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Knee, Ankle, & Foot Skeletal and muscular considerations in movement Knee Skeletal and muscular considerations in movement Knee Skeletal role in posture & movement? 1. Weightbearing 2. Keep the feet on the ground 3. In standing & walking, provides a mechanism for adjustment between supporting surface and the trunk Role of Boney Structures in Movement A: Frontal Plane B: Sagittal Plane C:Transverse Plane Concept: Free segment moves on the fixed segment Movement of Femur & Tibia: Femur on Tibia or Tibia on Femur Skeletal system considerations • A hinge joint…little boney stability • Ligaments & muscles provide stability • Always impacted above by hip alignment and below by ankle alignment Anterior view Right knee Skeletal system considerations •Tibial plateau flat •Femur angles down from the hip in the frontal plane •Typical angle at knee is 170-175° Anterior view Right knee Skeletal system considerations Skeletal system considerations • If angle less than 165°: Genu valgum (also called genu valgus & “knock-knees”) Skeletal system considerations • If angle greater than 180°: Genu varum (also called genu vargus & “bow legs”) Skeletal system considerations • In the sagittal plane, if the angle is greater than 180°: Genu recurvatum (also called “back knee”) Skeletal system considerations Patella: Improves the angle of pull of the quadsIn the sagittal plane, if the angle is greater than 180°: Patella alta: High riding patella, stretched patellar tendon Muscular system considerations Quadriceps (Knee extensors) rectus femoris vastus medialis vastus lateralis vastus intermedialis Rectus femoris: • 2 joint muscle • Crosses hip and knee Anterior view right thigh From: Novartis Interactive Atlas Frank Netter artist Thomas test for hip flexion contracture Test for Rectus femoris tightness Duncan-Ely Test for rectus femoris tightness Muscular system considerations Hamstrings Biceps femoris Semitendinosus Semi membranosus All are 2 joint muscles: hip knee Concept: With a 2 joint muscle, tightness can be expressed at either end depending on position of both joints Straight leg raise Popliteal Angle Ankle & Foot Skeletal and muscular considerations in movement Ankle & Foot Skeletal role in posture & movement? 1. Absorb shock 2. Allow the lower extremity to conform to different surface inclinations 3. Impart energy to standing and walking Role of Boney Structures in Movement A: Frontal Plane B: Sagittal Plane C:Transverse Plane Combined, the foot and ankle move in all planes The foot is divided into 3 general regions: Tibia Fibula Midfoot Forefoot Hindfoot 65% of weight is on the hindfoot Lateral view Right foot & ankle 26 bones in the foot tibia fibula calcaneus talus cuboid navicular lateral, middle, & medial cuneiforms Metatarsals Phalanges Skeletal system considerations Bones of the foot: • ossify as late as 4 yrs • continue to grow thru teen years PROTECT THE FOOT FROM DEFORMING FORCES!!!! Talocrural joint Subtalar joint (ankle joint) tibia, fibula, talus talus, calcaneus Midtarsal joint calcaneocuboid, talonavicular Tarsometatarsal joints Metatarsophalangeal joints Talocrural joint: ankle joint tibia, fibula, talus Movement: dorsiflexion, plantarflexion Foot deformities Deformity with fixed plantar flexion = Equinus deformity Deformity with fixed dorsiflexion = Calcaneal deformity Subtalar joint: talus, calcaneus allows the foot to move independent of the leg Movements: Inversion/eversion Abduction/adduction STJ helps maintain the arches of the foot: evaluate the foot in “subtalar neutral”. Subtalar joint: talus, calcaneus Movements: Due to diagonal axis, movements occur together!!!!! Pronation: Eversion & Abduction Supination: Inversion & Adduction Midtarsal joint talonavicular calcaneocuboid Movement: Pronation (mainly eversion) Supination (mainly inversion) Movement: Pronation (mainly abduction & dorsiflexion) Supination (mainly adduction & plantarflexion) Foot deformities Plantar flexion & supination= Equinovarus deformity Plantarflexion & pronation= Equinovalgus deformity Dorsiflexion & supination= Calcaneovarus Dorsiflexion & pronation = Calcaneovalgus Tarsometatarsal joints Movements: Dorsiflexion Plantarflexion Inversion Eversion Metatarsophalangeal Joints (also called MP joints) Movements: Extension (Dorsiflexion) to 65° Flexion (Plantarflexion) to40 ° 3 Arches in the Foot Anterior Arch : between the heads of the 1st and 5th metatarsals 3 Arches in the Foot Lateral Arch: between the head of the 5th metatarsal and lateral tubercle of calcaneous 3 Arches in the Foot Medial Longitudinal Arch: between the head of the 1st metatarsal and the posteromedial tubercle of the calcaneus Pes Planus: Flattened medial arch or “flat foot” Pes Cavus: High medial arch “Flat Feet” or Pes Planus Normal in toddlers Pes Planus: • Calcaneus is vertical (0-6 °) • Flattening is through the midfoot Calcaneal Valgus (or eversion) • Calcaneus is everted greater than 6° • First ray is high to accommodate to the floor Muscular system considerations Ankle Dorsiflexors Tibialis Anterior Extensor digitorum longus Extensor hallucis longus Anterior Tib crosses only the ankle joint Extensor digitorum and hallucis cross the ankle and all the joints of the foot Muscular system considerations Ankle Plantarflexors Gastrocnemius Soleus Gastroc is a 2 joint muscle Soleus is a single joint muscle Muscular system considerations Ankle Evertors Peroneals Longus Brevis Ankle Invertors Tibialis Posterior Flexor digitorum longus Flexor hallucis longus Testing for Gastroc and Soleus length: Gastroc Soleus