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Evaluation and assessment

Evaluation and assessment. Lower Extremity. Lower Extremity. Consists of the following joints: Foot Ankle Knee Hip Lower back. Lower Extremity. Foot 14 Phalanges 5 Tarsals 5 Metatarsals Calcaneus Talus. Lower Extremity. Ankle Talus Tibia Fibula. Lower Extremity. Knee Tibia

isabelle-barrett
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Evaluation and assessment

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  1. Evaluation and assessment Lower Extremity

  2. Lower Extremity • Consists of the following joints: • Foot • Ankle • Knee • Hip • Lower back

  3. Lower Extremity • Foot • 14 Phalanges • 5 Tarsals • 5 Metatarsals • Calcaneus • Talus

  4. Lower Extremity • Ankle • Talus • Tibia • Fibula

  5. Lower Extremity • Knee • Tibia • Patella • Femur

  6. Lower Extremity • Hip • Femur • Pelvis

  7. Lower Extremity • Lower Back • Sacrum • Pelvis • Lumbar Vertebrae

  8. Ankle and Foot • Ankle (tarsus) • Calcaneus supports the weight of the body • Muscles that move the foot connect to the calcaneus via Achilles tendon • Two arches to the foot • Longitudinal • Transverse • Phalanges • Three on each other than hallux

  9. Ankle and Foot • Muscles that move the ankle, foot, and toes are extensions of the muscles of the lower leg • Movements • Dorsiflexion (up) • Plantar flexion (down) • Inversion (in) • Eversion (out)

  10. Ankle and Foot • Primary inverter • Tibialis Posterior • Primary everter • Peroneus Longus • Dorsiflexors • Tibialis Anterior • Peroneus Tertius • Extensor DigitorumLongus • Plantar Flexors • Gastrocnemius • Soleus • Flexor DigitorumLongus

  11. Ankle and Foot

  12. Assessing Ankle and Foot Injuries • HOPS • History • Observation • Palpation • Special Tests • History • Symptoms • What the pt tells you • Observation • Signs • What you see, measure, feel

  13. Assessing Ankle and Foot Injuries • Palpation • When you being assessing the problem • Special Tests • Used to assess specific conditions

  14. ROM • ROM Ankle Inversion • Lie pt supine or short sit • Test both extremities at the same time for comparison • Passive ROM • U move the extremity • Limited ROM? • What is that!?!?! • Injury or past injury

  15. ROM • ROM for ankle • Inversion • Eversion • Dorsiflexion • Plantar Flexion

  16. ROM • ROM for foot • Flex toes • Extend toes • Flex great toe • Extend great toe • Splay toes

  17. Manual Muscle Tests • MMT • Isometric resistance with hands • Hold for 5 seconds

  18. Injuries • Fx • Usually caused by combo of plantar flexion and inversion • BKB, S, VB, and FB • Symptoms: • Swelling • PPT (pain, point tenderness) • Decreased ROM

  19. Injuries • Dislocations/Subluxations • Result of a twisting motion (usually) • BKB, S, VB, FB, and BB • SS: • Complete LOF (loss of function) • Severe Pain • Swelling • Deformity

  20. Injuries • Contusions • Heel (direct blows or improper fitting shoes) • Stone Bruise • BKB, Long Jumpers, BB • Symptom: • PPT • Care • Doughnut pad • Heel pad

  21. Injuries • Sprains • Most common LE injury • 85% are inversion • SS • Decreased ROM • Deformity (possible) • Crepitation • PPT • LOF • Instability (possible) • Abnormal Motion (possible) • Swelling

  22. Injuries • Sprain to the big toe • Turf Toe • Pushing off for running • Soccer Toe • Dragging Toe

  23. Injuries • Tendon Rupture • Achilles Tendon • Abrupt stops and starts • Athletes over age of 30 w/ past history of tendonitis • Feel a sudden snap like being hit • SS • Pain • Swelling • Deformity • LOF • (if incomplete) still function but painful

  24. Injuries • Achilles Rupture • Tx: • PRICE • Splint if possible • Help A’ maintain position • REFER • Prevention: • Proper warm-up • STRETCH

  25. Injuries • Tendonitis • Overstretching/overuse • SS • Chronic soreness • Pain • Mild swelling • Crepitation • Jumping activities (BKB, R, HJ, LJ) • Occurs at beginning

  26. Injuries • Tendonitis • Tx: • PRICE • Gradual slow stretching • Heel lifts • Pain-free ROM • Refer if no improvement between 7-10 days • Prevention • Proper conditioning • Stretching

  27. Injuries • Bursitis • Repeated stress to the bursa • BKB, S, J

  28. Injuries • Synovitis • Inflammation of sheath surrounding muscle/tendon

  29. Injuries • Ingrown Toenail • Condition where skin extends over edge of nail while nail grows into nail bed • Can cause pain and infection • Causes: • Tight shoes • Incorrect trimming • Tx: • Soak in warm saltwater solution • Cut V-shape into nail

  30. Injuries • Ingrown Toenail • Prevention • Well-fitted shoes • Properly trimmed toenails

  31. Injuries • Athlete’s Foot • Extremely contagious fungal condition of the foot caused by a buildup of moisture and heat in darkness • SS: • Extreme itching • Rash • Pimples • Blisters • Yellowish serum

  32. Injuries • Athlete’s Foot • Tx: • After showering, dry feet thoroughly • Powder before putting on shoes • OTC antifungal creams • Prevention • Best cure • Socks are clean and dry • Medicated, antifungal powder • Shower shoes

  33. INJURIES • Plantar Fasciitis: • Inflammation of the fibrous membranes supporting, covering, and separating the muscles of the sole of the foot • Caused by repeatedly standing on the toes • Results in stress to the supporting tissues and GPS

  34. Injuries • Plantar Fasciitis: • SS: • PPT • Runners and aerobic exercisers • Pain more so in the morning • Tx: • PRICE • Ice Massage • Stretching • Taping • Orthotics

  35. Injuries • Plantar Fasciitis: • Prevention • Proper warm-up • Proper conditioning • Ball on the bottom of the foot

  36. Injuries • High Ankle Sprain • Sprain of the syndesmosis between the tibia and fibula

  37. Injuries • PesPlanus • Flat foot • PesCavus • High arches

  38. Injuries • Hallux Valgus • Abnormal growth of great toe turning inward • Hallux Varus • Abnormal growth of great toe turning outward

  39. Injuries • Morton’s Neuroma • Bundle of nerve fibers in the mid-foot

  40. Injuries • Mallet Toe • Tx: • Surgery • Splint • Caused from improper fitting shoes

  41. Injuries • Hammer Toe • Tx: • Surgery • Splint • Caused from improper fitting shoes

  42. Injuries • Claw Toe • Tx: • Surgery • Splint • Caused from improper fitting shoes

  43. Special Tests • Talar Tilt • Sprain • Uninvolved then Involved • Short sit pt • Place jt at 90 degrees • Invert then evert foot • Looking for laxity • Tests Calcaneofibular Ligament (CFL) • Anterior and Posterior talofibular Ligaments (ATF, PTF)

  44. Special Tests • Anterior Drawer • Sprain • Uninvolved then involved • Short sit • Relaxed and slight plantar flexion • Anterior force on heel

  45. Special Tests • Posterior Drawer • Sprain • Uninvolved then involved • Short sit • Relaxed and slight plantar flexion • Posterior force on heel

  46. Special Tests • Kleiger’s • Short sit or supine • High ankle sprain • One hand on the leg • One hand on the foot • Evert the foot

  47. Special Tests • Thompson Test • Prone (facedown) • Feet hanging off the table • One hand on gastroc. • Carefully squeeze muscle • Foot should plantar flex • Little-no motion (rupture)

  48. Special Tests • Valgus/Varus Stress Test

  49. Special Tests • Joint Glides • Gliding joints against one another • Tests stability in the joint

  50. Special Tests • Mulder Sign • Tests for Morton’s neuroma

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