Skeletal and muscular considerations in movement Knee, Ankle, & Foot.
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Transcript of Skeletal and muscular considerations in movement Knee, Ankle, & Foot.
Skeletal and muscular considerations
in movement
Knee, Ankle, & Knee, Ankle, & FootFoot
Skeletal and muscular considerations
in movement
KneeKnee
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 BoneyStructures in Movement
A: A: Frontal Plane
B: B: Sagittal Plane
C:C:Transverse Plane
Concept: Concept: Free segment moves on the fixed segment
Movement of Femur & Tibia:
Femur on Tibiaor
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 viewRight knee
Skeletal system considerations
Anterior viewRight knee
•Tibial plateau flat
•Femur angles down from the hip in the frontal plane
•Typical angle at knee is 170-175°
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
Quadriceps (Knee extensors)
rectus femoris vastus medialis vastus lateralis vastus intermedialis
Muscular system considerations
Anterior view right thigh
From: Novartis Interactive Atlas
Frank Netter artist
Rectus femoris: • 2 joint muscle• Crosses hip and knee
Thomas test for hip flexion contracture
Test for Rectus femoris tightness
Duncan-ElyDuncan-ElyTest for rectus femoris tightness
Muscular system considerations
Hamstrings Biceps femoris Semitendinosus Semi membranosus
All are 2 joint muscles:hipknee
Concept: Concept: With a 2 joint muscle, tightness can be expressed at either end depending on position of both joints
Straight leg raise Popliteal Angle
Skeletal and muscular considerations
in movement
Ankle & FootAnkle & Foot
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 BoneyStructures in Movement
A: A: Frontal Plane
B: B: Sagittal Plane
C:C:Transverse Plane
Combined, the foot and ankle move in all planes
The foot is divided into 3 general regions:
HindfootHindfoot
Lateral viewRight foot & ankle
MidfootMidfoot
ForefootForefoot
FibulFibula
TibiTibiaa
65% of weight is on the hindfoot
tibiafibulacalcaneustalus
cuboidnavicularlateral, middle, &medial cuneiforms
Metatarsals
Phalanges
26 bones in the foot
Skeletal system considerations
Bones of the foot:
• ossify as late as 4 yrs
• continue to grow thru teen years
PROTECT THE FOOT PROTECT THE FOOT FROM DEFORMING FORCES!!!!FROM DEFORMING FORCES!!!!
Subtalar jointtalus, calcaneus
Talocrural joint(ankle joint)tibia, fibula, talus
Midtarsal jointcalcaneocuboid, talonavicular
Tarsometatarsaljoints
Metatarsophalangeal joints
Talocrural joint: ankle jointtibia, fibula, talus
Movement: dorsiflexion, plantarflexion
Foot deformities
Deformity with fixed plantar flexion =Equinus deformity
Deformity with fixed dorsiflexion =Calcaneal deformity
Subtalar joint: talus, calcaneusallows the foot to moveindependent of the leg
Movements:Inversion/eversionAbduction/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 jointtalonavicular
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
Tarsometatarsaljoints
Movements:DorsiflexionPlantarflexionInversionEversion
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 lateraltubercle 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
Ankle Dorsiflexors Tibialis Anterior Extensor digitorum longus Extensor hallucis longus
Muscular system considerations
Anterior Tib crosses only the ankle joint
Extensor digitorum and hallucis cross the ankle and all the joints of the foot
Ankle Plantarflexors Gastrocnemius Soleus
Muscular system considerations
Gastroc is a 2 joint muscle
Soleus is a single joint muscle
Ankle Evertors Peroneals
Longus Brevis
Ankle Invertors Tibialis Posterior Flexor digitorum longus Flexor hallucis longus
Muscular system considerations
Testing for Gastroc and Soleus length:
Gastroc Soleus