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