Basic Structure and Function of the Ankle and Foot
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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. -
June 3, 2016 Karen B. Desalvo, M.D., M.P.H., M.Sc. Acting Assistant
June 3, 2016 Karen B. DeSalvo, M.D., M.P.H., M.Sc. Acting Assistant Secretary Department of Health and Human Services Office of the National Coordinator for Health Information Technology Attention: RFI Regarding Assessing Interoperability for MACRA 330 C Street, SW, Room 7025A Washington, DC 20201 Subject: Office of the National Coordinator for Health Information Technology; Medicare Access and CHIP Reauthorization Act of 2015; Request for Information Regarding Assessing Interoperability for MACRA Dear Acting Assistant Secretary DeSalvo: The American Association of Orthopaedic Surgeons (AAOS) and orthopaedic specialty societies, representing over 18,000 board-certified orthopaedic surgeons, appreciate the opportunity to provide comments on the Request for Information Regarding Assessing Interoperability for MACRA by the Office of the National Coordinator (ONC) for Health Information Technology, and published in the Federal Register on April 8, 2016. The AAOS has been committed to working with ONC in the adoption of electronic health records. As surgical specialists, we have unique Health Information Technology (HIT) needs and respectfully offer some suggestions to improve interoperability to better reflect the needs of our surgical specialists and their patients and accelerate HIT adoption in the future by orthopaedic surgeons. The AAOS thanks ONC in advance for its solicitation and consideration of the following comments and concerns. We have structured our comments in the order that ONC is soliciting public feedback in the RFI document referenced above. Scope of Measurement: Defining Interoperability and Population The focus of measurement should not be limited to “meaningful Electronic Health Records (EHR) users,” as defined (e.g., eligible professionals, eligible hospitals, and CAHs that attest to meaningful use of certified EHR technology under CMS’ Medicare and Medicaid EHR Incentive Programs), and their exchange partners. -
Metatarsalgia
just the symptoms. What can I expect from treatment? With a proper diagnosis, and a well-rounded treatment plan including orthotics, the prog- nosis is excellent. With Sole Supports™ foot or- thotics you can expect either a dramatic loss The Truth About . of pain within the first weeks of use or a more gradual reduction of symptoms, depending Metatarsalgia on how long the problem has existed, normal body weight or how well you follow other ther- For more information and a apeutic regimens prescribed by your provider. professional consultation regarding Did you know that, with Sole whether Sole Supports may be Supports, metatarsal pads are rarely helpful for you, please contact the needed? following certified Sole Supports practitioner: What is it? Metatarsalgia is a term used to describe a pain- ful foot condition in the area just before the Arch Flattened small toes (more commonly referred to as the ball of the foot). The condition is characterized by pain and inflammation on the sole in the region of the metatarsal heads, which are the ends of the long bones in your foot. The joint This handout provides a general overview on this capsule or tendons may also be inflamed. topic and may not apply to everyone. To find out if this handout applies to you and to get more infor- mation on this subject, consult with your certified Sole Supports practitioner. Arch Restored The pain is generally aggravated by putting ments but your doctor is likely to recommend pressure off the metatarsals should also be pressure (as in walking) through the ball of a conservative approach first including: followed. -
Medial Lateral Malleolus
Acutrak 2® Headless Compression Screw System 4.7 mm and 5.5 mm Screws Supplemental Use Guide—Medial & Lateral Malleolus Acumed® is a global leader of innovative orthopaedic and medical solutions. We are dedicated to developing products, service methods, and approaches that improve patient care. Acumed® Acutrak 2® Headless Compression Screw System—4.7 mm and 5.5 mm This guide is intended for supplemental use only and is not intended to be used as a stand-alone surgical technique. Reference the Acumed Acutrak 2 Headless Compression Screw System Surgical Technique (SPF00-02) for more information. Definition Indicates critical information about a potential serious outcome to the Warning patient or the user. Indicates instructions that must be followed in order to ensure the proper Caution use of the device. Note Indicates information requiring special attention. Acumed® Acutrak 2® Headless Compression System—Supplemental Use Guide—Medial & Lateral Malleolus Table of Contents System Features ...........................................2 Surgical Techniques ........................................ 4 Fibula Fracture (Weber A and B Fractures) Surgical Technique: Acutrak 2®—5.5 .......................4 Medial Malleolus Surgical Technique: Acutrak 2®—4.7 ......................10 Ordering Information ......................................16 Acumed® Acutrak 2® Headless Compression System—Supplemental Use Guide—Medial & Lateral Malleolus System Features Headless screw design is intended to minimize soft tissue irritation D Acutrak 2 Screws Diameter -
Assessment, Management and Decision Making in the Treatment Of
Pediatric Ankle Fractures Anthony I. Riccio, MD Texas Scottish Rite Hospital for Children Update 07/2016 Pediatric Ankle Fractures The Ankle is the 2nd most Common Site of Physeal Injury in Children 10-25% of all Physeal Injuries Occur About the Ankle Pediatric Ankle Fractures Primary Concerns Are: • Anatomic Restoration of Articular Surface • Restoration of Symmetric Ankle Mortise • Preservation of Physeal Growth • Minimize Iatrogenic Physeal Injury • Avoid Fixation Across Physis in Younger Children Salter Harris Classification Prognosis and Treatment of Pediatric Ankle Fractures is Often Dictated by the Salter Harris Classification of Physeal Fractures Type I and II Fractures: Often Amenable to Closed Tx / Lower Risk of Physeal Arrest Type III and IV: More Likely to Require Operative Tx / Higher Risk of Physeal Arrest Herring JA, ed. Tachdjian’s Pediatric Orthopaedics, 5th Ed. 2014. Elsevier. Philadelphia, PA. ISOLATED DISTAL FIBULA FRACTURES Distal Fibula Fractures • The Physis is Weaker than the Lateral Ankle Ligaments – Children Often Fracture the Distal Fibula but…. – …ligamentous Injuries are Not Uncommon • Mechanism of Injury = Inversion of a Supinated Foot • SH I and II Fractures are Most Common – SH I Fractures: Average Age = 10 Years – SH II Fractures: Average Age = 12 Years Distal Fibula Fractures Lateral Ankle Tenderness SH I Distal Fibula Fracture vs. Lateral Ligamentous Injury (Sprain) Distal Fibula Fractures • Sankar et al (JPO 2008) – 37 Children – All with Open Physes, Lateral Ankle Tenderness + Normal Films – 18%: Periosteal -
Wound Classification
Wound Classification Presented by Dr. Karen Zulkowski, D.N.S., RN Montana State University Welcome! Thank you for joining this webinar about how to assess and measure a wound. 2 A Little About Myself… • Associate professor at Montana State University • Executive editor of the Journal of the World Council of Enterstomal Therapists (JWCET) and WCET International Ostomy Guidelines (2014) • Editorial board member of Ostomy Wound Management and Advances in Skin and Wound Care • Legal consultant • Former NPUAP board member 3 Today We Will Talk About • How to assess a wound • How to measure a wound Please make a note of your questions. Your Quality Improvement (QI) Specialists will follow up with you after this webinar to address them. 4 Assessing and Measuring Wounds • You completed a skin assessment and found a wound. • Now you need to determine what type of wound you found. • If it is a pressure ulcer, you need to determine the stage. 5 Assessing and Measuring Wounds This is important because— • Each type of wound has a different etiology. • Treatment may be very different. However— • Not all wounds are clear cut. • The cause may be multifactoral. 6 Types of Wounds • Vascular (arterial, venous, and mixed) • Neuropathic (diabetic) • Moisture-associated dermatitis • Skin tear • Pressure ulcer 7 Mixed Etiologies Many wounds have mixed etiologies. • There may be both venous and arterial insufficiency. • There may be diabetes and pressure characteristics. 8 Moisture-Associated Skin Damage • Also called perineal dermatitis, diaper rash, incontinence-associated dermatitis (often confused with pressure ulcers) • An inflammation of the skin in the perineal area, on and between the buttocks, into the skin folds, and down the inner thighs • Scaling of the skin with papule and vesicle formation: – These may open, with “weeping” of the skin, which exacerbates skin damage. -
Free Vascularized Fibula Graft with Femoral Allograft Sleeve for Lumbar Spine Defects After Spondylectomy of Malignant Tumors Acasereport
1 COPYRIGHT Ó 2020 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED Free Vascularized Fibula Graft with Femoral Allograft Sleeve for Lumbar Spine Defects After Spondylectomy of Malignant Tumors ACaseReport Michiel E.R. Bongers, MD, John H. Shin, MD, Sunita D. Srivastava, MD, Christopher R. Morse, MD, Sang-Gil Lee, MD, and Joseph H. Schwab, MD, MS Investigation performed at Massachusetts General Hospital, Boston, Massachusetts Abstract Case: We present a 65-year-old man with an L4 conventional chordoma. Total en bloc spondylectomy (TES) of the involved vertebral bodies and surrounding soft tissues with reconstruction of the spine using a free vascularized fibula autograft (FVFG) is a proven technique, limiting complications and recurrence. However, graft fracture has occurred only in the lumbar spine in our institutional cases. We used a technique in our patient to ensure extra stability and support, with the addition of a femoral allograft sleeve encasing the FVFG. Conclusions: Our technique for the reconstruction of the lumbar spine after TES of primary malignant spinal disease using a femoral allograft sleeve encasing the FVFG is viable to consider. he treatment of primary malignant neoplasms of the spine mended a magnetic resonance imaging (MRI), but the request currently mainly relies on surgery, often in conjunction with was denied by the insurance company, and the patient T 1-3 radiotherapy .Totalen bloc spondylectomy (TES) is a widely underwent a course of physical therapy with no benefitand accepted surgical technique and has lower reported recurrence rates progression of back pain and radiculopathy. Four months compared with patients who undergo intralesional surgery3,4. -
Common Stress Fractures BRENT W
COVER ARTICLE PRACTICAL THERAPEUTICS Common Stress Fractures BRENT W. SANDERLIN, LCDR, MC, USNR, Naval Branch Medical Clinic, Fort Worth, Texas ROBERT F. RASPA, CAPT, MC, USN, Naval Hospital Jacksonville, Jacksonville, Florida Lower extremity stress fractures are common injuries most often associated with partic- ipation in sports involving running, jumping, or repetitive stress. The initial diagnosis can be made by identifying localized bone pain that increases with weight bearing or repet- itive use. Plain film radiographs are frequently unrevealing. Confirmation of a stress frac- ture is best made using triple phase nuclear medicine bone scan or magnetic resonance imaging. Prevention of stress fractures is most effectively accomplished by increasing the level of exercise slowly, adequately warming up and stretching before exercise, and using cushioned insoles and appropriate footwear. Treatment involves rest of the injured bone, followed by a gradual return to the sport once free of pain. Recent evidence sup- ports the use of air splinting to reduce pain and decrease the time until return to full par- ticipation or intensity of exercise. (Am Fam Physician 2003;68:1527-32. Copyright© 2003 American Academy of Family Physicians) tress fractures are among the involving repetitive use of the arms, such most common sports injuries as baseball or tennis. Stress fractures of and are frequently managed the ribs occur in sports such as rowing. by family physicians. A stress Upper extremity and rib stress fractures fracture should be suspected in are far less common than lower extremity Sany patient presenting with localized stress fractures.1 bone or periosteal pain, especially if he or she recently started an exercise program Etiology and Pathophysiology or increased the intensity of exercise. -
Sports Ankle Injuries Assessment and Management
FOCUS Sports injuries Sports ankle injuries Drew Slimmon Peter Brukner Assessment and management Background Case study Lucia is a female, 16 years of age, who plays netball with the Sports ankle injuries present commonly in the general state under 17s netball team. She presents with an ankle injury practice setting. The majority of these injuries are inversion sustained at training the previous night. She is on crutches and plantar flexion injuries that result in damage to the and is nonweight bearing. Examination raises the possibility of lateral ligament complex. a fracture, but X-ray is negative. You diagnose a severe lateral Objective ligament sprain and manage Lucia with ice, a compression The aim of this article is to review the assessment and bandage and a backslab initially. She then progresses through management of sports ankle injuries in the general practice a 6 week rehabilitation program and you recommend she wear setting. an ankle brace for at least 6 months. Discussion Assessment of an ankle injury begins with a detailed history to determine the severity, mechanism and velocity of the injury, what happened immediately after and whether there is a past history of inadequately rehabilitated ankle injury. Examination involves assessment of weight bearing, inspection, palpation, movement, and application of special examination tests. Plain X-rays may be helpful to exclude a fracture. If the diagnosis is uncertain, consider second The majority of ankle injuries are inversion and plantar line investigations including bone scan, computerised flexion injuries that result in damage to the lateral tomography or magnetic resonance imaging, and referral to a ligament complex (Figure 1). -
Morphological Characteristics of the Lateral Talocalcaneal Ligament: a Large-Scale Anatomical Study
Surgical and Radiologic Anatomy (2019) 41:25–28 https://doi.org/10.1007/s00276-018-2128-8 ANATOMIC VARIATIONS Morphological characteristics of the lateral talocalcaneal ligament: a large-scale anatomical study Mutsuaki Edama1,2 · Ikuo Kageyama2 · Takaniri Kikumoto1 · Tomoya Takabayashi1 · Takuma Inai1 · Ryo Hirabayashi1 · Wataru Ito1 · Emi Nakamura1 · Masahiro Ikezu1 · Fumiya Kaneko1 · Akira Kumazaki3 · Hiromi Inaba4 · Go Omori3 Received: 9 August 2018 / Accepted: 4 September 2018 / Published online: 30 October 2018 © Springer-Verlag France SAS, part of Springer Nature 2018 Abstract Purpose The purpose of this study is to clarify the morphological characteristics of the lateral talocalcaneal ligament (LTCL). Methods This study examined 100 legs from 54 Japanese cadavers. The LTCL was classified into three types: Type I, the LTCL branches from the calcaneofibular ligament (CFL); Type II, the LTCL is independent of the CFL and runs parallel to the calcaneus; and Type III, the LTCL is absent. The morphological features measured were fiber bundle length, fiber bundle width, and fiber bundle thickness. Results The LTCL was classified as Type I in 18 feet (18%), Type II in 24 feet (24%), and Type III in 58 feet (58%). All LTCLs were associated with the anterior talofibular ligament at the talus. There was no significant difference in morphologi- cal characteristics by Type for each ligament. Conclusions The LTCL was similar to the CFL in terms of fiber bundle width and fiber bundle thickness. Keywords Calcaneofibular · Ligament · Subtalar joint · Gross anatomy Introduction features, as well as complex three-dimensional mobility, making it a challenge to conduct quantitative evaluations. Of patients with chronic ankle instability, 42% [6] present Ligaments that are associated with the stability of the with mechanical instability of the talocrural joint, and 58% subtalar joint include the calcaneofibular ligament (CFL), have mechanical instability of the subtalar joint [3], each of the lateral talocalcaneal ligament (LTCL), the interosseous them at high percentages. -
Mcilroy's Ankle Injury Explained
McIlroy’s Ankle Injury Explained By Eva Nugent MISCP The Anterior Talofibular Ligament is big news this week because of world number 1 golf player Rory McIlroy’s injury sustained while having a football “kick about” with friends. McIlroy reports sustaining a “total rupture of his left ATFL and damage to the associated ankle joint capsule”. This unfortunate injury has put his golf season in doubt with the Open Championship starting just next week the 16th of July. But what exactly is the ATFL? And what does the rehabilitation for this injury involve? The Anterior Talofibular Ligament is one of three ligaments that make of the lateral ligament complex of the ankle joint. It originates at the fibular malleoulus of the lateral shin bone (fibula) and runs forward to and attaches to the Talus (ankle bone). The other two ligaments are the Posterior talofibular ligament (PTFL) and the Calcaneofibular ligament (CFL). The function of these ligaments is to provide stability and support to the ankle joint. The ATFL specifically prevents the anterior translation of the shin in relation to the foot/ankle. The ATFL is the most commonly injured ankle ligament and is most vulnerable when the foot is pointing downwards and inwards as the body’s centre of gravity rolls over the ankle (plantarflexed and inverted position). This is commonly described as “going over on your ankle”. It is commonly injured in sports like football or GAA where unpredictable fast turns or cutting movements are involved. This is referred to as an ankle sprain and results in damage to the fibres of the ligament as they are overstretched.