Applied Anatomy of the Limbs Flashcards
Describe the different phases of gait.
Gait 1: SWING PHASE – lift lower limb - flex hip – iliopsoas and rectus
femoris; flex knee – momentum and gravity, but hamstrings (biceps
femoris; semitendinosus, semimembranosus) may help
Gait 2: SWING PHASE” – flex hip further – iliopsoas and rectus femoris;
extend knee – quadriceps (vastus medialis [also preventing patellar lateral
dislocation], lateralis and intermedius, rectus femoris)
Gait 3: STANCE PHASE – keep the pelvis level - abductors – gluteus medius
and minimus; with adductors (magnus, longus and brevis) to counter
balance
Medial rotation of the hip probably happens by momentum but may be
aided by the anterior fibres of gluteus medius and minimus
Gait 4: PUSH OFF PHASE – extend hip – hamstrings ordinarily, but gluteus
maximus if power is required; extend knee - quadriceps
Gait 5: SWING PHASE – keep foot pointing forward – lateral rotation at hip –
short, lateral rotators (piriformis, obturator externus and internus
What are the difference phases of gait ?
A) Heel strike (initial contact) B) Loading response (foot float) C) Midstance D) Terminal stance (heel off) E) Preswing (toe off) F) Initial and Midswing G) Terminal swing
What proportion of gait is swing, and which proportion is stance ?
Swing- 40%
Stance- 60%
Describe the main features of the terminal stance.
BASICS-
- The Left Lower Limb (LL) is about to take the body weight
- Momentum must be created by drawing the body forwards over the ankle
- Start with ankle and foot
MUSCLES-
- The toes of the right foot are dorsiflexed
- Fibrous flexor sheaths are pulled
- Plantar aponeurosis is pulled
- Plantar aponeurosis draws the calcaneus anteriorly and heighten the arch
Describe the main features of the pre-swing.
BASICS-
-The Right Lower Limb is about to push-off and enter the Swing Phase
MUSCLES-
- Right ankle plantarflexed (for powerful push off)
- By Gastrocnemius, Soleus and Tibialis Posterior
- Innervation by the tibial nerve
-Left ankle dorsiflexed
-By Tibialis Anterior Extensor, Digitorum Longus and
Extensor Hallucis Longus
-Innervation by deep fibular nerve
- Right toes plantarflexed (for powerful push off)
- By Flexor Hallucis Longus, Flexor Digitorum Longus, Flexor Hallucis Brevis, Flexor Digitorum Brevis
- Innervation by Medial Plantar Branch of Tibial nerve
- Right hip extended slightly (to help forward momentum)
- By Hamstring muscles
- Innervation by Sciatic nerve
Describe the main features of the initial mid-swing.
BASICS-
- Right LL enters Mid Swing, while the Left LL takes all the body weight
- Right LL is lifted up, and the toes must clear the ground
MUSCLES
- Right ankle & toes dorsiflexed
- By Tibialis Anterior, Extensor Digitorum Longus, and Extensor Hallucis Longus
- Innervation by Deep fibular nerve
- Right knee is flexed
- By Popliteus and Hamstrings
- Innervation by Sciatic nerve (hamstrings) and Tibial nerve (Popliteus)
- Right hip is flexed
- By Iliopsoas and Rectus Femoris
- Innervation by Femoral nerve (Iliacus and rectus femoris) L1, 2, 3 (Psoas)
What muscles/structures are involved in weight bearing, during gait ? Which movements are these muscles involved in ?
- Right hip is abducted
- By Gluteus medius and Gluteus minimus
- Innervated by Superior gluteal nerve
- Left knee is extended
- By Quadriceps femoris, Gluteus maximus and Tensor fascia lata
- Innervated by Femoral nerve, Inferior gluteal nerve, and superior gluteal nerve
- Weight-bearing (left) arches
- Supported by Flexor digitorum longus, Tibialis anterior, Tibialis posterior, Fibularis longus, Intrinsic muscles of the foot
How is balance maintained during gait ? Which muscles are involved ?
Balance maintained by interplay between
- Plantarflexion (plantar muscles as well)
- Dorsiflexion
- Inversion (tibialis anterior and posterior)
- Eversion (fibularis longus and brevis)
Describe the main features of the terminal swing.
BASICS-
- Right LL is thrown further forward
- The right side of the pelvis moves anteriorly too, using momentum to internally rotate at the left hip
MUSCLES-
- Right Hip is further flexed and laterally rotated to keep the foot pointing forwards
- (Lateral rotation) By lateral Rotators of the Hip
- (Lateral rotation) Innervation by L5, S1 and S2
Describe the main features of the heel strike.
BASICS-
- The right thigh decelerates and drops the Right LL and heel to the ground, the foot remains dorsiflexed
- The spring and resilience of the RIGHT ARCHES must continually be maintained for shock absorption and weight distribution
- The RIGHT ANKLE is DORSIFLEXED and that dorsiflexion is also pulling the body forwards, over the right foot so that it can accept the body weight in the Loading Response Phase
Describe the main features of the loading response.
MUSCLES-
- Inversion of subtalar joint
- By Tibialis anterior and Tibialis posterior
- Innervation by Deep Fibular (Tibialis anterior) Tibial nerve (Tibialis posterior)
- Eversion of subtalar joint
- By Fibularis longus and Fibularis brevis
- Innervation by Superficial fibular nerve
What is foot drop ? What muscles does it affect ?
Significant weakness of ankle and toe dorsiflexion.
Muscle affected: Tibialis anterior, the extensor hallucis longus (EHL), and the extensor digitorum longus (EDL)
