3. OSTEOLOGY Session Two: Leg (Tibia, Fibula) Leg (Tibia, Fibula) Foot Foot Arches of the foot Arches of the foot Gait Gait

4. Tibia Tibia Proximal End Distal End Shaft or Body 2 Condoyle: Lat. & Med. 2 Condoyle: Lat. & Med. Tibial Tuberosity Tibial Tuberosity 3 Borders: Anterior (Shin), 3 Borders: Anterior (Shin), Lat. (Interosseus), Med. Lat. (Interosseus), Med. 3 Surfaces: Med., Lat. 3 Surfaces: Med., Lat. & Post. & Post. 5 Surfaces: Ant.,Post.,Med. 5 Surfaces: Ant.,Post.,Med.,Lat. & Inf.,Lat. & Inf. 1 Malleolus (Medial) 1 Malleolus (Medial)

8. Landmarks of Tibia Tibial tuberosity Tibial tuberosity Lateral condyle Lateral condyle Medial condyle Medial condyle Anterior border (shin) Anterior border (shin) Medial malleolus Medial malleolus

9. Fibula Fibula Proximal End Distal End (Lat Malleolus) Shaft or Body Head: Apex Head: Apex Neck 3 Borders: Ant., Post. & 3 Borders: Ant., Post. & Med. (Interosseus) Med. (Interosseus) 3 Surfaces : Ant. or Med. (Narrow) 3 Surfaces : Ant. or Med. (Narrow), Lat. & Post. (Largest), Lat. & Post. (Largest) 4 Surfaces: 4 Surfaces: Ant. (Rounded) Ant. (Rounded) Post. (Groove) Post. (Groove) Med. (Articular Facet) Med. (Articular Facet) Lat. (Subcutaneous) Lat. (Subcutaneous)

11. Back

12. Landmarks of Fibula Landmarks of Fibula Head of fibula Head of fibula Neck of fibula Neck of fibula ¼ of distal end of body ¼ of distal end of body Lateral malleolus Lateral malleolus

14. Tarsal Bone Proximal Row Distal Row Middle Row Talus Calcaneus Navicular Medial to Lateral: Medial to Lateral: Medial, Intermediate Lateral Cuneiform Medial, Intermediate Lateral Cuneiform Cuboid

15. Superior view

16. Lateral view

17. HOW TO LEARN OF TARSAL BONES N T 1 54 3 2 C : show the names of 5 bones of the foot : 1. Calcaneus 2. Cuboid 3. Cuniform (Lat.) 4. Cuniform (Intermediat) 5. Cuniform (Med.) T : show the names of 1 bone of the foot : Talus N : show the names of 1 bone of the foot : Navicular Easy guess to the tarsal joints

19. Talus bone (superior & inferior view)

20. Talus bone (lateral & medial view)

24. Navicular bone

28. Tarsal Bone Proximal Row Distal Row Middle Row Talus Calcaneus Navicular Medial to Lateral: Medial to Lateral: Medial, Intermediate Lateral Cuneiform Medial, Intermediate Lateral Cuneiform Cuboid

31. ARCHE s OF THE FOOT Longitudinal arch Longitudinal arch  Medial  Lateral Transverse Arch Transverse Arch  Anterior  Posterior

34. Medial Longitudinal arch

35. Transverse Arch

41. Flexible Flatfoot Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence. It usually occurs in both feet and generally progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed.

44. GAIT

51. Walking abnormalities Walking abnormalities are unusual and uncontrollable walking patterns that are usually due to diseases or injuries to the legs, feet, brain, spinal cord, or inner ear. Considerations The pattern of how a person walks is called the gait. Many different types of walking problems occur without a person's control. Most, but not all, are due to some physical condition.

52. Scissors gait Scissors gait legs flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissors-like movement legs flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissors-like movement

53. Spastic gait Spastic gait A stiff, foot- dragging walk caused by a long muscle contraction on one side A stiff, foot- dragging walk caused by a long muscle contraction on one side

54. Propulsive gait Propulsive gait A stooped, stiff posture with the head and neck bent forward A stooped, stiff posture with the head and neck bent forward

55. Steppage gait Steppage gait foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking

56. Waddling gait A duck-like walk that may appear in childhood or later in life A duck-like walk that may appear in childhood or later in life

57. Some walking abnormalities have been given names: Propulsive gait - a stooped, stiff posture with the head and neck bent forward Scissors gait - legs flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissors-like movement Spastic gait - a stiff, foot-dragging walk caused by a long muscle contraction on one side Steppage gait - foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking Waddling gait - a duck-like walk that may appear in childhood or later in life

58. Cause: Abnormal gait may be caused by diseases in many different areas of the body.General causes of abnormal gait may include: Arthritis of the leg or foot jointsArthritis Conversion disorder (a psychological disorder)Conversion disorder Foot problems (such as a callus, corn, ingrown toenail, wart, pain, skin sore, swelling, or spasms) Fracture Injections into muscles that causes soreness in the leg or buttocks Infection Injury Legs that are different lengths Myositis Shin splints Shoe problems Tendonitis Torsion of the testis

59. Propulsive gait: –Carbon monoxide poisoningCarbon monoxide poisoning –Manganese poisoning –Parkinson's diseaseParkinson's disease –Use of certain drugs including phenothiazines, haloperidol, thiothixene, loxapine, and metoclopramide (usually drug effects are temporary)

60. Spastic (scissors) gait: –Brain abscessBrain abscess –Brain or head traumaBrain or head trauma –Brain tumorBrain tumor –Cerebrovascular accident (stroke)Cerebrovascular accident –Cerebral palsyCerebral palsy –Cervical spondylosis with myelopathy (a problem with the vertebrae in the neck)Cervical spondylosis –Liver failure –Multiple sclerosisMultiple sclerosis –Pernicious anemiaPernicious anemia –Spinal cord traumaSpinal cord trauma –Spinal cord tumortumor –Syphilitic meningomyelitis –Syringomy eliaSyringomy elia

61. Steppage gait: –Guillain-Barre syndromeGuillain-Barre syndrome –Herniated lumbar disk –Multiple sclerosis –Muscle weakness of the tibia –Peroneal neuropathyPeroneal neuropathy –PoliomyelitisPoliomyelitis –Spinal cord injury

62. Ataxic or broad-based gait –Acute cerebellar ataxiaAcute cerebellar ataxia –Alcohol intoxication –Brain injury –Damage to nerve cells in the cerebellum of the brain (cerebellar degeneration) –Medications (phenytoin and other seizure medications) –Polyneuropathy (damage to many nerves, as occurs with diabetes) –Stroke

63. Waddling gait: –Congenital hip dysplasiaCongenital hip dysplasia –Muscular dystrophyMuscular dystrophy –Muscle disease (myopathy) –Spinal muscle atrophySpinal muscle atrophy

64. Home Care Treating the cause often improves the gait. For example, gait abnormalities from trauma to part of the leg will improve as the leg heals. Physical therapy almost always helps with short-term or long-term gait disorders. Therapy will reduce the risk of falls and other injuries. For an abnormal gait that occurs with conversion disorder, counseling and support from family members are strongly recommended. For a propulsive gait: Encourage the person to be as independent as possible. Allow plenty of time for daily activities, especially walking. People with this problem are likely to fall because they have poor balance and are always trying to catch up. Provide walking assistance for safety reasons, especially on uneven ground. See a physical therapist for exercise therapy and walking retraining. For a scissors gait:

65. Home Care(con…) People with a scissors gait often lose skin sensation. Skin care should be used to avoid skin sores. Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. A physical therapist can supply these and provide exercise therapy, if needed. Medications (muscle relaxers, anti-spasticity medications) can reduce the muscle overactivity. For a spastic gait: Exercises are encouraged. Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. A physical therapist can supply these and provide exercise therapy, if needed. A cane or a walker is recommended for those with poor balance. Medications (muscle relaxers, anti-spasticity medications) can reduce the muscle overactivity. For a steppage gait: Get enough rest. Fatigue can often cause a person to stub a toe and fall. Leg braces and in-shoe splints can help keep the foot in the right position for standing and walking. A physical therapist can supply these and provide exercise therapy, if needed.