1. Skeletal and muscular considerations in movement Knee, Ankle, & Foot

2. Skeletal and muscular considerations in movement Knee

3. 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

4. Role of Boney Structures in Movement A: A: Frontal Plane B: B: Sagittal Plane C: C:Transverse Plane

5. Concept: Concept: Free segment moves on the fixed segment  Movement of  Femur & Tibia: Femur on Tibia or Tibia on Femur

6. 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

7. Skeletal system considerations Anterior view Right knee Tibial plateau flat Femur angles down from the hip in the frontal plane Typical angle at knee is 170-175°

8. Skeletal system considerations

9. If angle less than 165°: Genu valgum (also called genu valgus & “knock-knees”)

10. Skeletal system considerations If angle greater than 180°: Genu varum (also called genu vargus & “bow legs”)

11. Skeletal system considerations In the sagittal plane, if the angle is greater than 180°: Genu recurvatum (also called “back knee”)

12. 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

13.  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

14. Thomas test for hip flexion contracture Test for Rectus femoris tightness Duncan-Ely Test for rectus femoris tightness

15. Muscular system considerations  Hamstrings  Biceps femoris  Semitendinosus  Semi membranosus All are 2 joint muscles: hip knee

16. Concept: Concept: With a 2 joint muscle, tightness can be expressed at either end depending on position of both joints

17. Straight leg raise Popliteal Angle

18. Skeletal and muscular considerations in movement Ankle & Foot

19. 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

20. Role of Boney Structures in Movement A: A: Frontal Plane B: B: Sagittal Plane C: C:Transverse Plane Combined, the foot and ankle move in all planes

21. The foot is divided into 3 general regions: Hindfoot Lateral view Right foot & ankle Midfoot Forefoot Fibul Fibula Tibia 65% of weight is on the hindfoot

22. tibia fibula calcaneus talus cuboid navicular lateral, middle, & medial cuneiforms Metatarsals Phalanges 26 bones in the foot

23. 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!!!!

24. Subtalar joint talus, calcaneus Talocrural joint (ankle joint) tibia, fibula, talus Midtarsal joint calcaneocuboid, talonavicular Tarsometatarsal joints Metatarsophalangeal joints

25. Talocrural joint: ankle joint tibia, fibula, talus Movement: dorsiflexion, plantarflexion

26. Foot deformities Deformity with fixed plantar flexion = Equinus deformity Deformity with fixed dorsiflexion = Calcaneal deformity

27. 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”.

28. Subtalar joint: talus, calcaneus Movements: Due to diagonal axis, movements occur together!!!!! Pronation: Eversion & Abduction Supination: Inversion & Adduction

29. Midtarsal joint talonavicular calcaneocuboid Movement: Pronation (mainly eversion) Supination (mainly inversion) Movement: Pronation (mainly abduction & dorsiflexion) Supination (mainly adduction & plantarflexion )

30. Foot deformities Plantar flexion & supination= Equinovarus deformity Plantarflexion & pronation= Equinovalgus deformity Dorsiflexion & supination= Calcaneovarus Dorsiflexion & pronation = Calcaneovalgus

31. Tarsometatarsal joints Movements: Dorsiflexion Plantarflexion Inversion Eversion

32. Metatarsophalangeal Joints (also called MP joints) Movements: Extension (Dorsiflexion) to 65° Flexion (Plantarflexion) to40 °

33. 3 Arches in the Foot Anterior Arch : between the heads of the 1 st and 5 th metatarsals

34. 3 Arches in the Foot Lateral Arch: between the head of the 5 th metatarsal and lateral tubercle of calcaneous

35. 3 Arches in the Foot Medial Longitudinal Arch: between the head of the 1 st metatarsal and the posteromedial tubercle of the calcaneus Pes Planus: Flattened medial arch or “flat foot” Pes Cavus: High medial arch

36. “Flat Feet” or Pes Planus Normal in toddlers Pes Planus: Calcaneus is vertical (0-6 °) Flattening is through the midfoot

37. Calcaneal Valgus (or eversion) Calcaneus is everted greater than 6° First ray is high to accommodate to the floor

38.  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

39.  Ankle Plantarflexors  Gastrocnemius  Soleus Muscular system considerations Gastroc is a 2 joint muscle Soleus is a single joint muscle

40.  Ankle Evertors  Peroneals  Longus  Brevis  Ankle Invertors  Tibialis Posterior  Flexor digitorum longus  Flexor hallucis longus Muscular system considerations

41. Testing for Gastroc and Soleus length: Gastroc Soleus