This document provides an overview of the anatomy, common injuries, and clinical assessments related to the foot and ankle. It describes the bones, ligaments, muscles and other structures. The most common type of ankle sprain is an inversion sprain which results in injury to the lateral ligaments like the anterior talofibular ligament. Plantar fasciitis is a common overuse injury attributed to excessive tension on the plantar fascia from activities like running. Stress fractures are also addressed as an overuse injury that can occur with increased activity.
Common foot and ankle injuries and diseasesCATHY WILLIAMS
At RNV Podiatry, Dr. Rachel N. Verville provides you with the best treatment for your foot and ankle problems in Plano, Frisco, and Dallas, Texas.
http://www.rnvpodiatry.com/arthritic-foot-ankle-plano-texas.html
complete Knee joint assessment from physiotherapeutic point of view. Includes observation , palpation , assessment, special test, differential diagnosis of knee joint .
A comprehensive presentation about lameness in equine Covering almost all musculoskeletal and metabolic neurological diseases rendering a horse lame. Lameness examination i also explained.
a painful knee can be classified into arthritic and non-arthatic. Many doctor forget non-arthic knee pain. This non-arthritic pain affect many pat.. younger more affected than old pat.,
Common foot and ankle injuries and diseasesCATHY WILLIAMS
At RNV Podiatry, Dr. Rachel N. Verville provides you with the best treatment for your foot and ankle problems in Plano, Frisco, and Dallas, Texas.
http://www.rnvpodiatry.com/arthritic-foot-ankle-plano-texas.html
complete Knee joint assessment from physiotherapeutic point of view. Includes observation , palpation , assessment, special test, differential diagnosis of knee joint .
A comprehensive presentation about lameness in equine Covering almost all musculoskeletal and metabolic neurological diseases rendering a horse lame. Lameness examination i also explained.
a painful knee can be classified into arthritic and non-arthatic. Many doctor forget non-arthic knee pain. This non-arthritic pain affect many pat.. younger more affected than old pat.,
Fractures
Usually of femoral neck, a serious injury usually occurring in elderly with osteoporosis
Contusions
Usually in anterior aspect of thigh, during contact sports
Strains
Usually to hamstring during sprinting or over striding
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
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A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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14. FOOT/ANKLE ASSESSMENT
History
Generic history questions
Questions specific to the foot/ankle
Location of pain - heel, foot, toes, arches?
Training surfaces or changes in footwear?
Changes in training, volume or type?
Does footwear increase discomfort?
15. OBSERVATIONS
Does athlete favor a foot, limp, or is unable to bear weight?
Is there pes planus/cavus?
How is foot alignment?
Are there structural deformities?
16. ANKLE SPRAINS
**Single most common injury in athletics caused by sudden
inversion or eversion moments
Inversion Sprains
•Most common and result in injury to the lateral ligaments
•Anterior talofibular ligament is injured with inversion, plantar
flexion and internal rotation
•Occasionally the force is great enough for an avulsion fracture to
occur w/ the lateral malleolus
17. Severity of sprains is
graded (1-3)
The most common type
of sprain in an inversion
ankle sprain
?What structures are
injured?
18. EVERSION ANKLE SPRAINS
Etiology
• Bony protection and ligament
strength decreases likelihood of
injury
• Eversion force results in damage to
deltoid ligament and possibly fx of
the fibula
• Deltoid can also be impinged and
contused with inversion sprains
-(Represent 5-10% of all ankle sprains)
19. SIGNS AND SYMPTOMS
• 1st degree
• Mild pain and disability; weight bearing is minimally impaired; point tenderness
over ligaments and no laxity
•
2nd degree
• Feel or hear pop or snap; moderate pain w/ difficulty bearing weight; tenderness
and edema
• Positive ligament tests
• Possible tearing of the anterior talofibular and calcaneofibular ligaments (inversion
sprain) or deltoid ligament (eversion sprain)
•
3rd degree
• Severe pain, swelling, hemarthrosis, discoloration
• Unable to bear weight
• Positive ligament tests – torn ligaments
20. SYNDESMOTIC SPRAIN
Etiology
• Injury to the distal tibiofemoral joint
(anterior/posterior tibiofibular
ligament)
• Torn w/ increased external rotation or
dorsiflexion
• Injured in conjunction w/ medial and
lateral ligaments
Signs and Symptoms
• Severe pain, loss of function; passive
external rotation and dorsiflexion cause
pain
• Pain is usually anterolaterally located
23. ACHILLES TENDINITIS
Etiology
• Inflammatory condition involving tendon, sheath or paratenon
• Tendon is overloaded due to extensive stress
• Presents with gradual onset and worsens with continued use
• Decreased flexibility exacerbates condition
Signs and Symptoms
• Generalized pain and stiffness, localized proximal to calcaneal insertion
• Warm and painful with palpation, also presents with thickening
• May limit strength
• May progress to morning stiffness
• Crepitus with active plantar flexion and passive dorsiflexion
• Chronic inflammation may lead to thickening
24.
25. ACHILLES TENDON RUPTURE
Etiology
• Occurs w/ sudden stop and go; forceful plantar flexion w/ knee moving
into full extension
• Commonly seen in athletes > 30 years old
• Generally has history of chronic inflammation
Signs and Symptoms
• Sudden snap (kick in the leg) w/ immediate pain which rapidly subsides
• Point tenderness, swelling, discoloration; decreased ROM
• Obvious indentation and positive Thompson test
• Occurs 2-6 cm proximal the calcaneal insertion
26.
27. POSTERIOR TIBIALIS TENDINITIS
Etiology
• Common overuse condition in runners with foot
hypermobility or over pronation
• Repetitive microtrauma
Signs and Symptoms
• Pain and swelling in area of medial malleolus
• Edema, point tenderness and increased pain during resistive
inversion and plantar flexion
28. PERONEAL TENDINITIS
Etiology
• Not common, but can be found with athletes that have pes cavus
due to excessive supination placing stress on peroneal tendon
Signs and Symptoms
• Pain behind lateral malleolus during push-off or when rising on ball
of foot
• Pain along distolateral aspect of calcaneus and beneath the cuboid
29.
30. ACUTE LEG FRACTURES
Etiology
• Fibula has highest incidence of fracture, occurring primarily in the
middle third
• Tibial fractures occur predominantly in the lower third
• Result of direct blow or indirect trauma
Signs and Symptoms
• Pain, swelling, soft tissue insult
• Leg will appear hard and swollen (Compartment Syndrome)
31.
32. MEDIAL TIBIAL STRESS SYNDROME
Etiology
• Pain in anterior portion of shin
• Catch all for stress fractures, muscle strains, chronic anterior compartment
syndrome
• Accounts for 10-15% of all running injuries, 60% of leg pain in athletes
• Caused by repetitive microtrauma
• Weak muscles, improper footwear, training errors, varus foot, tight heel cord,
hypermobile or pronated feet and even forefoot supination can contribute to
MTSS
• May also involve, stress fractures or exertional compartment syndrome
33. MTSS CONTINUED
Signs and Symptoms
• Four grades of pain
• Pain after activity
• Pain before and after activity and not affecting performance
• Pain before, during and after activity, affecting performance
• Pain so severe, performance is impossible
•Recall you may hear “Periostitis”
34. STRESS FRACTURE
Etiology
• Common overuse condition, particularly in those with structural and
biomechanical insufficiencies
• Runners tends to develop in lower third of lower leg (dancers middle
third)
• Often occur in unconditioned, non-experienced individuals
• Often training errors are involved
• Component of female athlete triad
Signs and Symptoms
• Pain more intense after exercise than before
• Point tenderness; difficult to discern bone and soft tissue pain
• Bone scan results (stress fracture vs. periostitis)
35.
36. INJURIES TO THE FOOT
Apophysitis of the Calcaneus (Sever’s Disease)
Etiology
• Traction injury at apophysis of calcaneus, where Achilles attaches
Sign and Symptoms
• Pain occurs at posterior heel below Achilles attachment in
children and adolescent athletes
• Pain occurs during vigorous activity and ceases following activity
37. RETROCALCANEAL BURSITIS
(Pump Bump)
Etiology
• Caused by inflammation of bursa beneath Achilles tendon
• Result of pressure and rubbing of shoe heel counter
• Chronic condition that develops over time and may take extensive
time to resolve, exostosis may also develop
Sign and Symptoms
• Pain w/ palpation superior and anterior to Achilles insertion,
swelling on both sides of the heel cord
38.
39. HEEL CONTUSION
Etiology
• Caused by sudden starts, stops or changes of direction, irritation of fat pad
• Pain often on the lateral aspect due to heel strike pattern
Sign and Symptoms
• Severe pain in heel and is unable to withstand stress of weight bearing
• Often warmth and redness over the tender area
40. INJURIES TO METATARSAL REGION
Pes Planus Foot (Flatfoot)
Etiology
• Associated with excessive pronation, forefoot varus, wearing
tight shoes (weakening supportive structures) being overweight,
excessive exercise placing undo stress on arch
Sign and Symptoms
• Pain, weakness or fatigue in medial longitudinal arch; calcaneal
eversion, bulging navicular, flattening of medial longitudinal arch
and dorsiflexion with lateral splaying of 1st metatarsal
41.
42. PES CAVUS
Etiology
• Higher arch than normal; associated with excessive
supination, accentuated high medial longitudinal arch
Sign and Symptoms
• Poor shock absorption resulting in metatarsalgia, foot pain,
clawed or hammer toes
• Associated with forefoot valgus, shortening of Achilles and
plantar fascia; heavy callus development on ball and heel of
foot
43.
44. PLANTAR FASCIITIS
• Common in athletes and nonathletes
• Attributed to heel spurs, plantar fascia irritation, and bursitis
• Plantar fascia, dense, broad band of connective tissue
attaching proximal and medially on the calcaneus and fans
out over the plantar aspect of the foot
45.
46. PLANTAR FASCIITIS CONT.
Etiology
•
Increased tension and stress on fascia (particularly during push off of running phase)
•
Change from rigid supportive footwear to flexible footwear
•
•
Poor running technique
Leg length discrepancy, excessive pronation, inflexible longitudinal arch, tight gastroc-soleus
complex
•
Running on soft surfaces, shoes with poor support
Sign and Symptoms
•
Pain in anterior medial heel, along medial longitudinal arch
•
Increased pain in morning, loosens after first few steps
•
Increased pain with forefoot dorsiflexion
47. JONES FRACTURE
Etiology
• Fracture of metatarsal caused by inversion and plantar
flexion, direct force (stepped on) or repetitive trauma
• Most common = base of 5th metatarsal
Sign and Symptoms
• Immediate swelling, pain over 5th metatarsal
• High nonunion rate and course of healing is unpredictable
48.
49. METATARSAL STRESS FRACTURES
Etiology
• 2nd metatarsal fracture (March fracture)
• Change in running pattern, mileage, hills, or hard surfaces
• Forefoot varus, hallux valgus, flatfoot or short 1st metatarsal
• Occasional 5th metatarsal fracture at base and insertion of
peroneus brevis
50. BUNION
Etiology
• Exostosis of 1st metatarsal head; associated with forefoot varus; shoes that are too
narrow, pointed or short
• Bursa becomes inflamed and thickens, enlarging joint, and causing lateral malalignment
of great toe
• Bunionette (Tailor’s bunion) impacts 5th metatarsophalangeal joint - causes medial
displacement of 5th toe
Sign and Symptoms
• Tenderness, swelling, and enlargement of joint initially
• As inflammation continues, angulation increases causing painful ambulation
• Tendinitis in great toe flexors may develop
51.
52. TURF TOE
Etiology
• Hyperextension injury resulting in sprain of 1st metatarsophalangeal joint
• May be the result of single or repetitive trauma
Signs and Symptoms
• Pain and swelling which increases during push off in walking, running,
and jumping
53. SUBUNGUAL HEMATOMA
MOI
•
Direct pressure, dropping an object on toe,
kicking another object
•
Repetitive shear forces on toenail
Signs of Injury
•
•
Accumulation of blood underneath toenail
Likely to produce extreme pain and ultimately
loss of nail