Lower Body Evaluation ATC 328

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Lower Body EvaluationATC 328

• The Foot and Toes
• Chapter 4

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Foot and Toe Anatomy

• 26 bones
• Plus sesamoids
• Rearfoot
• Midfoot
• Forefoot

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Rearfoot Anatomy

• Calcaneus
• Sustentaculum tali
• Peroneal tubercle
• Talus

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Midfoot

• Navicular
• Posterior tibialis
• Cuneiforms
• Cuboid

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Forefoot Anatomy

• 5 metatarsals
• MP or MCP
• 14 phalanges
• PIP
• DIP
• IP

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Articulations
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Arches

• Medial longitudinal arch
• Lateral longitudinal arch
• Rarely injured
• Transverse metatarsal arch
• 1st and 5th metatarsal weight bearing

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Medial Longitudinal Arch

• Calcaneus, talus, navicular, first cuneiform,
  first metatarsal
• Supporting structures
• Plantar fascia
• Plantar calcaneonavicular ligament spring
  ligament
• Deltoid ligament
• Long plantar ligament

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Muscular Anatomy

• Intrinsic Muscles
• Extensor digitorum brevis
• Who cares!!!
• Extrinsic Muscles
• Flexor digitorum longus
• Flexor hallucis longus
• Gastrocnemius/soleus complex
• Peroneals
• Plantaris
• Tibialis posterior/anterior
• Extensor digitorum longus
• Extensor hallucis longus

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Evaluation

• History
• Blah, blah, blah
• Observation
• Edema, effusion, deformity, etc
• Palpation
• Special Tests
• ROM
• MMT
• Stability
• Etc.

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Toe Injuries

• MP, DIP, PIP, IP sprains
• 1st MP joint sprain (turf toe)
• Hyperextension mechanism
• Rule out fx
• Valgus, varus, glide testing
• Treatment options

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Metatarsal Sprains

• Intermetatarsal glides
• Tarsometatarsal glides
• Midtarsal glides ???

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Pes Planus vs. Pes Cavus

• Most often are congenital abnormalities
• Other causes
• Ligaments
• Muscles
• Accessory navicular
• Tarsal coalition
• Plantar fascia
• Navicular drop test
• Complications associated with these arch types?

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Transverse Metatarsal Arch

• Most common problem is a loss of this arch.
• Consequences of fall TMA

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Plantar Fasciitis

• Causes
• Acute and chronic
• Signs and symptoms
• Pain at medial calcaneal tubercle
• AM pain
• Decreased ROM/MMT
• Treatment
• Rupture
• Acute and steroids

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Heel Spurs

• Related to Plantar Fasciitis?
• Primary complaint
• Pain with heel strike
• Treatment
• Similar to plantar fasciitis
• Surgery with chronic cases

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Tarsal Coalition

• Bony, fibrous, or cartilaginous union of tarsal
  bones
• Most often affects talus, calcaneus, and/or
  navicular
• S/S
• Rigid flatfoot
• Calcaneal valgus
• Forefoot abduction
• NWB and WB identical
• Treatment

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Tarsal Coalition
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Tarsal Tunnel Syndrome

• Compression of posterior tibial nerve

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Tarsal Tunnel Syndrome

• Causes
• Acute inversion or eversion
• Chronic structural and biomechanical
  abnormalities
• S/S
• Plantar/medial foot pain
• Positive Tinel sign
• Treatment

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Metatarsal Fractures

• Stress fractures
• Mortons toe
• Acute fractures
• Avulsion of base of 5th
• Jones fracture

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Phalangeal Fracture

• S/S
• Pain
• Swelling
• Positive compression/percussion
• Crepitus
• Treatment
• Buddy taping
• Stiff insert
• Relief pad/bar

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Intermetatarsal Neuroma

• 3 interdigital nerve most common
• Mortons Neuroma
• Fibrous formation and demyelenization
• Causes
• Thickened/shortened transverse ligament
• Fallen transverse arch
• Excessive forefoot weight bearing
• Excessive pronation
• Shoes?

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Interdigital Neuroma

• S/S
• Pain and paresthesia
• Nodule
• Pain with compression
• Decreased pain barefoot
• Pencil eraser test
• Treatment