Therapeutic Foot Care Certificate Program Part I: Online Home Study Program

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1 Therapeutic Foot Care Certificate Program Part I: Online Home Study Program 1

2 Anatomy And Terminology Of The Lower Extremity Joan E. Edelstein, MA, PT, FISPO Associate Professor of Clinical Physical Therapy Director of the Program in Physical Therapy Columbia University, College of Physicians and Surgeons, New York, NY 2

3 Anatomy And Terminology Of The Lower Extremity Learning Objectives At the Conclusion of this Program, Participants i t Should Be Able to: 1. Identify Structure and Function of the Foot and Lower Extremity 2. Describe Anatomical Positioning of the Foot and Lower Extremity 3. Understand Basic Medical Terminology 4. Identify Major Blood Vessels and Nerves in the Foot And Lower Extremity 3

4 Anatomy And Terminology Of The Lower Extremity Planes of the Body Body Positions Joint Movements Bones Muscles Tendons Ligaments Blood Vessels Nerves Medical Terminology 4

5 Planes Of The Body Frontal / Coronal Sagittal Transverse / Horizontal 5

6 Planes Of The Body Frontal or Coronal Plane Associated Movements - Abduction - Adduction 6

7 Planes Of The Body Sagittal Plane Associated Movements -Flexion - Extension - Hyperextension 7

8 Planes Of The Body Transverse or Horizontal Plane Associated Movements - Arm and Leg Internal or Medial Rotation External or Lateral a Rotation o - Foot External Rotation or Supination Internal Rotation or Pronation 8

9 Body Positions Anterior / Posterior Superior / Inferior Proximal / Distal Dorsum / Plantar Longitudinal / Transverse Medial / Lateral 9

10 Body Positions Anterior Posterior Posterior Anterior 10

11 Body Positions Anterior Posterior Posterior Anterior 11

12 Superior Inferior Body Positions Superior Inferior 12

13 Proximal Distal Body Positions Proximal Distal 13

14 Proximal Distal Body Positions Proximal Distal 14

15 Plantar Dorsal Body Positions Dorsal Plantar 15

16 Dorsal Plantar Body Positions Dorsal Plantar 16

17 Body Positions Longitudinal Transverse 17

18 Medial Lateral Body Positions Medial L R Lateral 18

19 Joint Movements Normal Joint Movements Abduction / Adduction Flexion / Extension Plantarflexion / Dorsiflexion Eversion / Inversion Internal Rotation / External Rotation Pronation / Supination Abnormal Position Valgus / Varus 19

20 Joint Movements Abduction Adduction Abduction Adduction 20

21 Joint Movements Abduction Adduction Abduction Adduction 21

22 Joint Movements Flexion Extension Flexion Extension 22

23 Joint Movements Plantarflexion Dorsiflexion Dorsiflexion Plantarflexion 23

24 Joint Movements Inversion Eversion Inversion Eversion 24

25 Joint Movements Eversion 25

26 Inversion Joint Movements 26

27 Joint Movements Inversion Eversion Eversion Inversion 27

28 Joint Movements External Rotation Internal Rotation External Internal 28

29 Joint Movements Pronation Supination Tri-plane Motion (Oblique Plane) Pronation Eversion (Transverse) Dorsiflexion (Sagittal) Abduction (Frontal) Supination Inversion (Transverse) Plantarflexion (Sagittal) Adduction (Frontal) Supination Pronation 29

30 Valgus Varus Joint Movements Valgus Varus 30

31 Valgus / Varus Joint Movements Valgus Varus 31

32 Medical Terminology Motor Sense: Movement Position Sense: Proprioception Internal Sensation Equilibrium i Tendon Joint Muscle Viscera 32

33 Medical Terminology External Sensation Sight Hearing Taste Smell Touch Light Touch Deep Touch Hot Cold Pain 33

34 Medical Terminology Osteo Bone (e.g. Osteomyelitis: Infection of the Bone) Arthro Joint (e.g. Arthritis: Inflammation of the Joints) Myo Muscle (e.g. Myocyte: Muscle Cell) Neuro Nerve (e.g. Neuropathy: Disorder of the Nerves) Arterio Artery (e.g. Arteriosclerosis: Blockage of an Artery) Phlebo Vein (e.g. Phlebitis: Inflammation of a Vein) Dermo Skin (e.g. Dermatology: Study of the Skin) 34

35 Valgus Medical Terminology Angular Deformity where the Limb Distal to the Deformity Points away from the Midline (e.g. Genu Valgum: Knock-kneed ) Varus Angular Deformity where the Limb Distal to the Deformity Moves Closer to the Midline (e.g. Genu Varum: Bow-legged ) Planus Flat (e.g. Pes Planus: Flat Foot ) Cavus Hollow (e.g. Pes Cavus: Exaggeration of Normal Arch) 35

36 Hyper Medical Terminology Greater than (e.g. Hypertension Blood Pressure Greater Than Normal) Hypo Less than (e.g. Hypotension Blood Pressure Less than Normal) -Itis Refers To Inflammation (e.g. Sesamoiditis Inflammation of the Sesamoid Bones) -Osis Condition Or Process (e.g. Hyperhidrosis Condition of Excessive Sweating -Algia Pain (e.g. Metatarsalgia Metatarsal Pain) 36

37 Anatomy Of The Foot Bones Muscles Tendons Ligaments Nerves Blood Vessels Skin 37

38 Anatomy Of The Foot Basic Foot Anatomy 26 Bones One-fourth of All the Bones in the Human Body are Located in the Feet 33 Joints 19 Muscles 107 Ligaments 38

39 Bones Of The Foot Forefoot Phalanges Metatarsals Midfoot Lesser Tarsus Rearfoot Tarsus 39

40 Bones Of The Foot Malleoli Lateral Malleolus Most Lateral Portion of Distal Fibula Medial Malleolus Most Medial Portion of Distal Tibia Tarsus - The Seven Bones that Comprise the Hind and Mid Portions of the Foot Hindfoot Talus Calcaneus The Largest Bone in Foot Midfoot Navicular, Also Known as Scaphoid (Medial Side) 3 Cuneiforms (Medial Side) Cuboid (Lateral Side) 40

41 Bones Of The Foot Forefoot Five Metatarsals Head of First Palpable Two Sesamoid Bones Beneath Head of First Met Base of Fifth Palpable Fourteen Phalanges Two In Hallux Three In Each of the Other Four Toes 41

42 Distal Phalanges Proximal Phalanges Metatarsals Cuneiforms Cuboid Navicular Talus Calcaneus Bones Of The Foot 42

43 Muscle Muscles Tough Elastic Tissue that Makes Body Parts Move Skeletal Muscles are Attached to Bones by Tendons Intrinsic Muscles are those which have Both their Origin and Insertion within the Same Body Structure, t (i.e., the Foot) Extrinsic Muscles are those which Originate in Another Body Structure than the Insertion 43

44 Muscles Of The Lower Extremity Extensor Digitorum Longus ORIGIN Upper two thirds of anterior shaft of fibula, interosseous membrane and superior tibiofibular joint INSERTION Extensor expansion of lateral four toes ACTION Extends toes and extends foot at ankle NERVE Deep peroneal nerve (L5, S1) 44

45 Muscles Of The Lower Extremity Extensor Hallucis Longus ORIGIN Middle half of anterior shaft of fibula INSERTION Base of distal phalanx of great toe ACTION Extends big toe and foot. Inverts foot and tightens subtalar joints NERVE Deep peroneal nerve (L5, S1) 45

46 Muscles Of The Lower Extremity Gastrocnemius ORIGIN Lateral head: posterior surface of lateral condyle of femur and highest of three facets on lateral condyle. medial head: posterior surface of femur above medial condyle INSERTION Tendo calcaneus to middle of three facets on posterior aspect of calcaneus ACTION Plantarflexes foot. Flexes knee NERVE Tibial nerve (S1, 2) 46

47 Muscles Of The Lower Extremity Peroneus Brevis ORIGIN Lower two-thirds lateral shaft of fibula INSERTION Tuberosity of base of 5th metatarsal ACTION Plantarflexes and everts foot. Supports lateral longitudinal arch NERVE Superficial peroneal nerve (L5, S1) 47

48 Muscles Of The Lower Extremity Peroneus Longus ORIGIN Upper two-thirds of lateral shaft of fibula, head of fibula and superior tibiofibular joint INSERTION Plantar aspect of base of 1st metatarsal and medial cuneiform,,passing deep to long gplantar ligament ACTION Plantarflexes the ankle and everts the foot. Supports lateral longitudinal and transverse arches NERVE Superficial peroneal nerve (L5,S1) 48

49 Muscles Of The Lower Extremity Tibialis Anterior ORIGIN Upper half of lateral shaft of tibia and interosseous membrane INSERTION Inferomedial aspect of 1 st medial cuneiform and base of 1st metatarsal ACTION Dorsiflexes the ankle and inverts the foot. Holds up medial longitudinal arch of foot NERVE Deep peroneal nerve (L4, 5) 49

50 Muscles Of The Lower Extremity Tibialis Posterior ORIGIN Upper half of posterior shaft of tibia and upper half of fibula between medial nerve crest and interosseous border, and interosseous membrane INSERTION Tuberosity of navicular bone and all tarsal bones (except talus) and spring ligament ACTION Plantarflexes the ankle and inverts the foot. Supports medial longitudinal l arch of foot NERVE Tibial nerve (L4, 5) 50

51 Tendon Tendons And Ligaments Tough, Flexible, Fibrous, Connective Tissue That Connects Skeletal Muscles to Bones Ligament Tough, Fibrous, Connective Tissue That Holds Tendons in Place, Stabilizes Joints, and Connects Bone to Bone 51

52 Tendons and Ligaments Of The Foot Ankle Ligaments Medial Collateral Also Known As Deltoid Ligament; Resists Foot Eversion Lateral Collateral Resists Foot Inversion; Frequently Sprained 52

53 Tendons Of The Lower Extremity Achilles Tendon 53

54 Tendons Of The Lower Extremity Extensor Digitorum Longus Tendon Superior Anterior Extensor Hallucis Longus Tendon 54

55 Tendons Of The Lower Extremity Extensor Hallucis Longus Tendon 55

56 Tendons Of The Lower Extremity Tibialis Posterior Tendon Achilles Tendon Tibialis Anterior Tendon 56

57 Nerves and Vessels Nerves Cordlike Fibers that Transmit Sensory and Motor Information Between the CNS and the Body Blood Vessels Small Tube-like Structures which Transport Blood and Nutrients within the Body Arteries Carry Blood away from the Heart Veins Carry Blood to the Heart Capillaries Smallest Vessels that t Provide Nutrients t to the Cells and Return Waste Materials to the Veins 57

58 Nerves Of The Lower Extremity Tibial Nerve Primary Nerve that Innervates the Posterior Portion of the Lower Extremity and the Sole of the Foot Common Peroneal Nerve 58

59 Nerves Of The Lower Extremity Common Peroneal Nerve Passes the Head of the Fibula then Bifurcates to the Deep and Superficial i Branches Superficial Peroneal Nerve Innervates the Lateral Lower Extremity Muscles Deep Peroneal Nerve Innervates the Anterior Lower Extremity Muscles 59

60 Nerves Of The Lower Extremity Superficial Peroneal Nerve 60

61 Blood Vessels Of The Lower Extremity Peroneal Artery Anterior Tibial Artery Posterior Tibial Artery Dorsalis Pedis Artery 61

62 Blood Vessels Of The Lower Extremity Posterior Tibial Artery Supplies the Posterior Compartment of the Leg Pulse Palpated Immediately Posterior to the Medial Malleolus Peroneal Artery Runs along Fibula of Lower Leg and Supplies Ankle Region Nerve Network Lower Branch of Posterior Tibial Artery Anterior Tibial Artery Supplies the Anterior Compartment of Leg Terminates as the Dorsalis Pedis Dorsalis Pedis Artery Continuation of the Anterior Tibial Artery; Supplies the Dorsum of the Foot Pulse Palpated On Dorsum for Between the Tendons of the Extensor Hallucis Longus And Extensor Digitorum Longus 62

63 Blood Vessels Of The Lower Extremity Posterior Tibial Artery Anterior Tibial Artery 63

64 Largest Organ of the Body Protects Inner Structure of the Body Provides Sensations Two Layers Epidermis Dermis Skin 64

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