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Lower Leg, Ankle, and Foot Conditions Chapter 16
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Anatomical Review Lower leg provides –Support for the entire body –Propulsion through space –Adaptation to uneven terrain –Absorption of shock
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Forefoot 5 metatarsals 14 phalanges Work together to form arches which distribute body weight throughout the foot MTP-Metatarsophalangeal joints IP-Interphalangeal –Phalanges work to transition weight from one foot to the other Tarsometatarsal and Intermetatarsal joints –Allow foot to adapt to uneven surfaces during gait
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Midfoot Navicular –Bridges movements between the hindfoot and forefoot Cuboid 1 st, 2 nd, 3 rd cuneiforms Transverse tarsal joint –Calcaneocuboid (CC) lateral side –Talonavicular (TC) medial side –Permit only limited gliding
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Midfoot continued… Talocalcaneonavicular (TCN) joint Allow gliding and rotation by a modified ball and socket joint –Plantar calcaneonavicular (spring) ligament inferiorly –Deltoid ligament medially –Bifurcate ligament laterally Remaining midtarsal joints –Cuneonavicular, cuboideonavicular, cuneocuboid, and the intercuneiform
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Hindfoot Calcaneus –Anteromedial surface is the sustentaculum tali Talus –Talus provides main articulation between the foot and the ankle –Articulations of the talus are Talocrural Subtalar
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Talocrural Modifies synovial hinge joint formed by the tibia, lateral malleolus of the fibula, and the talus –Fibula accounts for only 17% of the weighbearing –Lateral malleolus extends farther than medial which allows more inversion Medial collateral ligament (deltoid) –Aterior tibiotalar (ATT) –Tibionavicular (TN) –Tibiocalcaneal (TC) –Posterior tibiotalar (PTT)
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Talocrural continued… Lateral ankle –Anterior talofibular (ATF) –Calcaneofibular (CF) –Posterior talofibular (PTF)
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Subtalar Joint Articulation between the facets of the talus and the sustentaculum tali on the superior calcaneus Supported by –Intra-articular ligament –Talocalcaneal –Four small talocalcaneal ligaments
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Tibioibular Joints Proximal or superior joint is in the knee Distal or inferior joint is supported by –Anterior and posterior tibiofibular ligaments –Allows some rotation –Some abduction or spreading –Space in-between is called the mortise
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Plantar Arches Longitudinal Transverse Primary supporting ligaments are: –Calcaneonavicular ligament (spring) –Long plantar ligament –Plantar fascia (plantar aponeurosis) –Short plantar ligament (plantar calcaneocuboid)
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Muscles Anterior compartment Deep and superficial posterior compartment Lateral compartment
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Anterior compartment Tibialis anterior Extensor digitorum Extensor hallucis longus Peroneous tertius
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Deep posterior compartment Tibialis posterior Flexor digitorum longus Flexor hallucis longus
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Superficial posterior compartment Gastrocnemius Soleus Plantaris
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Lateral compartment Peroneus longus Peroneus brevis
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Muscles of the foot Intrinsic- muscle has both attachments within the foot Extrinsis- muscle has one attachment outside of the foot
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Nerves Sciatic Tibial nerve (L4-S3) Peroneal nerve (L4-S1) Superficial peroneal nerve Sural nerve
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Blood vessels
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Kinematics Toe flexion and extension –Flexor digitorum and hallucis –Extensor digitorum and halluci Dorsiflexion –Tibialis anterior, extensor digitorum longus, and peroneous tertius Plantarflexion –Soleus, gastrocnemius, plantaris, and flexor hallucis longus
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Kinematics continued… Supination –Calcaneal inversion, foot adduction and plantar flexion of the subtalar joint Pronation –Calcaneal eversion, foot abduction, foot dorsiflexion
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Toe and Foot Conditions Hallus Rigidus Hallus Valgus Claw, hammer, and mallet toe Turf toe Reverse turf toe Ingrown toenail Metatarsalgia Bunions Retrocalcaneal bursitis
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Contusions Foot contusions Lower leg contusions Anterior compartment syndrome
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Foot and Ankle sprains Toe and Foot Sprains and dislocations Lateral ankle sprains Medial ankle sprains Syndesmosis sprain Subtalar sprain Subtalar dislocation
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Lower leg strains Strains and tendinitis Foot strains Peroneal tendon strains Tibialis posterior strain and rupture Gastrocnemius strain Achilles tendinitis Achilles tendon rupture
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Overuse Conditions Plantar Fasciitis Medial Tibial Stress Syndrome (MTSS) Exertional Compartment Syndrome
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Vascular and Neural Disorders Venous disorders –DVT –Embolism Plantar Interdigitial Neuroma Tarsal Tunnel syndrome Sural Nerve entrapment
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Fractures Freiberg’s disease Sever’s disease Stress fractures Avulsion fractures Osteochondral Fracture of the Talus
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Displaced Fractures and Fracture Dislocations Forefoot fractures Tarsal fractures –LisFranc injury Tibia-fibula fractures –Maisonneuve fracture Ankle fracture-dislocations
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