Transcript 26 bones in the foot

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