5. Overview of lower limb movement

Question 1

Hip

Answer 1

1) flexion + extension
2) abduction + adduction
3) inversion + eversion

Question 2

Knee

Answer 2

flexion + extension

Question 3

Ankle

Answer 3

dorsiflexion+ plantarflexion

25 degrees dorsiflexion

45 degrees plantarflexion

Question 4

Sub-talar

Answer 4

inversion + eversion

Question 5

Mid-tarsal

Answer 5

pronation + supination

Question 6

1st MPJ

Answer 6

dorsiflexion + plantarflexion

Question 7

Answer 7

Inversion

Question 8

Answer 8

Eversion

Question 9

1st MTPJ

Answer 9

70-90 degrees dorsiflexion

45 degrees plantarflexion

Question 10

Rear foot

Answer 10

• calcaneus
• talus

Question 11

Midfoot

Answer 11

navicular

cuboid

cuneiforms

Question 12

Forefoot

Answer 12

• metatarsals
• phalanges

Question 13

Arches within the foot

Answer 13

1) Medial longitudinal
2) Lateral longitudinal
3) Transverse

Question 14

Plantar Fascia

Answer 14

• tightens via the windlass mechanism, if the toes are dorsiflexed

Question 15

Hick’s Windlass Mechanism

Answer 15

toes are dorsiflexed in the propulsive phase of gait

plantar fascia becomes tense

elevation of the longitudinal arch

shortening of the foot

big toe dorsiflexes

plantar fascia is drawn tightly around the MP joint, developing tension

tension packs all the joints of the foot tightly together

converts the foot to a rigid structure

This increased foot rigidity is reflected by the increase in arch height, as the forefoot is drawn down and closer to the rearfoot

For the windlass to function properly, the 1st metatarsal must be allowed to plantarflex

Question 16

Deviations from “normal” gait pattern

Answer 16

1) Antalgic gait
2) Neuropathic gait
3) Dementia-like gait

Question 17

Antalgic Gait

Answer 17

Patient avoids certain movements in order to avoid acute pain

stance phase is shortened on painful leg

Associated limp

Question 18

Neuropathic

Answer 18

High stepping gait

Question 19

Dementia-like Gait

Answer 19

In elderly people with dementia and Alzheimer

Unsteadiness associated with unprovoked falls

Question 20

3 Muscle pumps in the lower limb

Answer 20

1) Plantar pump (body-weight and locomotion)
2) Calf-muscle pump (locomotion)
3) Thigh pump (locomotion, but much smaller contribution)

Question 21

Calf-pump function

Answer 21

Venous blood from the lower limbs returns to the right side of the heart

against gravity

through deep + superficial venous systems

Question 22

Chronic Venous Insufficiency (CVI)

Answer 22

valves in the leg veins are not working effectively

causes blood to “pool” = stasis

often caused by either blood clots or varicose veins

Question 23

Answer 23

CVI