndrome

3 Categories: 1. Acute compartment syndrome 2. Acute exertional compartment syndrome. 3. Chronic compartment syndrome. ETIOL: 1. Acute CS: secondary to direct trauma and is a MEDICAL EMERGENCY to check compression of arterial and nerve supply to distal structures. 2. Acute Exertional CS: Without trauma and can revolve with minimal to moderate activity. 3. Chronic compartment syndrome: Symptoms occur during activity and stop when activity stops. MGMT: Immediate 1st Aid for acute compartment syndrome should include ice and elevation. Compression SHOULD NOT be used. In case of both acute and acute exertional compartment syndrome, patient should be referred to MD for possible surgery.

Stance Phases of Gait

60% of gait Five phases: Initial contact (heel) - supination, external rotation of tibia Loading Response - pronation and internal rotation of tibia Midstance & Terminal stance, pronation and internal rotation of tibia Pre Swing/Toe off -Supination/external rotation of tibia

Fibroblastic Repair or Regeneration Phase of Healing

72 hrs to 6 weeks. After debris is removed by granulocytes and macrophages, capillaries are formed to bring oxygen and nutrients into the damaged area.

Tension - Soft Tissue Injury

A force and pulls and extends tissue in the same direction that fiber run. Because a tendon is usually double the strength of the muscle it attaches to, tears occur at the muscle belly, musculotendinous junction or body attachment.

Shear - Soft Tissue Injury

A force that moves ACROSS the PARALLEL organization of collagen fibers. (CF MFT)

Compression - Soft Tissue Injury

A force that, if excessive, crushes tissue because it is directed through the fibers. The result is a contusion or bruise. Depending on the severity of force and level of muscular tension at the time of injury, thee will be muscle fiber disruption and intramuscular bleeding. It is important to grade contusions since moderate to severe incidents of developing modifies ossificans, the formation of bone in the injured muscle.

What is a trigger point?

A hyper-irritable spot usually within a taut band of skeletal muscle or in the muscle's fascia, that is painful on compression and that can give rise to characteristic referred pain, tenderness and autonomic phenomena.

Iliotibial Band Friction Syndrome (Runner's Knee)

A painful overuse inflammatory condition of the lateral aspect of the knee joint over the epicondyle of the femur usually experienced early in training. Pain is usually not disabling. Common causes: It occurs most commonly in runners (especially long distance) and cyclists who have genu varum (bowlegged knee alignment) and excessively pronated feet, in athletes who run more than 2000 miles a week and have recently changed training habits (terrain, speed, distance, surface, footwear). Symptoms: Diffuse pain and tenderness well localized at insertion point of ITB on the lateral femoral condyle. Ache and burning sensation during or after running. Pain may radiate up the side of the thigh to the hip. Swelling is not usually present; motion is normal, but some "snapping" and tightness of lateral muscles may be perceived. Test: A positive Ober's Test will cause pain at the point of irritation. Note: ITB friction may often happen in the absence of visible tightness with Ober's Test. Another test is the Noble Compression Test Treatment: Includes stretching the iliotibial band and performing techniques for reducing inflammation (including application of ice) and reducing tensile stress on ITB by decreasing tension on gluteus maximus and TFL. Massage of quadriceps and hamstrings should be included, as well as DTF to distal ITB to help prevent fibrous scar tissue buildup in this region.

Motor Unit

A single motor neuron and all of the muscle fibers it innervates/attaches to.

Patellofemoral Stress Syndrome (PFSS)

AKA: Lateral patellar compression syndrome. Etiology: Results from lateral deviation of patella femoral groove, usually do trauma or repetitive bending micro trauma. Gait analysis usually reveals genu valgus or genu varum. S/s. Tenderness of lateral aspect of patella, some swelling, dull ache in center of knee, pain on compression and crepitus. Patient will display apprehension when patella is forced laterally. Tx; Strengthening adductors to correct imbalance between VMO and vastus lateralis. Stretching hamstrings, gastroc and ITB; conservative inflammation of NSAID's, taping and CKC exercises.

Dorsal Interossei (ABDUCT)

ATT: Adjacent surface all metatarsal & medial surface of proximal phalanx of 2nd toe, 2-4th toes ACTION: Flex 2-4th toes ACTIV/PERP: Tight shoes, cast immobilization, fracture of foot, bumping, stubbing or trauma. S/S: Tight shoes, cast immobilization, fracture of foot, bumping, stubbing or trauma.

Quadratus Plantae & Lumbricals

ATT: Calcaneus & tendon of flexor Digitorum Longus ACTION: Flex the proximal phalanges of 4 lesser toes and extend the 2 distal phalanges ACTIV/PERP: Tight shoes, cast immobilization, fracture of foot, bumping, stubbing or trauma. S/S: Pain to the plantar surface of the heel

Abductor Hallucis

ATT: Calcaneus tuberosity & medial side of plantar aspect of proximal phalanx of great toe ACTION: Stabilizes the foot and flexes and may abduct the proximal phalanx of the great toe ACTIV/PERP: Tight shoes, slipper floor under a desk, etc. Tight cap/toebox shoes, cast immobilization, stubbing, bruising Morton's foot, hyperpronation, hyper or hypo mobility, walking or running on uneven surfaces or slopes. S/S: Pain in the medial side of heel to instep and back of heel medially

Flexor Digiti Minimi

ATT: Extends from base of 5th metatarsal to the proximal phalanx of the 5th toe. ACTION: Flex 5th toe. ACTIV/PERP: Tight shoes, cast immobilization, fracture of foot, bumping, stubbing or trauma. S/S: Pain restricting walk

Peroneus Tertius (weak Ankle Muscle) **Located in the anterior compartment but considered part of Lateral**

ATT: Fibula (as per. Longus and Per. Brevis) but Per Tertius passes in FRONTof the lateral malleolus and ends on the proximal portion of the 5th metatarsal ACTION: Assists in eversion but DORSIFLEXES rather than plantar flexes the foot ACTIV/PERP: Prolonged immobilization, Morton's foot, high elastic socks, crossing legs when seated and flat foot S/S: Pain in the ankle and ankle weakness

Peroneus Longus (Weak Ankle Muscle)

ATT: Head of fibula, proximal 2/3 of lateral fibula & base of 1st metatarsal and medial cuneiform (lateral compartment) ACTION: Everts foot, assist to plantar flex ACTIV/PERP: Prolonged immobilization, Morton's foot, high elastic socks, crossing legs when seated and flat foot S/S: Pain in the ankle and ankle weakness

Extensor Digitorum Longus defined

ATT: Lateral condyle of tibia; proximal, anterior shaft of fibula AND interrosseus membrane & distal phalanges of the 2nd through 5th toes (medial cuneiform and base of 1st metatarsal) ACTION: Everts foot, assists in preventing foot drop and extends 2nd-5th toes; dorsiflex ankle at talocrural joint. ACTIV/PERP: Prolonged plantar flexion in sleep; catching foot on ground when kicking a ball and high heels.

Abductor Digiti Minimi (part of the Superficial Intrinsic Foot Muscle Group/short extensor of toes)

ATT: Lateral process of calcaneus and lateral side of proximal phalanx of 5th toe ACTION: Abducts and assists flexion of the proximal phalanx of the 5th toe ACTIV/PERP: Tight cap/toebox shoes, cast immobilization, stubbing, bruising Morton's foot, hyperpronation, hyper or hypo mobility, walking or running on uneven surfaces or slopes.

Plantaris *short muscle belly but LARGEST TENDON IN THE BODY"

ATT: Lateral supracondylar line of femur & calcaneus via calcaneal tendon ACTION: Weakly assists in knee flexion to gastroc ACTIV/PERP: Overload when wearing slippery shoes, on sand or laterally slanted surface, high heels, slipping or almost falling, heel lift in shorter limb. S/S: Pain behind knee & downward over calf, pain in ball of foot and base of big toe.

Flexor Digitorum Brevis (part of the Superficial Intrinsic Foot Muscle Group/short extensor of toes)

ATT: Medial calcaneus and plant aponeurosis & middle phalanx of 2nd-5th toes ACTION: Flexes middle/second phalanges of the lesser 4 toes ACTIV/PERP: Tight shoes, slipper floors under desk, etc. Tight cap/toebox shoes, cast immobilization, stubbing, bruising Morton's foot, hyperpronation, hyper or hypo mobility, walking or running on uneven surfaces or slopes. S/S: Pain in plantar aspect of the 5th metatarsal head and maybe to adjacent sole

Plantar Interossei. (ADDUCT)

ATT: Medial surface 3-5 metatarsals and medial surface of proximal phalanges. ACTION: ADDUCT 3-5th toes, flex 3-5th toes ACTIV/PERP: Tight shoes, cast immobilization, fracture of foot, bumping, stubbing or trauma. S/S: Tight shoes, cast immobilization, fracture of foot, bumping, stubbing or trauma.

Extensor Hallucis Longus defined

ATT: Middle, anterior surface of fibula and interosseus membrane & distal phalanx of big toe ACTION: Prevent foot slap, extend proximal phalanx of great toe and assist in dorsiflexion and INVERSION of the foot ACTIV/PERP: Using muscle in extended position for long periods, L4/5 radiculopathy, and stress overload S/S: Persistent pain over the dorsum of the foot; sometimes foot slap, night cramps in the extensors of the toes and "growing pains

Extensor Hallucis Brevis (part of the Superficial Intrinsic Foot Muscle Group/short extensor of toes)

ATT: Proximal calcaneus & proximal phalanx of great toe ACTION: Extends the proximal phalanx of the great toe ACTIV/PERP: ACTIV/PERP: Tight shoes, slippery floor under desk, etc. Tight cap/toebox shoes, cast immobilization, stubbing, bruising, Morton's foot, hyperpronation, hyper or hypo mobility, walking or running on uneven surfaces or slopes. S/S: Pain in dorsal foot like a nail in top of the foot while walking, pain in the mid dorsum of the foot

Extensor Digitorum Brevis (part of the Superficial Intrinsic Foot Muscle Group/short extensor of toes)

ATT: Proximally to calcaneus & distal to lateral surfaces of the corresponding tendons, 2nd-4th toes via extensor Digitorum Longus tendons ACTION: Extent phalanges of 2-4th toes ACTIV/PERP: Tight shoes, slippery floor under desk, etc. S/S: Pain in dorsal foot like a nail in top of the foot while walking, pain in the mid dorsum of the foot

Soleus "Second Heart".

ATT: Soleal line, proximal posterior surface of Tibia and posterior aspect of head of fibula (*crosses only ankle joint and NOT KNEE*) & Calcaneus via calcaneal tendon. ACTION: Assists in knee flexion, and is known as "second heart" in getting blood flow back to heart, and assists to invert foot. ACTIV/PERP: Overload when wearing slippery shoes, on sand or laterally slanted surface, high heels, slipping or almost falling, heel lift in shorter limb. S/S: Referred pain and tenderness, walking can be difficult, growing pains, restricted dorsiflexion

Gastrocnemius "Calf cramp muscle" Most superficial muscle of the calf

ATT: Spans 2 Joints, proximally medial and lateral heads to the distal femur, & calcaneus via calcaneal tendon ACTION: Flex the knee, assists other flexors to control forward rotation of leg over foot during ambulation and plantar flexion ACTIV/PERP: Climbing slopes, jogging uphill, riding bike with seat too low, cast immobilization, leaving foot plantar flexed for prolonged periods, chilling of muscle and overload, long socks S/S: Night calf cramps

Flexor Hallucis Brevis.

ATT: The two parts of FHB extend from a common proximal attachment onto the adjacent surfaces of the cuboid and lateral cuneiform bones to distal attachments by two tendons, one to each side of the proximal phalanx of the large toe. ACTION: Flexes 1st Toe ACTIV/PERP: Tight shoes, cast immobilization, fracture of foot, bumping, stubbing or trauma. S/S: Tight shoes, cast immobilization, fracture of foot, bumping, stubbing or trauma.

Adductor Hallucis "7"

ATT: Two heads, similar to "7" or backward "7", obliquely slant across 1st-4th metatarsal bones; transverse plantar ligament of 3rd-5th metatarsal joints & lateral surface of base of proximal phalanx of 1st toe. ACTION: Assist to flex 1st toe and maintain transverse arch of foot. S/S: Tight shoes, cast immobilization, fracture of foot, bumping, stubbing or trauma.

Medial collateral ligamentous sprains result most often from a violently directed force pushing the leg into?

Abduction, internal rotation.

Morton's Toe (Greek foot)

Abnormally short 1st Toe, extremely tight extrinsics Can cause stress fracture of 2nd metatarsal due to, webbed toes common As described by Dudley Morton, condition is usually hereditary and involves a short first metatarsal which is hypermobile at its base and thickening of the 2nd metatarsal shaft. Weight bearing of the foot is limited to the middle of the foot. S/S: Pain in ball of foot, foot abnormally pronates, callus at area of pain and often leads to bunion. Tests include passive flexion of MTP joints of toes and if 2nd appears longer then positive for Morton's toe.

Intrinsic muscles of the foot

All originate & insert within the foot Extensor digitorum brevis is on dorsum of foot Remainder are in a plantar compartment in 4 layers on plantar surface of foot

Lateral Collateral Ligament (LCL)

Also called the fibular collateral ligament, it is a round, fibrous cord that attaches to the lateral epicondyle of the femur and to the head of the fibula. It is taut during knee extension but relaxed during flexion. The LCL contributes to lateral stability of the knee.

Medial Collateral Ligament (MCL)

Also called the tibial collateral ligament, it attaches above the joint line on the medial epicondyle of the femur and below beneath the pes anserinus (the common attachment on the tibia of the semitendinosus, sartorius and gracilis tendons). The posterior aspect of the ligament blends into the deep posterior capsular ligament and semimembranosus muscle. Deeper fibers of the MCL merge with the joint capsule and medial meniscus to connect the medial epicondyle of the femur to the medial tibia. The MCL resists medially directed shear (valgus) and rotational forces acting on the knee.

The Lachment test is used to evaluate stability of what?

Anterior cruciate ligament.

Most sprained ligament

Anterior talofibular

Name the Compartments of the leg

Anterior; lateral, posterior and deep posterior

Tibialis Anterior Muscle (foot drop muscle) attaches where?

Att: subcutaneous, lateral condyle of tibia AND medial cuneiform and base of 1st metatarsal Action: prevent foot slap at heel strike, dorsiflexion of foot at talocrural joint, acts to supinate foot S/S: Referred pain and tenderness in ankle anteromedially and in big toe; painful motion of ankle, dragging of toes, and ankle weakness; pain usually in upper 3rd of muscle NO NIGHT CRAMPS ACT/PERP: Major overload or accident

Anterior Cruciate Ligament

Attaches from the anterior aspect of the intercondylar fossa of the tibia to the posterior medial surface of the lateral condyle of the femur. It prevents the femur from moving posteriorly during weight bearing. It stabilizes the tibia against excessive internal rotation and serves as a secondary restraint for valgus and varus stress with collateral ligament damage. When the knee is fully extended, the posterolateral section of the ACL is tight; in flexion, the posterolateral fibers loosen and the anteromedial fibers tighten. The ACL works in conjunction with the thigh muscles, especially the hamstrings, to stabilize the knee joint. Considered the weaker of the two cruciate ligaments, it is often subject to deceleration injuries.

Brevis Muscles/Longus Muscles

Brevis muscles are intrinsic and Longus muscles are extrinsic *** EXCEPTION OF peroneus brevis ***

Over supination is combination of which foot movements? Excess Supination

Calcaneal Inversion, foot Adduction and plantar flexion At heel strike in prolonged or excessive supination, movement at the subtalar joint will not allow the midtarsal joint to unlock, keeping the foot excessively rigid and foot cannot absorb ground reactive forces as efficiciently. Excessive supination limits Tibial internal rotation Injuries: Inversion ankle sprain, medial tibial stress syndrome, fibularis tendinitis, IT band friction syndrome and trochanteric bursitis S/S: Wear pattern on lateral border of shoe

Excess pronation combination of which movements?

Calcaneal eversion, foot abduction and dorsiflexion. Causes extremely loose foot, increased stress on plantar fascia and Achilles' tendon. Foot loses power in push-off due to loose foot. Problems include 2nd metatarsal fracture, plantar fasciitis, posterior tibial tendinitis, Achilles tendonitis, tibial stress syndrome and medial knee pain. Too-many toes sign from behind, if client shows 2-3 toes on one side and four on other, it is positive sign

Hindfoot bones

Calcaneus and Talus

Local Twitch Response

Characteristic of taut band associated with TP. Twitch response elicited by snapping palpating of a trigger point (movement through skin seen along the band of taut band fibers). Not known to occur in any other circumstance.

Lateral Collateral Ligament (LCL) Sprain - Much less prevalent than MCL sprains.

Common Causes: When foot is everted and knee is forced laterally into a varus position, often with tibia internally rotated. Direct blows to medial aspect of knee are rare. If blow or force is severe enough, both cruciate ligaments, attachments of ITB and biceps femoris may be torn, the menisci could be disrupted, and avulsion fractures could occur to the femur, tibia or fibula. Symptoms: Pain and tenderness over LCL (pain greatest in Grade 1 and 2 sprains, in Grade 3 pain is intense initially, turning into a dull ache); palpable defect when knee flexed and internally rotated; swelling and effusion over LCL; some joint laxity with varus stress test at 30 degrees of flexion. If the peroneal nerve is also injured, this could result in temporary or permanent palsy, weakness and paralysis of lateral aspect of lower leg, requiring immediate medical attention. Tests: Varus stress test Treatment: Similar rehab program as that for MCL sprain.

Thompson Test

Compression of the calf muscle while observing for plantar flexion to assess the stability of the Achilles tendon

Tonic Contractions

Constant low grade tension (tone)

Eccentric

Controlled lenthening

What is the midfoot made up of?

Cuboid; Navicular and 3 cuneiforms (middle, medial & lateral)

Tibialis Posterior "Runner's Nemesis" -

DEEPEST MUSCLE ATT: Proximal, posterior shafts of tibia and interosseus membranes & all 5 tarsal bones. ACTION: Invert foot, plantar flex ankle (talocrural) and prevent excessive pronation of foot during mid stance phase. ACTIV/PERP: Chronic postural overload, jogging on uneven surfaces, badly worn shoes, Morton's foot, Hyperuricemia, polymyalgia rheumatica, hyperpronation of foot due to hyper mobile midfoot. S/S: Pain in the sole of the foot when running or walking, espectially on uneven surface. Pain is felt severely in the ARCH of the foot, Achilles' tendon and to lesser degree in heel, toes and calf.

EVERSION ANKLE SPRAINS

DELTOID LIGAMENT, less common but more severe than inversion; probably have adulation of tibia before deltoid ligament tears. S/S: Pain, sometimes severe, over foot & lower leg. Usually patient is unable to bear weight. Both abduction and adduction cause pain but pushing upward on bottom of foot does not cause pain. MGMT: X-rays often needed; PRICE, NSAIDS, same as inversion sprains.

Deep Medial Capsular Ligaments

Divided into the anterior, medial and posterior capsular ligaments: The anterior connects with the medial meniscus through the coronary ligaments and relaxes during knee extension and tightens during knee flexion. The medial attaches the medial meniscus to the femur and allows the tibia to move on the meniscus inferiorly. The posterior capsular ligament (sometimes called the posterior oblique ligament), attaches to the posterior medial aspect of the meniscus and joins with the semimembranosus muscle.

Eversion (same as Dorsieflexion)

Dorsiflexion, abduction, eversion

Hallux Valgus/Bunion

ET: A very painful deformity, it is an exostosis that forms over the head of the first metatarsal. The bursa over the metatarsophalangeal joint becomes inflamed and eventually thickens and hardens. Often due to forefoot varus and over pronation of the foot. S/S: Pain and inflammation, tenderness at the site. MGMT: Wider shoe (toe box), lacing shoes for more comfort (skipping 1st hole), possible bunionectomy MT: Work on adductor Hallucis muscle.

Hallux Rigidus

ET: Development of bone spurs on dorsal aspect of first metatarsophalangeal joint resulting in impingement and loss of active and passive dorsiflexion; IS a degenerative arthritis condition. S/S: Unable to dorsiflex hallux; Can be due to TURF toe; walking awkward due to weight bearing on later foot. MGMT: Stiffer shoe with larger toe box, orthotic, NSAID's, possible surgery.

Sesamoiditis

ET: Repetitive hyperextension of the great toe Sx: Pain under great toe, especially in toe-off MGMT: Orthotics, decrease activity

Syndesmosis

ETIOL: "high ankle sprain" resulting from a stretch or tear of the tibiofibular ligaments causing a spreading of the DISTAL tibiofibular joint. Initial rupture occurs distally at the tibiofibular ligament above ankle mortise; as force of increased external rotation or forced dorsiflexion, the interosseus is torn more proximally. S/S: Severe and prolonged pain and loss of function in ankle region above talocrural joint. MRI may be needed. MGMT: Extremely hard to treat and often takes month to heal. Same treatment as other sprains except for prolonged immobilization.

Retrocalcaneal Bursitis (Pump Bump)

ETIOL: Caused by inflammation of bursa beneath Achilles tendon. Chronic condition that develops overtime, can result in Haglund's deformity/bone spur if not treated. MGMT: PRICE, NSAIDS, ultrasound, stretching, donut pad, comfy shoes!

Stress Fracture of Tibia or Fibula

ETIOL: Common overuse condition especially among runner. Stress fractures to lower extremities are more likely in patients with foot deformities, i.e. hyper mobile pronated foot FIBULAR stress fracture and pes cavus rigid foot = tibial fracture. The wider the tibia the less incident of fracture. More frequent in inexperienced or non-conditioned clients and/or training errors. Also higher incident with amenorrhea and nutritional deficiencies. S/S: Pain in leg that is more intense after activity than during. Point tenderness. Bone percussion (above level of tenderness) can help distinguish fracture vs soft tissue damage or percussion on heel up into leg. Diagnosis is difficult, x-rays not always reliable but bone scan can help distinguish between fracture and periostitis (inflammation of periosteum). MGMT: Difficult to treat due to unclear causes. Discontinue running or other activities for at least 14 days. With severe pain patient should use a crutch or wear a cast. Resume weightbearing when pain subsides. Bicycling before returning to running. After two weeks pain free, can gradually begin running. Orthotics where appropriate.

Metatarsal Stress Fracture

ETIOL: Most common stress fracture of the foot involves shaft of 2nd metatarsal or MARCH FRACTURE. Common in runners who change course, length of time running, etc. Other contributing factors - structure forefoot varus, hallux valgus, flatfoot or Morton's Toe. S/S: 2-3 weeks of dull pain developing during exercise, then to pain at rest. Initially pain is diffuse then localized to site of fracture. MGMT: Bone scan is best diagnostic. 2-4 days of partial weightbearing followed by 2 weeks of rest. Orthotics if needed.

Achilles Tendon Strain

ETIOL: Often occurs after ankle sprains or sudden excessive dorsiflexion of the ankle. S/S: Mild to severe injury, severe is complete avulsion of Achilles' tendon. During injury the patient feels acute pain and extreme weakness on plantar flexion. MGMT: Elastic wrap, PRICE for possible extended period, stretching and strengthening when appropriate.

Define Cuboid Subluxation

ETIOL: Pronation and trauma injury with partial dislocation of cuboid. S/S: Pain at 4th and 5th metatarsals and cuboid with prolonged standing. Can be confused with plantar fasciitis symptoms as pain can often refer to the heel. MGMT: Manual manipulation to realign cuboid and once it is realigned, foot orthotics for support.

Tarsal Tunnel Syndrome

ETIOL: Tarsal tunnel is area behind medial malleolus with an osseus floor and roof is flexor retinaculum. Through this tunnel pass the tibialis posterior, flexor Hallucis longus and flexor digitorum muscles with their surrounding synovial sheaths, the tibial nerve artery and vein. Any compromise of this area is Tarsal Tunnel syndrome including tenosynovitis, previous fractures, excessive pronation or acute trauma. S/S: Pain and paresthesia, particularly along the medial nad plantar aspects of the foot. Night pain also common. Tinel's sign will be positive. MGMT: NSAID's, orthotic if pronation is contributing. Surgery may be necessary.

Achilles Tendinosis

ETIOL: Thickening of tendon due to injury and scarring. MGMT: Cross-friction massage and strengtening of gastroc.

PLANTAR FASCIITIS

ETIOL: an inflammation of the plantar fascia on the sole of the foot; most common hindfoot problem in runners; secondary to trauma or repetitive strain of the plantar fascia, most commonly where it attaches to the calcaneus, causing micro tears, pregnancy or excessively high arch. S/S: Anterior medial heel pain, pain in the morning on first walking, pain at the medial tubercle of the calcaneus. MGMT: Ice, stretching, strengthening, work on intrinsics, taping and cortisone shot.

Achilles Tendon Rupture...OUCH!

ETIOL: occurs in athletes over 30, patients with history of chronic inflammation and gradual degeneration; sudden pushing off action of forefoot. S/S: Sudden snap, initial pain which subsides, toe raising is impossible, swelling, discoloration, point tenderness MGMT: Surgery Recommended, rehab can be longer than six months.

Cyclist's Knee - Pes Anserinus Tendinitis/Bursitis

Etiol: The pes anserinus (goose foot) is attachment site on tibia of sartorius, gracilis and semitendinosus muscles where there is a bursa that becomes inflamed and causes pain in same lateral leg area of ITB pain. This conditions results from EXCESSIVE GENU VARUM. S/S: Pain and local swelling of pes anserine bursa with palpable fluidity, local tenderness and redness when acute. A stress fracture of tibia should be ruled out due to similar symptoms. MGMT: Nobel compression test positive. Correction of foot and leg alignment problems, if any. Ice therapy before and after activity, proper warm up and stretching, NSAIDs, exercises.

Acute Patellar Subluxation/Dislocation

Etiol: Usually from action of athlete plants food, decelerates and cuts in opposite direction. Patella rests in abnormal position, causes pain, swelling, loss of knee function, knee reduction, immobilization 4 weeks. Quads try to pull patella in straight line and pulls patella laterally. S/S: pain, swelling, complete loss of knee function with patella resting abnormally. Mgmt: reduction by physician, may be done under anesthesia, then conservative immobilization, ice and splinting, and follow up x-rays.

Runner's Knee - IT Band Friction Syndrome

Etiol: painful overuse inflammatory condition of lateral aspect of knee joint over the epicondyle of femur. Pain usually not disabling. S/S: Diffuse pain/tenderness at insertion point of ITB on lateral femoral convulse. Have and burning during or after running; pain may radiate up thigh to hip. Swelling is not usually present with normal ROM but possibly "snapping" and tightness of ITB. MGMT: Following POSITIVE OBER'S TEST; stretching of ITB, inflammatory treatment including ice and reduce tense muscles of glute medius; TFL, and vastus medialis.

Bunionette (Tailor's bunion)

Exostosis at the 5th metatarsophalangeal joint. MGMT: Shoes, orthotics, shoe lacing, surgery. MT: Work on adductor Hallucis.

What are the Superficial Intrinsic Foot Muscles? **Refer pain & tenderness to the foot BUT NOT THE ANKLE**

Extensor Digitorum Brevis, Extensor Hallucis Brevis, Abductor Hallucis, Flexor Digitorum Brevus, Abductor Digitorum Minimi

What are the Long Extensor of Toes (Muscles of classic hammertoes)?

Extensor digitorum Longus Extensor Hallucis Longus

"Peroneal" same as....

Fibularis

sartorius muscle action

Flexes, abducts, and laterally rotates thigh at the hip; flexes knee

Long Flexor Muscles of the Toes ("Clawtoe Muscles") Flexor Digitorum Longus Flexor Hallucis Longus

Flexor Digitorum Longus - Proximally to posterior surface of TIBIA; distally to base of distal phalanx of 4 lesser toes Flexor Hallucis Longus - Prox to posterior surface of FIBULA; distally to distal phalanx of Great Toe. Muscles cross-cross down into the foot. ACTION: Help maintain equilibrium wen body weight is one forefoot and stabilize foot & ankle during mid stance to late stance. FDL-Flex 2nd-5th toes, weak plantar flexion of ankle, invert foot. FHL-Flex 1st Toe, weak plantar flexion and Invert foot. ACTIV/PERP: Running on uneven ground, particularly in badly won footwear; walking or running barefoot on sand; Morton's foot. S/S: FDL: middle of plantar forefoot proximal to 4 lesser toes, NEVER to heel. FHL: Strongly to plantar surface of great toe and head of first metatarsal - may radiate to plantar surface but NOT TO HEEL

Equinus forefoot

Forefoot is plantarly flexed relative to rearfoot

Muscles that Produce: Posterior Knee Pain

Gastocnemius Biceps femoris Popliteus Plantaris Soleus TrP2 Semitendinosus Semimembranosus

Define Triceps Surae

Gastrocnemius and Soleus

Metatarsalgia

Generalized term to describe pain the ball of the foot, it is commonly associated with pain under the 2nd and 3rd metarsal head and resultant heavy callus formation Cause: One of the causes is restricted extensibility of the gastroc-Soleus where patient emphasizes toe-off, such as in wearing high heels MGMT: Elevate, remove callus, stretching gastrocnemius, strengthen foot intrinsics

INVERSION ANKLE SPRAINS

Grade 1: Anterior talofibular ligament (most common) -Weightbearing is only minimally affected, mild pain, no joint laxity. POLICE 30-60 min every 2hrs for 1-2 days Grade 2: Anterior Talofibular ligament & calcaneofibular ligament -Positive talar tilt test, moderate pain, swelling, ecchymosis with blood in joint, anterior drawer elicits slight movement. POLICE intermittently for 72 hours, Anterior & posterior mobilization as soon as tolerated, crutches 5-10 days, early movement, PNF, PRE, taping. Grade 3: Anterior talofibular ligament, calcaneofibular ligament and posterior talofibular ligament. Uncommon and extremely disabling. -Severe pain in lateral malleolus, weightbearing not tolerable, immobilization for at least 10 days; POLICE for at least 3 days, air stirrup brace or below knee cast.

Hammertoe Mallet Toe Claw toe

Hammertoe is a flexible deformity that becomes fixed at the PIP joint. Mallet toe is flexion deformity of the DIP joint involving the flexor Digitorum longus tendon. Claw toe is flexion contracture at the DIP joint but ALSO hyperextension of MP joint. ETIOL: Wearing shoes that are too short and cramping the toes. S/S: In all three deformity can become fixed. There may be blistering, swelling, pain, callus formation and sometimes infection. MGMT: Change to proper fitting shoes, padding and protective taping. In fixed contractures, surgical correction with K-wire is indicated.

Stance and Swing: Heel strike, Footflat, Midstance

Heel strike: inability of a foot to heelstrike is an indication of heel spur and associated bursitis or blister. A harsh heelstrike is usually associated with knee hyperextesion, frequently a sign of weak hamstrings. Footflat: When foot slaps down sharply after heel strike, weak dorsiflexors should be suspected. Midstance: Weak quads display themselves in excessive flexion and poor knee stability during mid stance. A mid stance forward lurch of the hip is a typical indication of weak gluteus medius. A Mid stance backward lurch is indication of weak gluteus Maximus.

Peroneus longus, tibialis anterior, gastrocnemius, soleus, extensor digitorum longus, peroneus brevis

Identify the muscles indicated....

Apophysitis of Calcaneus (Sever's Disease)

Inflammation of heel growth plate where Achilles' tendon attaches.

Jumper's Knee/Patellar Tendinitis

Jumping, kicking and running can place extreme tension on the knee extensor muscle complex. Sudden or repetitive forceful extension can lead to tendinitis in the patellar or quadriceps tendon, tendon degeneration, and, on rare occasions, complete failure and rupture of the patella. Patellar subluxation or patellofemoral stress syndrome share similar symptoms and can also overload the patellar tendon. Common Causes: Acute, violent jumping episode; chronic repetitive jumping, climbing and running activities which can weaken the tendon. Foot imbalance and running up hills can aggravate symptoms. Symptoms: Pain and tenderness at the region of the inferior patella develops in three stages: 1. Pain after sports activity; 2. Pain during and after activity (athlete is able to perform at appropriate level); 3. Pain during activity and prolonged after activity (athlete's performance is hampered Test: Tenderness is elicited by stabilizing the patella superiorly with one hand while directing localized pressure against the distal pole of the patella and the most proximal portion of the patellar tendon. Treatment: Ice, compression, elevation, rest, restricted activity and antiinflammatories. Heat therapy, electrical stimulation, ultrasound, patellar bracing, aquatic therapy (to reduce gravitational force) and other modalities can be used. Eccentric quadriceps strengthening and a stretching program for the quadriceps, hamstrings, plantar flexors, hip flexors and extensors will assist in absorbing strain. Sudden explosive movements should be avoided; restriction of jumping activity is common for up to 1-2 years. Deep transverse friction (DTF) massage of the patellar tendon has been used successfully to treat jumper's knee.

Inflammatory Phase of Healing

Lasts up to 72 hours. Pain, swelling, redness and warmth. Treatment: PRICE Classics signs of accurate injury in this phase are not present in chronic overload, but injury component still exists.

What is the most common direction for the patella to sublux

Laterally

Meniscus Injuries

Lesions of the medial meniscus are much more common than lateral meniscal tears. This is a result of the coronary ligament which attaches the medial meniscus to the tibia, the capsular ligament and the semimembranosus. The lateral meniscus is more mobile during knee movement. Mensical tears can be longitudinal, oblique or transverse. Because of its blood supply, tears in the outer third layer of a meniscus may heal in time and with reduction of stress; tears in the mid- and inner layers often fail to heal because these layers are less vascular. Ruptured edges of a torn meniscus can harden and eventually atrophy Common Causes: Medial meniscus can be prone to tearing from valgus and torsional forces (weight bearing combined with rotation while flexing or extending the knee; cutting motion while running). Forced flexion produces a peripheral tear. Cutting motion with foot fixed produces a "bucket-handle" shaped tear. Forcefully extending the knee from a flexed position when femur is internally rotated produces a longitudinal tear. The lateral meniscus can sustain an oblique tear by forcefully knee extension with femur externally rotated. Symptoms: Gradual effusion may develop after 48 - 72 hours; joint-line pain and loss of motion; intermittent locking and unlocking; pain when squatting. Signs would be vastas medialis atrophy and pain with forceful flexion and extension. Tests: Apley's distraction Test (see Orthopedic Test # 33a,b). Treatment: Surgically repaired menisci usually require immobilization in a rehabilitative brace for 5-6 weeks. ROM and resistance exercises can then be undertaken; emphasis should be on endurance.

Wrisberg's Ligament (or meniscofemoral ligament)

Ligament that is part of the lateral meniscus that projects upward, close to the attachment of the posterior cruciate ligament.

Latent Trigger Point

May show features of active trigger point but pain only on examination.

Morton's neuroma

Medial and lateral nerves between 3rd and 4th toes swell from pressure of Morton's toe and a bump forms from the friction. Squeeze testing of the metatarsals is positive if pain is elicited. Treatment: Teardrop pad for cushioning area

Name the four arches of the foot.

Metatarsal Transverse Medial Lateral

What is the forefoot made up of?

Metatarsals (14); Phalanges (5) and Sesamoid (2)

Define Jones Fracture

Most common fracture of the metatarsals, it is a fracture to the diaphysis at the base of the fifth metatarsal. S/S: Immediate swelling and pain over the fifth metatarsal. HIGH NONUNION RATE Type I , Type II MGMT: No immobilization, crutches to assist, early activity to stimulate regeneration and possible surgical wire fixation.

Posterior Cruciate Ligament (PCL) Sprain

Most important ligament, the PCL provides a central axis for rotation, and 95% of the total force restraining posterior displacement of the tibia. It also resists hyperextension and assists in medial stability of the knee. * The PCL is most at risk when the knee is flexed to 90 degrees. Common Causes: Falling with full weight on anterior aspect of bent knee with foot in plantar flexion; hard blow to front of bent knee; extreme rotational force. Symptoms: Sensation of "pop" in the back of the knee; tenderness and some swelling in popliteal fossa; laxity demonstrated by orthopedic tests. Tests: Posterior Drawer Test, Posterior Sag Test Treatment: Non-surgical rehab should focus on quadriceps strengthening; surgery; post-surgical rehab involves 6 weeks of immobilization in extension with full weight bearing on crutches; ROM exercises and progressive resistive exercises.

Medial Collateral Ligament (MCL) Sprain

Most often due to adduction and internal rotation. Common Causes: Direct blow from the lateral side, or severe outward twist of knee (violent adduction and internal rotation). Symptoms: MCL sprains can be divided into three grades of severity: 1. Few ligament fibers torn and stretched; joint stable during valgus stress tests; little or no joint effusion but some stiffness and point tenderness below medial joint line; almost full passive and active range of motion (ROM). 2. Complete tear of deep capsular ligament and partial tear of superficial layer of MCL or partial tear of both; no gross instability, but slight laxity during full extension; 5-15 degrees laxity when valgus stress test performed at 30 degrees of flexion; some swelling. 3. Complete tear of supporting ligaments Tests: Valgus stress test Treatment: Depending on severity: RICE, crutches, cryokinetic therapy, massage, knee immobilizing splints, taping and bracing; and knee joint rehab exercises.

Shin Splints

Pain in the anterior medial leg associated with exercised.

Referred Trigger Pain

Pain that arises from a trigger point but is felt at a distance, often entirely remote from its source.

Percussion & Compression Test

Percussion and compression at bottom of foot to test for possible distal tibia or fibula fracture

What are the Peroneal (Fibularis) Muscles "Weak Ankle Muscles"

Peroneus Longus, Peroneus Brevis and Peroneus Tertius

The main supporting ligament of the medial longitudinal arch is?

Plantar calcaneonavicular

Tibialis posterior

Plantar flexion and inversion of foot

Which muscle allows for internal rotation of the tibia?

Popliteus

Which is the strongest cruciate ligament of the knee?

Posterior cruciate

Varus forefoot

Produces excess pronation (loose foot), less power in propulsion

Valgus forefoot

Produces excess supination (rigid foot)

Inversion (same as Supination)

Pronation, adduction and inversion

Q angle and A angle

Q angle: ASIS to patella and public to patella. INCREASES WITH VALGUS STRESS, decreases with varus. A angle: Lines which bisect patella relative to ASIS & tibial tubercle. DECREASES WITH VALGUS, increases with varus. Angles should be 10 degrees for males and 15 degrees for females.

Gait: If a person must rotate the pelvis severely anterior to provide a thrust for the leg, what muscle is weak?

Quadcriceps

Name the Deep Intrinsic Foot Muscles

Quadratus Plantae Lumbricals Flexor Hallucis Brevis Adductor Hallucis Flexor Digiti Minimi Brevis Interossei

Muscles that Produce: Anterior Knee Pain

Rectus Femoris Vastus Medius Adductors longus and Brevis

Functions of Bursa

Reduce Friction

Medial Tibial Stress Syndrome

Shinsplints. ETIOL: General term used to describe pain in the anterior part of the shin. Accounts for 10-15% of all running injuries and up to 6% of all conditions that cause pain in the area. Miss is caused by repetitive microtrauma, commonly in running and jumping activities. Other factors are weak leg muscles, shoes w/o support and training errors. Malalignment problems also contribute. S/S: Four grades of pain. 1. Pain occurring after activity. 2. Pain before and after activity. 3) Pain before, during and after activity. 4. Pain so severe that activity is impossible. MGMT: Dufficult to manage due to many factors. Dr. Referral may be needed to rule out stress fracture with bone scan/x-rays. Activity modification, correction of malalignment with orthotics as needed, ice massage and flexibility exercises. Arch taping.

What happens with a Palpable Taut Band?

Shortening of the sarcomeres of the muscle fibers comprising the taut band. Characteristic of myofascial trigger points.

Posterior Cruciate Ligament

Shorter and stronger than ACL Attaches from the posterior aspect of the intercondylar fossa of the tibia to the lateral side of the medial femoral condyle. Some portion of the PCL is taut throughout the full range of motion. It acts as a drag during the gliding phase of motion and resists internal rotation of the tibia. The PCL prevents hyperextension of the knee and femur sliding forward during weight bearing.

Three major functional JOINTS of the foot

Subtalar, midtarsal and metatarsophalangeal

Quadriceps Femoris Group "Four Faced Troublemaker"

Symptoms: Pain at night, buckling hip syndrome, weakness in knee extension, locked patella syndrome Vastus medialis - feels like toothache in the knee Vastus Intermedius - 3 pronged pain pattern across the lateral thigh Vastus Lateralis - TrP similar to IT TrP across lateral thigh as a burning pain Activ/Perp Injections of insulin or other meds Acute overload, i.e. stepping in a hole Knee extensions Tight antagonists, hamstrings group tight Immobilization Small hemipelvis

Runner's Knee/Cyclists Knee

Terms used to describe many repetitive and overuse conditions which can be attributed to malalignment and structural asymmetries of the foot and lower leg including leg-length discrepancy. Joggers, distance runners and cyclists commonly experience iliotibial band syndrome and pes anserinus tendinitis or bursitis.

Ankle Drawer Test

Test for *Rupture of Anterior Talofibular Ligament*, most common sprain of ankle, an *inversion injury* (from malleolus of fibula to talus) 1. Pt sitting or supine, w/ feet in slight plantar flexion 2. One hand above anterior ankle; other hand grasps calcaneus 3. Draw heel forward while pushing tibia rearward POS: Anterior shift of talus. May "clunk."

Other Stabilizing Structures at the Knee

The joint capsule of the knee is supported by several tendons and ligaments. Besides the quadriceps and semimembranosus tendons and the oblique popliteal ligament, the iliotibial band (ITB), popliteus muscle, and biceps femoris muscle reinforce the knee. The ITB is a broad, thickened band of fibrous tissue that extends from the tensor fascia lata over the lateral epicondyle of the femur to Gerdy's tubercle on the lateral tibia.

Pes Anserinus Tendinitis/Bursitis (Cyclist's Knee)

The pes anserinus ("goose foot") is the attachment site on the tibia of the sartorius, gracilis and semitendinosis muscles. There is a bursa which lies in close proximity to this attachment which can become inflammed and cause pain in the same lateral knee region as ITB friction syndrome. Common Causes: In contrast to ITB friction syndrome, this condition results from excessive genu valgum (knock-kneed alignment), though some sports medicine authors tend to think the pes anserine tendons could be compensating for excessive tibia varum at heel strike. Weakness of the vastus medialis muscle is usually associated with this condition. Symptoms: Pain and local swelling of the pes anserine bursa (which lies close to the tendinous insertion point) with palpable fluidity, local tenderness and redness when acute. Note: a stress fracture of the tibia might present with the same symptoms and should be ruled out. Test: Nobel Compression Test Treatment: Management involves correction of foot and leg alignment problems, if any. Therapy includes cold packs or ice massage before and after activity, proper warm-up and stretching, avoidance of activities that aggravate the problem (such as running on inclines), administration of antiinflammatory medications, orthotic shoe devices, exercises to improve the vastus medialis and pes anserine muscle groups. Corticosteroid injections will occasionally be administered for pain. Treatment: Management involves correction of foot and leg alignment problems, if any. Therapy includes cold packs or ice massage before and after activity, proper warm-up and stretching, avoidance of activities that aggravate the problem (such as running on inclines), administration of antiinflammatory medications, orthotic shoe devices, exercises to improve the vastus medialis and pes anserine muscle groups. Corticosteroid injections will occasionally be administered for pain.

rectus femoris

The rectus femoris muscle is one of the four quadriceps muscles of the human body. The others are the: vastus medialis, the vastus intermedius and the vastus lateralis. The rectus femoris is situated in the middle of the front of the thigh; it is fusiform in shape, and its superficial fibers are arranged in a bipenniform manner, the deep fibers running straight (Latin: rectus) down to the deep aponeurosis. Its functions are to flex the thigh at the hip joint and to extend the leg at the knee joint.[1]

Stress Failure or Fatigue - Soft Tissue Injury

This injury results from periodic loading with small stress over a a prolonged time, until failure of the tissue occurs.

Chondromalacia Patella

This is a degeneration of the articular cartilage of the patella which results from excessive compressive forces or abnormal shear forces damage the articular surface. The medial and lateral patellar facets are most commonly involved. This condition is sometimes considered an early localized form of primary osteoarthritis or degenerative arthritis. Common Causes: Direct local trauma or repeated bending microtrauma, especially if the lower extremity is not aligned properly. Gait analysis might reveal knock knees or bow legs with pronation of the feet. Symptoms: Dull, aching pain leading to sharp localized pain in the front of the knee; grinding sensation; stiffness in squatting, bending and climbing stairs; sensation of knee giving way; swelling and effusion generally not present. Tests: Clarke's Sign Test Chondromalacia has four stages: 1. Articular cartilage shows only softening or blistering. 2. Fissures appear in the cartilage. 3. Fibrillation of the cartilage occurs, causing a "crab meat" appearance. 4. Full cartilage defects are present and subchondral bone is exposed. Treatment: If chondromalacia is asymptomatic, no treatment is required. If symptoms develop, mild antiinflammatory medication can be effective. Follow with quadriceps strengthening and a program to increase hamstring flexibility. Avoid exercises with resistance involving knee extension from a fully flexed position, crouches and deep knee bends as these position may aggravate the condition. Surgical intervention includes possible arthroscopic patellar debridement, lateral retinacular release, extensor mechanism realignment or elevation of the tibial tubercle to relieve patellar compression forces.

Anterior Cruciate Ligament (ACL) Sprain

This is considered the most serious ligament injury in the knee, as it can lead to serious knee instability and major joint degeneration. The ACL is responsible for about 85% of anterior displacement of the tibia, limits tibial rotation upon the femur and limits valgus and varus stress upon the knee. Common Causes: Tibia externally rotated with knee in valgus position; lower leg rotated when foot is fixed (as in deceleration and cutting motion in running); hyperextension from force to front of knee with foot planted; direct blow. Symptoms: "Pop" followed by immediate disability; sensation that knee is "coming apart;" rapid swelling at joint line; athlete typically cannot walk without help. Tests: Lachman's test, Anterior drawer test, pivot-shift test; jerk test, flexion-rotation drawer test. Treatment: Controversy exists as to whether an ACL injury should be treated nonoperatively or with surgery.

Maturation-Remodeling phase of Healing

Three week to 12 months. Collagen is remodeled to increase the functional capabilities of the tissues. It is critical that injured structures by exposed o progressively increasing loads (Wolff's law). Aggressive active ROM and strengthening exercises should be incorporated to facilitate tissue remodeling and realignment. Any exacerbation of pain, swelling or other symptoms are indicative over overload and should be modified accordingly.

Which Muscles pronate and supinate the foot?

Tibialis posterior and flexor digitorum longus

Muscles that Produce: Anteromedial Knee Pain

Vastus Medialis Gracilis Rectus Femoris Sartorious, Lower TrP Adductors Longus and Brevis

Muscles that Produce: Lateral Knee Pain

Vastus lateralis

Weight transferred during gait

Walking: 110% body weight is transferred across the foot with each step Running: 250% of body weight is transferred 150 lb. person walks 1 mile and each foot absorbs 63.5 tons of weight over the distance; If running marathon, same person would put 2,800 tons of force on each foot during the race

The Gait Cycle, Support/Stance Phase, Swing Phase & Float Phase (with running)

Walking: Begins with heel strike and ends when same heel strikes the ground again. Normal gait cycle lasts one second (120 steps/min). The cycles are divided into support/stance phase and the swing phase. Running adds third phase when both feet are off the ground: float phase. Stance Phase: Contact, mid stance and propulsion.

Gait: if the foot has trouble clearing the foot during push off what is this an indication of?

Weak ankle dorsiflexors

Gait: A flat-footed calcaneal gait during push off is indication of what?

Weak gastroc, Soleus and and flexor Hallucis longus

Tom Dick An Harry/Tarsal Tunnel

Within the tarsal tunnel: Deep posterior compartment, behind the ankle: Tom: Tibialis posterior Dick: Flexor Digitorum Longus A: Artery N: Nerve Harry: Flexor Hallucis Longus

Abductor digiti minimi

abducts and flexes little toe

abductor hallucis

abducts the great toe; flexes the metatarsophalageal joint

Tibialis anterior

dorsiflexes and inverts foot

Tibialis anterior

dorsiflexion and inversion of foot

Extensor hallucis longus

extends great toe; dorsiflexes foot

Vastus medius

extends knee

Rectus femoris

extends knee and flexes thigh at hip

Vastus lateralis

extends leg at knee

Extensor digitorum brevis

extends toes 2-4

Vastus Intermedius

extension of knee

Flexor digitorum longus

flexes toes, plantar flexes and inverts foot

Popliteus muscle

medially rotates the tibia (or laterally rotates the femur) to unlock the knee joint.

Isotonic muscle contraction

muscle changes in length with no change in tension such as doing a biceps curl and holding the weight with the arm fully extended.

Peroneus longus

plantar flexes and everts foot; helps keep foot flat on ground

Peroneus brevis

plantar flexion and eversion

soleus action

plantar flexion of foot

Plantaris

plantar flexion, flexion of knee, inversion

Extensor digitorum longus

prime mover of toe extension

What is the smallest contractile unit of a muscle?

sacromere

Pes Anserinus (Goose's Foot)

sartorius, gracilis, semitendinosus attachments

Chondromaliacia patella

softening and degeneration of cartilage on posterior of patella causing anterior knee pain. Sometimes considered an early localized OA or RA Stage 1 -Swelling and softening of articular cartilage Stage 2 - Fissuring of softened cartilage Stage 3 - deformation of surface of articular cartilage caused by fragmentation S/S: Dull aching pain leading to sharp localized pain in the front of the knee., grinding; stiffness in squatting, bending and climbing stairs; sensation of knee giving way; swelling and effusion generally NOT present. Positive grind test. Clarke's sign test positive. Treatment: Conservative treatment and strengthening. Possible surgical excision.