HV Chapter 02-Normal Anatomy of the Forefoot
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Knee Flow Chart Acute
Symptom chart for acute knee pain START HERE Did the knee pain begin Does the knee joint You may have a fracture or Stop what you are doing immediately and go to a hospital emergency room YES YES suddenly, with an injury, appear deformed, or dislocated patella. or an orthopedic surgeon specializing in knee problems. slip, fall, or collision? out of position? If possible, splint the leg to limit the movement of the knee until you reach NO the doctor. Do not put any weight on the knee. Use a wheelchair, a cane, or NO crutch to prevent putting any weight on the leg, which might cause further damage to the joint. GO TO FLOW CHART #2 Go to an orthopedic surgeon Stop what you are doing. Continuing activity despite the feeling that the knee ON CHRONIC KNEE Did you hear a “pop” YES immediately, you may have is unstable can cause additional damage to other ligaments, meniscus , and PROBLEMS THAT DEVELOP and does your knee feel torn your anterior cruciate, or cartilage. Try ice on the knee to control swelling. Take anti-in ammatories OR WORSEN OVER TIME. unstable or wobbly? other ligaments in the knee. like Advil or Nuprin until your doctor’s appointment. About a third of ligament tears get better with exercises, a third may need a brace, and a third may need sur gery. NO Use R•I•C•E for sore knees Does your knee hurt YES You may have damaged the articular Try anti-in ammatories, as directed on the bottle, for two days to reduce R: Rest as you bend it? cartilage on the bottom of the the chronic in ammation. -
Skeletal Foot Structure
Foot Skeletal Structure The disarticulated bones of the left foot, from above (The talus and calcaneus remain articulated) 1 Calcaneus 2 Talus 3 Navicular 4 Medial cuneiform 5 Intermediate cuneiform 6 Lateral cuneiform 7 Cuboid 8 First metatarsal 9 Second metatarsal 10 Third metatarsal 11 Fourth metatarsal 12 Fifth metatarsal 13 Proximal phalanx of great toe 14 Distal phalanx of great toe 15 Proximal phalanx of second toe 16 Middle phalanx of second toe 17 Distal phalanx of second toe Bones of the tarsus, the back part of the foot Talus Calcaneus Navicular bone Cuboid bone Medial, intermediate and lateral cuneiform bones Bones of the metatarsus, the forepart of the foot First to fifth metatarsal bones (numbered from the medial side) Bones of the toes or digits Phalanges -- a proximal and a distal phalanx for the great toe; proximal, middle and distal phalanges for the second to fifth toes Sesamoid bones Two always present in the tendons of flexor hallucis brevis Origin and meaning of some terms associated with the foot Tibia: Latin for a flute or pipe; the shin bone has a fanciful resemblance to this wind instrument. Fibula: Latin for a pin or skewer; the long thin bone of the leg. Adjective fibular or peroneal, which is from the Greek for pin. Tarsus: Greek for a wicker frame; the basic framework for the back of the foot. Metatarsus: Greek for beyond the tarsus; the forepart of the foot. Talus (astragalus): Latin (Greek) for one of a set of dice; viewed from above the main part of the talus has a rather square appearance. -
Total HIP Replacement Exercise Program 1. Ankle Pumps 2. Quad
3 sets of 10 reps (30 ea) 2 times a day Total HIP Replacement Exercise Program 5. Heel slides 1. Ankle Pumps Bend knee and pull heel toward buttocks. DO NOT GO Gently point toes up towards your nose and down PAST 90* HIP FLEXION towards the surface. Do both ankles at the same time or alternating feet. Perform slowly. 2. Quad Sets Slowly tighten thigh muscles of legs, pushing knees down into the surface. Hold for 10 count. 6. Short Arc Quads Place a large can or rolled towel (about 8”diameter) under the leg. Straighten knee and leg. Hold straight for 5 count. 3. Gluteal Sets Squeeze the buttocks together as tightly as possible. Hold for a 10 count. 7. Knee extension - Long Arc Quads Slowly straighten operated leg and try to hold it for 5 sec. Bend knee, taking foot under the chair. 4. Abduction and Adduction Slide leg out to the side. Keep kneecap pointing toward ceiling. Gently bring leg back to pillow. May do both legs at the same time. Copywriter VHI Corp 3 sets of 10 reps (30 ea) 2 times a day Total HIP Replacement Exercise Program 8. Standing Stair/Step Training: Heel/Toe Raises: 1. The “good” (non-operated) leg goes Holding on to an immovable surface. UP first. Rise up on toes slowly 2. The “bad” (operated) leg goes for a 5 count. Come back to foot flat and lift DOWN first. toes from floor. 3. The cane stays on the level of the operated leg. Resting positions: To Stretch your hip to neutral position: 1. -
Human Functional Anatomy 213 the Ankle and Foot In
2 HUMAN FUNCTIONAL ANATOMY 213 JOINTS OF THE FOOT THE ANKLE AND FOOT IN LOCOMOTION THE HINDFOOT -(JOINTS OF THE TALUS) THIS WEEKS LAB: Forearm and hand TROCHLEAR The ankle, and distal tibiofibular joints READINGS BODY The leg and sole of foot Subtalar joint (Posterior talocalcaneal) 1. Stern – Core concepts – sections 99, 100 and 101 (plus appendices) HEAD 2. Faiz and Moffat – Anatomy at a Glance – Sections 50 and 51 Talocalcaneonavicular 3. Grants Method:- The bones and sole of foot & Joints of the lower limb & Transverse tarsal joints or any other regional textbook - similar sections IN THIS LECTURE I WILL COVER: Joints related to the talus Ankle Subtalar Talocalcaneonavicular THE MID FOOT Transverse tarsal Other tarsal joints THE FOREFOOT Toe joints METATARSAL AND PHALANGEAL Ligaments of the foot JOINTS (same as in the hand) Arches of the foot Except 1st metatarsal and Hallux Movements of the foot & Compartments of the leg No saddle joint at base is 1st metatarsal The ankle in Locomotion Metatarsal head is bound by deep Ankle limps transverse metatarsal ligament 1. Flexor limp Toes are like fingers 2. Extensor limp Same joints, Lumbricals, Interossei, Extensor expansion Axis of foot (for abduction-adduction) is the 2nd toe. 3 4 JOINTS OF THE FOOT JOINTS OF THE FOOT (2 joints that allow inversion and eversion) DISTAL TIBIOFIBULAR SUBTALAR (Posterior talocalcaneal) JOINT Syndesmosis (fibrous joint like interosseous membrane) Two (or three) talocalcaneal joints Posterior is subtalar Fibres arranged to allow a little movement Anterior (and middle) is part of the talocalcaneonavicular. With a strong interosseus ligament running between them (tarsal sinus) THE TALOCALCANEONAVICULAR JOINT The head of the talus fits into a socket formed from the: The anterior talocalcaneal facets. -
Ultrasound Evaluation of the Abductor Hallucis Muscle: Reliability Study Alyse FM Cameron, Keith Rome and Wayne a Hing*
Journal of Foot and Ankle Research BioMed Central Research Open Access Ultrasound evaluation of the abductor hallucis muscle: Reliability study Alyse FM Cameron, Keith Rome and Wayne A Hing* Address: AUT University, School of Rehabilitation & Occupation Studies, Health & Rehabilitation Research Centre, Private Bag 92006, Auckland, 1142, New Zealand Email: Alyse FM Cameron - [email protected]; Keith Rome - [email protected]; Wayne A Hing* - [email protected] * Corresponding author Published: 25 September 2008 Received: 29 May 2008 Accepted: 25 September 2008 Journal of Foot and Ankle Research 2008, 1:12 doi:10.1186/1757-1146-1-12 This article is available from: http://www.jfootankleres.com/content/1/1/12 © 2008 Cameron et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: The Abductor hallucis muscle (AbdH) plays an integral role during gait and is often affected in pathological foot conditions. The aim of this study was to evaluate the within and between-session intra-tester reliability using diagnostic ultrasound of the dorso-plantar thickness, medio-lateral width and cross-sectional area, of the AbdH in asymptomatic adults. Methods: The AbdH muscles of thirty asymptomatic subjects were imaged and then measured using a Philips HD11 Ultrasound machine. Interclass correlation coefficients (ICC) with 95% confidence intervals (CI) were used to calculate both within and between session intra-tester reliability. Results: The within-session reliability results demonstrated for dorso-plantar thickness an ICC of 0.97 (95% CI: 0.99–0.99); medio-lateral width an ICC: of 0.97 (95% CI: 0.92–0.97) and cross- sectional area an ICC of 0.98 (95% CI: 0.98–0.99). -
Iliopsoas Tendonitis/Bursitis Exercises
ILIOPSOAS TENDONITIS / BURSITIS What is the Iliopsoas and Bursa? The iliopsoas is a muscle that runs from your lower back through the pelvis to attach to a small bump (the lesser trochanter) on the top portion of the thighbone near your groin. This muscle has the important job of helping to bend the hip—it helps you to lift your leg when going up and down stairs or to start getting out of a car. A fluid-filled sac (bursa) helps to protect and allow the tendon to glide during these movements. The iliopsoas tendon can become inflamed or overworked during repetitive activities. The tendon can also become irritated after hip replacement surgery. Signs and Symptoms Iliopsoas issues may feel like “a pulled groin muscle”. The main symptom is usually a catch during certain movements such as when trying to put on socks or rising from a seated position. You may find yourself leading with your other leg when going up the stairs to avoid lifting the painful leg. The pain may extend from the groin to the inside of the thigh area. Snapping or clicking within the front of the hip can also be experienced. Do not worry this is not your hip trying to pop out of socket but it is usually the iliopsoas tendon rubbing over the hip joint or pelvis. Treatment Conservative treatment in the form of stretching and strengthening usually helps with the majority of patients with iliopsoas bursitis. This issue is the result of soft tissue inflammation, therefore rest, ice, anti- inflammatory medications, physical therapy exercises, and/or injections are effective treatment options. -
Tibialis Posterior Tendon Transfer Corrects the Foot Drop Component
456 COPYRIGHT Ó 2014 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED Tibialis Posterior Tendon Transfer Corrects the Foot DropComponentofCavovarusFootDeformity in Charcot-Marie-Tooth Disease T. Dreher, MD, S.I. Wolf, PhD, D. Heitzmann, MSc, C. Fremd, M.C. Klotz, MD, and W. Wenz, MD Investigation performed at the Division for Paediatric Orthopaedics and Foot Surgery, Department for Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Heidelberg, Germany Background: The foot drop component of cavovarus foot deformity in patients with Charcot-Marie-Tooth disease is commonly treated by tendon transfer to provide substitute foot dorsiflexion or by tenodesis to prevent the foot from dropping. Our goals were to use three-dimensional foot analysis to evaluate the outcome of tibialis posterior tendon transfer to the dorsum of the foot and to investigate whether the transfer works as an active substitution or as a tenodesis. Methods: We prospectively studied fourteen patients with Charcot-Marie-Tooth disease and cavovarus foot deformity in whom twenty-three feet were treated with tibialis posterior tendon transfer to correct the foot drop component as part of a foot deformity correction procedure. Five patients underwent unilateral treatment and nine underwent bilateral treatment; only one foot was analyzed in each of the latter patients. Standardized clinical examinations and three-dimensional gait analysis with a special foot model (Heidelberg Foot Measurement Method) were performed before and at a mean of 28.8 months after surgery. Results: The three-dimensional gait analysis revealed significant increases in tibiotalar and foot-tibia dorsiflexion during the swing phase after surgery. These increases were accompanied by a significant reduction in maximum plantar flexion at the stance-swing transition but without a reduction in active range of motion. -
The Anterior View of the Extraosseous Blood Supply to the Foot and Ankle in a Specimen That Was Injected with Batson's Com- Po
The Journal of Bone and Joint Surgery (Gilbert) Final 32 Author(s): Paragraph text formatting will be adjusted prior to publication. Fig. E-1 The anterior view of the extraosseous blood supply to the foot and ankle in a specimen that was injected with Batson’s com- pound. 1 = first cuneiform, 2 = second cuneiform, 3 = third cu- neiform, 4 = cuboid, 5 = calcaneus, 6 = fibula, 7 = tibia, 8 = talus, 9 = navicular, A = anterior tibial artery, B = anterior medial malleolar artery, C = anterior lateral malleolar artery, D = dorsa- lis pedis artery, E = proximal lateral tarsal artery, F = proximal medial tarsal artery, G = distal medial tarsal artery, H = distal lateral tarsal artery, I = arcuate artery, J = first dorsal metatar- sal artery, K = artery of the sinus tarsi, L = longitudinal branch to second intermetatarsal space, M = longitudinal branch to third intermetatarsal space, N = longitudinal branch to fourth in- termetatarsal space, and O = transverse pedicle branch. Author: Illustration(s) on this page may have been modified. Please check illustration(s) carefully! TABLE E-1 Extraosseous Vessel Characteristics Artery Artery Present (%) Internal Diameter (mean [range]) (mm) Anterior tibial artery 95 1.828 (1.302 - 2.222) Medial metaphyseal artery 100 0.389 (0.106 - 0.818) Medial malleolar branch 100 0.316 (0.103 - 0.595) Annular branch 100 0.243 (0.122 - 0.464) Recurrent branch 90 0.218 (0.100 - 0.491) Lateral metaphyseal artery 100 0.352 (0.143 - 0.778) Anterior medial malleolar artery 80 0.430 (0.119 - 1.039) Superficial branch 100 -
The Femoral Hernia: Some Necessary Additions
International Journal of Clinical Medicine, 2014, 5, 752-765 Published Online July 2014 in SciRes. http://www.scirp.org/journal/ijcm http://dx.doi.org/10.4236/ijcm.2014.513102 The Femoral Hernia: Some Necessary Additions Ljubomir S. Kovachev Department of General Surgery, Medical University, Pleven, Bulgaria Email: [email protected] Received 28 April 2014; revised 27 May 2014; accepted 26 June 2014 Copyright © 2014 by author and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Abstract Purpose: The anatomic region through which most inguinal hernias emerge is overcrowded by various anatomical structures with intricate relationships. This is reflected by the wide range of anatomic interpretations. Material and Methods: A prospective anatomic study of over 100 fresh cadavers and 47 patients operated on for femoral hernias. Results: It was found that the transver- salis fascia did not continue distally into the lymphatic lacuna. Medially this fascia did not reach the lacunar ligament, but was rather positioned above it forming laterally the vascular sheath. Here the fascia participates in the formation of a fossa, which varies in width and depth—the pre- peritoneal femoral fossa. The results did not confirm the presence of a femoral canal. The dis- tances were measured between the pubic tubercle and the medial margin of the femoral vein, and between the inguinal and the Cooper’s ligaments. The results clearly indicate that in women with femoral hernias these distances are much larger. Along the course of femoral hernia exploration we established the presence of three zones that are rigid and narrow. -
Knee Joint Distraction Compared with Total Knee Arthroplasty a RANDOMISED CONTROLLED TRIAL
KNEE Knee joint distraction compared with total knee arthroplasty A RANDOMISED CONTROLLED TRIAL J. A. D. van der Woude, Aims K. Wiegant, Knee joint distraction (KJD) is a relatively new, knee-joint preserving procedure with the R. J. van Heerwaarden, goal of delaying total knee arthroplasty (TKA) in young and middle-aged patients. We S. Spruijt, present a randomised controlled trial comparing the two. P. J. E m ans , Patients and Methods S. C. Mastbergen, The 60 patients ≤ 65 years with end-stage knee osteoarthritis were randomised to either F. P. J. G. Lafeber KJD (n = 20) or TKA (n = 40). Outcomes were assessed at baseline, three, six, nine, and 12 months. In the KJD group, the joint space width (JSW) was radiologically assessed, From UMC Utrecht, representing a surrogate marker of cartilage thickness. Utrecht, The Netherlands Results In total 56 patients completed their allocated treatment (TKA = 36, KJD = 20). All patient reported outcome measures improved significantly over one year (p < 0.02) in both groups. J. A. D. van der Woude, MD, At one year, the TKA group showed a greater improvement in only one of the 16 patient- PhD, Resident in Orthopaedic Surgery, Limb and Knee related outcome measures assessed (p = 0.034). Outcome Measures in Rheumatology- Reconstruction Unit, Department of Orthopaedic Osteoarthritis Research Society International clinical response was 83% after TKA and 80% Surgery after KJD. A total of 12 patients (60%) in the KJD group sustained pin track infections. In the R. J. van Heerwaarden, MD, PhD, Orthopaedic Surgeon, KJD group both mean minimum (0.9 mm, standard deviation (SD) 1.1) and mean JSW (1.2 mm, Limb and Knee Reconstruction Unit, Department of SD 1.1) increased significantly (p = 0.004 and p = 0.0003). -
Multiplanar CT Analysis of Fifth Metatarsal Morphology
FAIXXX10.1177/1071100715623041Foot & Ankle InternationalDeSandis et al 623041research-article2015 Article Foot & Ankle International® 2016, Vol. 37(5) 528 –536 Multiplanar CT Analysis of Fifth Metatarsal © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav Morphology: Implications for Operative DOI: 10.1177/1071100715623041 Management of Zone II Fractures fai.sagepub.com Bridget DeSandis, BA1, Conor Murphy, MD2, Andrew Rosenbaum, MD1, Matthew Levitsky, BA1, Quinn O’Malley1, Gabrielle Konin, MD1, and Mark Drakos, MD1 Abstract Background: Percutaneous internal fixation is currently the method of choice treating proximal zone II fifth metatarsal fractures. Complications have been reported due to poor screw placement and inadequate screw sizing. The purpose of this study was to define the morphology of the fifth metatarsal to help guide surgeons in selecting the appropriate screw size preoperatively. Methods: Multiplanar analysis of fifth metatarsal morphology was completed using computed tomographic (CT) scans from 241 patients. Specific parameters were analyzed and defined in anteroposterior (AP), lateral, and oblique views including metatarsal length, distance from the base to apex of curvature, apex medullary canal width, apex height, and fifth metatarsal angle. Results: The average metatarsal length in the AP view was 71.4 ± 6.1 mm and in the lateral view 70.4 ± 6.0 mm, with 95% of patients having lengths between 59.3 and 83.5 mm and 58.4 and 82.4 mm, respectively. The average canal width at the apex of curvature was 4.1 ± 0.9 mm in the AP view and 5.3 ± 1.1 mm in the lateral view, with 95% of patients having widths between 2.2 and 5.9 mm and 3.2 and 7.5 mm, respectively. -
The Deep Femoral Artery and Branching Variations: a Case Report Arteria Profunda Femoris Ve Dallarının Varyasyonu: Olgu Sunumu
Cumhuriyet Tıp Dergisi Cumhuriyet Tıp Derg 2009; 31: 279-282 Cumhuriyet Medical Journal Cumhuriyet Med J 2009; 31: 279-282 The deep femoral artery and branching variations: a case report Arteria profunda femoris ve dallarının varyasyonu: olgu sunumu Vedat Sabancıoğulları, Mehmet İlkay Koşar, Ekrem Ölçü, Mehmet Çimen Department of Anatomy (Assist. Prof. V. Sabancıoğulları, MD; Assist. Prof. M. İ. Koşar, MD; Prof. M. Çimen, PhD), Cumhuriyet University School of Medicine, TR-58140, Sivas; and Department of Radiology (E. Ölçü, MD, Specialist in Radiology) Afşin State Hospital, TR-46500 Kahramanmaraş Abstract The deep femoral artery is the major branch of the femoral artery. Its branches and branching show various variations. For this reason, an extensive knowledge about the anatomy of the deep femoral artery is indeed important in vascular reconstructive surgery involving the groin. In this investigation, a case with variations of the deep femoral artery origin and branching has been presented. The case was a 45-year old male cadaver and the arterial variation was noted during routine dissection. The right and left origins of the deep femoral artery varied. When the midpoint of the inguinal ligament was taken as a reference, the right artery originated at 5.58 cm and the left artery at 2.22 cm. In the left, the ascending branch and transverse branch of the lateral circumflex femoral artery originated. At a joint root and the descending branch originated directly at the deep femoral artery. Also in the left, it was observed that there were eight perforating arteries. Keywords: Deep femoral artery, anatomic variation, cadaver Özet Arteria profunda femoris, arteria femoralis’in uyluğu besleyen en büyük dalıdır.