Lower Extremities Flashcards
1
Q
The Knee:
- Complex Joint
- how many bones?
- 3 __surfaces enclosed in a common joint capsule
- how many degrees of freedom of movement? meaning it moves in 2 planes
- One of the more frequently injured joints (because in the middle of the body)
A
3 bones
3 articulating surfaces enclosed in a common joint capsule
2 degrees of freedom
2
Q
What are the functions of the knee?
Name 3
A
- transmit loads (remind me of ground forces, every time we jump we are transmit load to the knee
- participate in motion (it rotates, it helps shorten the limb as we walk
- aids in conservation of momentum ( during gait when we are walking, we stretch the quads= passive tension.
3
Q
how many Joints make up the knee?
- which joint is not part of knee complex? And why
A
tibiofemoral , largest joint
patellofemoral ( P-F )
- TF joint, because it does not lie within joint capsule.
4
Q
Degrees of Freedom:
Two DOF:
list 2
A
- flexion/extension in sagittal plane (x-axis aka m/lateral
- internal/external rotation in transverse plane (y-axis
5
Q
What is the ROM in the knee TF joint?
- sagittal plane?
- transverse plane?
- full extension:
- when the knee is maximum rotation in 90 degree flexion: External Rotation is ? and IR is what degree?
A
- 0- 140 degree
- full extension: 0 degree, our knee is lock so there is no movement in transverse plane
- when the knee is maximum rotation at 90 degree: External rotation is 45 degree, and IR = 30 degree
6
Q
What is the ROM in the knee?
Frontal plane?
- Full extension:
- 30 degree flexion: few degrees only.
- what action?
- voluntary or involuntary?
A
- 0 degree
- abd/add
- INvoluntary
7
Q
Functional ROM:
- what degree to what degree lies within norm
A
- 0-117 degree
8
Q
Anatomy of the Tibiofemoral Joint:
- double condyloid joint
- two articulating surfaces
- medial
- lateral
- what is the 3rd articulating surface?
- Composed of two bones:??
A
patella
femur
tibia
9
Q
Anatomy of Femur:
- 2 condyles (articulating surfaces) separated by ____-
- notch becomes shallow = patella groove
- medial condyle approximately 2/3 inches longer anterior- posterior
- ___condyle extends further distally.
A
intercondylar fossa/notch
medial condyle
10
Q
Anatomy of Tibia:
- 2 condyles separated by :
- medial condyle is approx. 50 percent larger
- 2 articular disks = ?…. between femur and tibia.
A
menisci, act as shock absorber/help deepen the convex on tibia
11
Q
Knee Menisci:
- ___ as opposed to static structures.
- Describe 3, what kind of disk-like structures?
- open ends, is call? and they are susceptible to?
- Vascularized only in ____
- poorly vascularize in the?
Medial Menisci:
- what shaped?
- Attaches to MCL
- and attach to what muscle?
Lateral Menisci:
- almost circle, 80 percent of a ring, what shaped?
- More loosely attached to tibia so it is….?
- what muscle attach more lateral?
A
-Dynamic (movement occurs
- asymmetric, wedge-shaped, fibrocartilagenous
- horns, tears
-periphery, meaning the external/outermost.
Thicker outside and more blood, neuro supply- norcireceiptor, propriceptor
- poorly vascularize in the center.
MediaL: attach more securely so more injury
- C shaped
- semimembranosus
Lateral: O shaped
- less susceptible to injury.
- popliteous
12
Q
what are the functions of the Menisci?
if you don’t have menisci, then it would be bone on bone lead to arthritis.
- list 4
A
- distribute and absorb forces ( joint reaction)
- enhance joint congruency. How? …it enable contact to articulate each other. When congruency= more stable
- enhance arthrokinematics (joint movement) …. able to move because it is more congruency
- aids in nutrients and lubrication.
13
Q
Meniscus Tears:
- knee pain, swelling, tenderness, popping/clicking, limited motion.
Meniscus Tears- debridement (to remove)
- central tear: debride(to clean) pieces torn
- Outer periphery: Debride if small or repair if large tear
- Post Operative Treatment: walking in 1-2 days and full activities in 4 weeks
Meniscus Tears- Post operation Repair:
- Immediately:
= knee immobilizer or brace
= flexion to 60 degree
= WBAT with knee locked in \_\_\_\_
- 1 month
= continue with brace but not in ____
= ROM less/greater than 60 degree? - 3-4 months
= return to activities
A
extension
extension
greater
14
Q
Tibiofemoral Alignment: measure in lateral for this note
- Frontal Plane:
= Anatomical axes of femur and tibie (x-ray)
= Normal: call it slight valgus. Range is from?
-if less than 170 degree, it is call? aka knock knee
-if greater than 180 degree, it is call? aka bow legged
Tibiofemoral Alignment:
What changes in forces occur at the knee with?
- Genu valgum: increase ____ forces laterally, increase ___ forces medially
- Genu Varum: increase ___forces medially and increase ____forces laterally.
- What structures may be affected by: ?????????
Genu Valgum:
= medial,
= lateral,
Genu Varum:
= medial,
= lateral,
stretch MCL/LCL, compression LCL/MCL, and compress L/M meniscus.
A
genu valgum or valgus (think of gum sticking together, knock knee)
genu varum
–
- increase compressive forces laterally, increase tensile
- increase compressive forces medially, increase tensile forces latearlly
Valgum:
stretch MCL, compression lateral collateral ligament, and lateral menisci
Varum:
Stretch LCL, compress medial menisus, compression MCL
15
Q
Tibiofemoral Alignment: second measure, more clinical
Quadriceps (Q) angel measure in (supine), non weight bearing
- formula?
Normal Q angle:
- males?
- females?
- pathological Q angle?
A
ASIS to midpoint of patella , from midpoint of patella to tibial tuberosity
–
males less than 10 degree
females less than 16 degree
greater than 20 degree.
16
Q
Arthrokinematics of the Tibiofemoral Joint:
what is the basic orientation of the AOR (instantaneous AOR) for the knee?
- AOR moves as knee moves through ROM. Typical of what type of motion?
(femur, glide and slide as knee flexing anteriorly)
A
- curvilinear
17
Q
Aside: basics of arthokinematics
- spin- pure rotation (top). AOR is _____
- glide/slide (skid) ..think of carpal/tarsal
= pure ____/no rotation - roll (ball/wheel?
= ____ and ___ which is ____
A
fixed
translation
translation and rotation=curvilinear
18
Q
Aside: Convex/concave rule
- convex on stable concave surface: convex surface slides in ___ direction as motion of bony lever.
- concave on stable convex surface: concave surface slides in ___ direction as motion of bony lever.
A
opposite
same
19
Q
Arthrokinematics of the Tibiofemoral Joint:
- standing position= fixed/stable tibia
- 0 to 25 degree flexion (think of squat) = primarily ____, not sliding yet
- Beyond 25 degree flexion= anterior ____ of femur along with _____
- Gliding offsets ____ displacement that would result from _____ alone.
- Meniscus contribute to ___glide. How? because of……
A
ROLL
anterior gliding, ROLL
posterior, Rolling
anterior glide, wedge-shape
20
Q
Screw Home/ Locking Mechanism (lock knee in extension)
- Tibia ___ rotation during last 30 degree of knee extension , it is an ___chain because femur is fixed, tibia is moving.
- Greatest during final __ degree.
why?
- asymmetry(not same size, medial condyle is longer) of ….
- _____ tension
- slight lateral pull of…..
~~(tibia is fixed) In femoral on tibial extension, standing up from a deep squat position , femoral condyles roll anteriorly and slide posteriorly on articular surface of tibia. (close chain
continue with screw home mechanism
- with full knee extension:
- tibial tubercles lodged in intercondylar notch
- menisci tightly interposed between femur and tibia
- ligaments taut
A
External rotation, open chain
5
- femoral condyles
- ACL
- quadricep
21
Q
Passive Stabilizers of the Tibiofemoral Joint:
- joint capsule, diarthroses joint.
- MCL
- ___omedial femur to anterior tibia
- blends with …
- attaches to ….
- resists/block……
- MCL
- LCL
- lateral femur to ……
- resists/block…..
- does not blend with……
- ACL
- posteromedial aspect of ….to _____intercondylar region of tibia
- taut in knee ____
- resists ……
- what is a test for ACL intact (not damage)? flex knee and I would pull on tibia so if I get excessive movement, ACL is not so strong
- how about PCL? posterior draw test, draw tibia posterior
ACL more to injury, when knee in flexion
- when knee is in flexion with femoral ___Rotation (ACL winds around ____)
- flexion with femoral \_\_\_\_\_ rotation (ACL winds around..................
ACL injury- Reconstruction
- Immediately begin edema control measures
- 1 to 2 weeks
- AROm
- 3-6 weeks
- Progress strengthening - 7-12 weeks
- sports activities without side to side movement or pivoting - 4-7 months
- progress sports
A
- posteromedial
- capsule
- medial meniscus
- valgus stresses
- fibula head
- varus stress
- does not blend with lateral meniscus
- lateral femoral condyle to anterior
- extension
- anterior tibial translation and Internal rotation
ER; PCL
IR , lateral femoral condyle
22
Q
Passive Stabilizers of the Tibiofemoral Joint:
PCL
- ___ surface of ____femoral condyle to ___intercondylar region of tibia
- primary restraint to …
- ____is common mechanism of injury.
** Difference btw ACL and PCL regarding to taut? PCL is taut in knee ____ vs ACL taut in knee ___
A
anterolateral surface of medial femoral condyle to posterior
- posterior tibial translation
- hyperextension
*** PCL is taut in knee flexion, ACL is taut in knee extension
23
Q
Passive Stabilizers of the Tibiofemoral Joint:
Iliotibial band:
- fascia from tensor fascia lata, glute max and medius
- attaches to ___ and lateral ……
- gives rise to ___ band leads to patella ___ problems
- reinforces ___aspect of knee
A
- linea aspera of femur and lateral tubercule of tibia
- iliopatellar band, tracking
- anterolateral
24
Q
Patella:
Function:
- aids in extension by increase ____ of the quadriceps muscle, greater effect at …..degree flexion .
- allows for….. forces , and decrease ….. between quad tendon and femur.
- protection
A
moment arm, shortest distance between AOR and line of force
20-40
- allows for wider distribution of contract forces lead to decrease pressure and friction between quad tendon and femur.
25
Anatomy of Patella:
- what shaped?
- largest ___bone
- least ____joint
- how many facets?
triangular
- sesamoid
- congruent
- 3
26
Kinematics of Patella:
- with knee flexion patella translates ___ and .....
- FULL knee flexion, lead to sinks into femoral ___
- patella also tilts (___ axis, side to side) and rotates (___ axis)
~~~lateral condyle sits higher up, superior. Why? patella has to slide to tract laterally.
---
- Failure of patella to slide, tilt, or rotate properly can lead to :
- restricted ___and ___ ROM
- Patellafemoral tracking problems leads to pain lead to ....
- PF instability lead to....
inferiorly, medial to lateral
trochlea
vertical axis and rotates A-P axis
----
PF and Knee
tissue damage
subluxation/dislocation
27
Stabilizers of the patella
- medial/lateral
medial patellar retinacula -> vastus medialis
lateral patella retinacula--> vastus lateralis
- Superiorly/inferiorly
- paterlla tendon (ligament
- quadripceps tendon
pic?
28
Abnormal Lateral forces on the patella :
- what 2 muscles affected?
- if taut, what direction will pull my patella? laterally ....... glut max/medius attach to itb, so if glute is weak, it pull patella medially
- anything that increase the obliquity (laterally) of the pull could cause: list 2
- vastus lateralis
- ITB
---
1- excessive lateral compression
2- subluxation and or/dislocation laterally
29
Other Causes of Excessive Lateral Oblique Pull:
- Weakness of ____, my patella go lateral
- Excessive ____ , would increase Q angle, more bow stringing and it will pull my patella laterally.
- Excessive femoral ____, patella go lateral when head of femur rotate internally to fit acetabulum.
- Tight lateral retinaculum/ loose medial retinaculum
- tight ITB
- diminished height of lateral femoral lip
Vastus medialis oblique
- Genu Valgum
- anteversion
30
Other factors affecting patella alignment/tracking:
- status of ___muscles , affect IT bands.
- position of ......... , depends on IR/ER will change force how patella sit on it.
- mechanics of feet , whatever happen to one affect the other
gluteal muscle
tibial tuberosity
31
Specific Problems with Vastus Medialis Oblique:
- barely reaches top of the patella
- fibers run more ___rather than _____
vertical rather than oblique
32
Musculature of the KNee:
Extensors
- Quadriceps, list 4
-----
Flexors- Rotator
- Hamstrings
1- Lateral (what rotation?____ tibia); what muscle_____
2- Media (what rotation____ tibia); What two muscles ____
---
Flexors: not primary
- List 4
```
VMO
VL
VIntermedius
Rectus Femoris
---
```
ER, biceps femoris (long/short
IR, semimembranosus and semitendinosus
```
---
popliteus- unlocks the knee
gracilis
sartoruis
gastrocs, why? because it crosses the knee
```
33
The Hip Joint:
Function: Support..... and transmit...
support weight of HAT (head, arm, and trunks)
transmit forces between pelvis
34
Anatomy:
- bi/tri axial diarthrodial? ..
- ball and socket
- how many degrees of freedom
- femoral head and pelvic acetabulum
- loose capsule
- ligaments
- strong musculature
triaxial diarthrodial: flex/ext, abd/add, and int/ext
- 3 DOF
35
Anatomy of the Acetabulum
- Formed by 3 bones: ilium, ischium, pubis.
- covered with thick articular cartilage, ____ what kind?
- ____ shaped, where articulating area?
- labrum, is what cartilage _____ ?
hyaline
horseshoe shaped, superior articulating area
fibrocartilage
36
Center Edge (CE) Angle or Angle of Wiberg :
- angle between ____ and ___- ____rim . what plane?
- degree of ___ tilt
- varies but on average = ____
smaller Central edge= diminished head coverage leads to increase....
vertical and antero-lateral rim. frontal plane?
degree of inferior tilt
varies but on average = 35-38 degree (adults)
increase risk of superior dislocation
37
Center Edge (CE) Angle or Angle of Wiberg :
- angle increase with age for example: children more susceptible to dislocation because of small angle
- newborn, what degree to what?
- most common joint for congenital(inborn/inherited) dislocations
- 18-20 degree
38
Acetabular Anteversion:
- Degree of ____tilt (what plane?
- average ( ____- ____ degree)
- pathological leads to decrease stability = ____ dislocation
anterior, transverse
- 19-40 degree
anterior dislocation
----==if anteversion even more: pop out anterior dislocation even more.
39
Acetabulum - Labrum
- Deepens socket leads to increase ____
- grasp the head= ____
- concave
| - joint stability
40
Femoral Head:
2/3 of a sphere
- covered by articular cartilage
- fovea, ligament of head of the femur call ___, it carries ____ supply to femoral head.
- ligamentum teres
| - neurovascular
41
Femoral Head- Angle of Inclination (what plane?) , similiar to center edge angle
- congruent what degree in adults?
- decrease with age : newborn what degree? elderly what degree?
less than 125 degree= coxa what?
greater than 125 degree= coxa what?
----what produce genum varum/valgum at knee?
frontal plane
125 degree in adults
150 degree, elderly 120 degree
- coxa vera, produce genu valgum at knee
- coxa valga, produce genu varum at knee
42
Femoral Head- Angle of Torsion (what plane?)
- angle between femoral ____ and _____
- averages ___-____ in normal adult
- increase torsion angle = ____ leads to ____rotation femoral torsion
- decrease torsion angle leads to ___ position , leads to ____ femoral torsion
Transverse Plane
- neck ad condyles
- 12-15 degrees
- anteversion, internal femoral torsion .. walk when toe point towards.
- retroversion, external
43
Hip Joint Congruence (how much joint is contact with each other
- good so considered stable but far from perfect
- _____ does not cover head superiorly
- pathological angle of inclination/torsion leads to less congruent and instability
---
- change in Center edge can alter congruent leads to ___stability
- only ___ of acetabulum is articular
- deep acetabular fossa important for ___
- acetabulum
----
decrease...also means instability
periphery
vacuum
44
Hip Joint Capsule:
- Strong and dense , so it important contributor to ____
- attaches to periphery of ____and blends with ____
- covers femoral neck and attaches to the base of the___
stability
acetabulum , labrum
neck
45
Hip Joint Ligaments- Anterior (2 front, 1 in back)
1- iliofemoral ligament or called ______
- it is from ___ to the ____
* checks(stop/prevent) hip ___ so it stretch and gives tension
2- ______ ligament , from pubic ____ to .......?
- taut in ___ and ____ ...so same as it is checks(stop/prevent) __and ___
--
Hip Joint Ligaments- Posterior
- ....ligament?
- femoral neck to ______
- what kind of fibers? ...tighten during ...?
- what kind of fibers?... tighten during ....and loosen during...?
Y ligament of bigelow
AIIS to the intertrochanteric line
extension
pubofemoral, pubic ramus to intertrochanteric fossa
- abduction and extension
----
ischiofemoral ligament
- femoral neck to acetabular rim/labrum
- horizontal fibers, tighten during adduction
- spiral fibers, tighten during extension and loosen during flexion.
46
Hip Close- Pack Position: (most congruent , taut)
- full ...with slight ....and ......
extension with slight aBDuction and IR
47
Ligament of head of femur:
- does or does not play major role in stability??
- ____ supply(Esp. in young since vessels cannot across cartilagenous endplate)
- does not play
| - Neurovascular
48
W/B structures :
- where is the zone weakness? that is where people fx
- susceptible to bending ___
- fx 2 degree to increase forces or tissue changes ex: osteoporosis
- femoral neck, not a lot of
| - force
49
Arthrokinematics
- neutral (not abd/add) , i just flex/entend , the movement is almost a .....
- outside of neutral , it is a .....and....
- IR/ER and Abd/ADD , it is ___ and ___
- In WB= pelvis moving on fixed femur (close chain)
concave on convex it means......
pure spin
combined spin and glide
spin and glide
SAME DIRECTION
50
Osteokinematics:
- flexion, gives degree, less flexion of the knee when it extended because hamstring stop us because of passive insuff
- extension, gives degree, may be limited with knee flexion because of quadracip (rectus femoris, 2 joint musc
- aBduction , what degree; adduction what degrees
- ER, ?
- IR, ? degree
measured with hip flexed at 90 degree, why? allow legs to move more capsule is loose rotate more
120-135
10-30
30-50 , 10-30
45-60 , 30-45
51
Functional HIP ROM (activities normal
124 degree flexion, give example
10 degree extension, give example
28 degree abduction, give example
75-90 degree ER, give example
tying a shoe, squatting
gait
abduction, squatting
foot across opposite thigh
52
Primary Hip Flexors?
- list 4, give main one ?
Secondary hip flexors... give 4
Iliopsoas, main one....
rectus femoris(2 joint muscle)
and TFL with abduction,
and sartorius with aBD and ER
secondary: pectineus, adductor longus, adductor magnus, and gracilis
53
Primary Hip Extensors?
- give 2
may receive assistance from :
- 3 muscles
G.maximus
hamstrings (2 joint
---
G.Medius (post. fibers
posterior adductor magnus
piriformis
54
ABductors : give 2 and 1 more that has hip flexed
Adductors: give 5
G.medius/minimus and TFL
pectineus, adductor brevis, longus, magnus, and gracilis
55
Lateral Rotators /ER
- give 6
Medial Rotators/IR
- give 3
obturator internus, externus, gemellus sup/inferior, quadratus femoris, piriformis and posterior g.max
--
anterior gluteus medius, minimus, and TFL
56
Ankle and Foot:
Functions?
- Stability :
stable ___for the body in WB (without muscular effort or energy expenditure)
and rigid___ for push off during gait.
- Mobility:
1-dampening of ____ imposed by proximal joints
2- flexible enough to ..... from the ground
3-conform to terrain
BOS
lever
---
dampening (make less strong) of rotations
absorb force
57
Anatomy?
- how many bones/joints?
- Tibia and Fibula and Foot
- Foot = 3 functional segments? ....
- name the sub components underneath 3 of them
Joints: 3 of them?
- what covered 70% with (specialize hyaline )articular cartilage?
hindfoot, midfoot, forefoot
hindfoot= talus, calcaneus
midfoot (tarsals)= navicular, cuboid, 3 cuneiforms
forefoot= 5 metatarsals, and 14 phalanges
- - talocrural (ankle)
- subtalar (underneath talus, articulate with calcaneus
- transverse tarsal (talonavicular and calcaneocuiboid)
talus
58
Movement Definitions Fundamental:
- what axis for abduction/adduction?
- what axis for dorsif/plantarf?
- what axis for inversion/eversion?
---
Movement definitions-applied movement of the foot
- Pronation/supination?
(eversion/inversion, abduction/adduction, dorsiflexion, plantarflexion) ??????
vertical axis
coronal
longitudinal (A-P)
---
Pronation:
E
ABd
D
and supination is the opposite of pronation.
59
Talocrural Joint aka .....
- what kind of joint?
- how many freedom? with oblique AOR = _____(what action?)
```
Proximal concave(form by fib/tib) surface articulating.....
-------
```
-TALUS : includes 3 things?
-------
- Oblique Axis: runs from ..... to ..... to ....
(@@@the role of fibula is to form the other side of articulation, called mortise. ...because medial malleolus sits more superior than lateral malleolus in frontal/coronal plane...also medial mallelous sits anterior to the plane)... if i look straight down the lateral m. --->looks behinds, transverse plane.
- what kind of motion ?
--------
- very congruent(tight) joint 2 degree bony mortise and..........
ankle joint
plantar/dorsiflexion means 1 DOF
distal convex surface (talus)
---
body, head and neck , and 3 facets (posterior, middle, anterior)
---
lateral malleolus to body of talus to distal medial malleolus
tri-planar (crosses 3 planes ) but only 1 DOF
----
- strong ligamentous support
60
Talocrural Joint Ligamentous Support :
- has a joint capsule* , thin, weak ____and ___
- *deltoid ligament aka ___. It goes from ......to ......
- very strong
- checks/block.... stress
- *Lateral Collateral Ligament- weakest, what are the 3 bands?
- and which one is the weakest one out of all?
- checks varus (inversion) stresses
anteriorly and posteriorly
MCL...from tibial malleolus to navicular, talus, calcaneus
- valgus (eversion) stresses , means away from the midline
3 bands: anterior talofibular, posterior talofibular, and calcaneofibular ..... anterior talofibular , weakest
checks varus (inversion) stresses
61
Proximal Tibiofibular JOint:
- has joint capsule, synovial
- fibula head
- posterolateral tibia
Distal Tibiofibular Joint:
- what kind ?
- between distal tibia and fibula
- ligamentous structures important for ....?
- .....tibiofibular
- .....tibiofibular
fibrous union, syndesmosis
important for mortise stability:
crural interosseous tibiofibular
ant/post
62
Talocrural kinematics:
arthrokinematics:
- convex ___
- concave ___
Osteokinematics:
- give degree for dorsiflexion
- give degree for platarflexion
- convex talus
- concave mortise
- 15-25 degree of dorsiflexion
- 40-55 degree of plantarflexion
63
Subtalar (talocalcaneal) Joint:
3 separate plane articulations:
1- posterior talocalcaneal joint (largest)
concave/convex talus sitting on concave/convex calcaneus?
2- anterior and 3 middle talocalcaneal joint
concave/convex talus sitting on concave/convex calcaneus ?
---
Function:
1- ___________imposed by BW during foot-floor contact
2- Maintain foot in ______________
- concave talus sitting on convex calcaneus
- convex talus sitting on concave calcaneus
--
dampen rotational forces
contact with supporting surface
64
Subtalar (talocalcaneal joint) arthrokinematics:
- complex- screw like motion
- what kind of planar motion about oblique axis ?
- how many degree of freedom? which equal ......?
side notes Oblique axis of subtalar joint:
- what plane is subtalar joint?
- no pure abd/add and dorsi/plantarf (least movement) compare to the others) , ever/inv
- triplanar , moves in 3 planes
- 1 DOF= supination/pronation
---
sagittal
(vertical axis) , (ML axis), AP axis
65
Subtalar (talocalcaneal ) joint Ligamentous Support:
- stable joint:
1) ___and ___talocalcaneal ligament (ant/post bands)
2) MCL and LCL of ankle
3) Posterior and lateral talocalcaneal ligaments
- cervical and interosseous talocalcaneal ligament
66
subtalar/ talocalcaneal SUPINATION (non-w/B)
- _* cALcaneus moving on fixed ____
Calcaneus:
- _____ ( vertical axis)
- ____ (AP axis of foot)
- ______ (ML axis)
----
subtalar/ talocalcaneal PRONATION (non-w/B):
* cALcaneus moving on fixed talus
Calcaneus:
- _____ ( vertical axis)
- ____ (AP axis of foot)
- ______ (ML axis)
-----
subtalar/ talocalcaneal SUPINATION (W/B) **think of screw cap******
*Relatively fixed ____, so talus is moving
- Calcaneus _____ ( valgus/varus?)
- Talus ____ (ER/IR- vertical axis)
- Talus ______
- Tibial ____
----
subtalar/ talocalcaneal PRONATION (W/B)
*Relatively fixed ____
- Calcaneus _____ ( valgus/varus)
- Talus ____ (ER/IR- vertical axis???)
- Talus ______
- Tibial ____
talus
adduction
inversion
plantarflexion
----
ABDUCTION
Eversion
Dorsiflexion
---
fixed calcaneus
- inversion (varus)
- aBduction (ER)
- dorsiflexion
- ER
----
fixed calcaneus
- eversion (valgus)
- adduction (IR)
- Plantarf
- IR
67
Subtalar /Talocalcaneal Pronation (W/B) *close chain
- Function?
- Foot= __________because pronate in WB allows foot to conform to the surface of the ground.
- Weight acceptance during gait
- attenuation (weakening) of Ground reaction force
- conform to ....
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Subtalar /Talocalcaneal SUP (W/B)
Function:
- foot= ............
- push off during...
- rigid ___
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bag of bones
ground
---
lock-up foot
during gait
lever
68
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Transverse Tarsal (midtarsal), S shape joint
= two articulations, between what 2 joints?
```
- divides hindfoot from midfoot
- talus/calcaneus move on *fixed of ___and___
- most versatile joint of the foot
- moves through an oblique path almost equally through all planes
- allows the WB foot to adapt to a variety of srufaces
* - strutural/functional relationship with ....? (share that common joint capsule
= talonavicular joint and calcaneocuboid joint
navicular and cuboid
the subtalar joint
69
Talo Calcaneo Navicular Joint = common joint capsule
Joint Interaction in the Foot:
- subtalar joint contributing to : what joint?
- talonavicular joint contributing to what 2 joints?
- calcaneocuboid joint contributing to : ?
- talo calcaneo navicular joint
- talocalcaneonavicular joint and transverse tarsal
- transverse tarsal
70
Talo calcaneo navicular joint Key to Foot function:
= 2 joints articulation?
- Talus head (convex/concave) moves on relatively fixed .....(convex/concave?
- what motion?
- how many degree and what is the primary movement at TCN?
ST and TN joint
navicular (concave)
triplanar
1 degree , pronation/supination
71
NAVICULAR Socket :
deepened by: 3 ligaments
- inferiorly? sit inferior to the head of the talus
- medially?
- laterally
plantar calcaneonavicular (spring) - not very elastic, quite resistant. It's more for prevent subluxing.
deltoid ligament
bifurcate/lateral calcaneonavicular ligament
72
Talo calcaneo navicular joint Key to Foot function:
In WB, Talus analogous to a ball bearing between the:
- .......?
- calcaneus
- navicular
- tibiofibular mortise
- calcaneus
- navicular
73
Joint Interaction in the foot- .....is the key to foot function
* -TCN dictates motion of ......joints and .....joint follows along.
- TCN is supinated(locked) --> .... supinated (locked
TCN
transverse tarsal joints and Calcaneocuboid joint follows along.
TCN is supinated(locked) , and transverse tarsal supinated locked.
74
Joint Interaction in the Foot - Functions of TT joint
- Trasitional link between hindfoot and forefoot
* - enhance ___/___ of TCN joint.
- Allow forefoot to remain flat on ground while calcaneus is in varus or valgus (compensation)
Dr. scott said,
overly pronate is call flat foot aka...
for high arch/supinate aka ....
supination/pronation
pes planus
pes cavus
75
Biomechanics of Foot:
- TCN supinate/pronation ?? --> foot "bag of bones" ------> both hindfoot and midfoot free to compensate to accommodate to floor (weight acceptance)
- TCN supination/pronation (lock up)??----->restricts.....joint motion. When transverse tarsal joint is supinated --> ......to push off from
pronation
supination , transverse tarsal joint motion ...rigid lever to push off from
76
Tarsal metatarsal joints (tmt): forefoot
- functional unit is called a ...? is a tarsal and mts articulate with.
- 1st TMT= 1st MET and
- 2nd TMT= 2nd MET and
- 3rd TMT= 3rd MET and
- 4th and 5th TMT = 4th and 5th MET and
which digit occurs the most? dr scott said: 1, 3,4,5 .
2nd digit almost forming a .....not moving much, hitting all 3 cuneiform. ........what have most movement.
RAY
- 1st MET and medial cuneiform
- 2nd MET and mortise (cuneiforms)
- 3rd MET and lateral cuneiform
- 4th and 5th MET and cuboid
mortise, 1 and 5 toes
77
TMT Joints Function:
- function is continuation of transverse tarsal joint
- if inadequate motion exists at transverse tarsal joint, TMT will provide additional motion for full compensation.
read
78
Supination versus pronation twist:
Supination twist:
- If my ..... pronates, what has to supinate? ..so calcaneus/hindfoot evert then all of the weigh will go medial and toes have to supinate if i want to go back gorund.
Pronation twist:
- If hindfoot supinate, my forefoot has to ... to keep feet on ground.
like wring a towel, vice versa
- hindfoot.......forefoot (metarsal and phalanges) supinate
| - pronate
79
Metatarsalphalangeal (MTP) Joints :
* - how many DOF? and what are they?
- 1st : 2 sesamoid bones at head of 1st mts head
* - anatomical pulleys for _____. it also create a tunnel for
* - protection of ___tendon from WB stress
2 degree, flex/ext and abd/add
FHB, flexor hallucis brevis
FHL
80
MTP joints:
* - Functionally, what motion is most important for MTPs?
- 1st MTP(my big toe) : what degree for extension? , degree for flexion?
when i walk, my toe extend...gait when i go forward, my toes extend to push of lever.
flex more mcp, but foot more extension on mtp
extension more important than flexion ----> gait
82 degree extension , and 17 flexion
81
IP joints:
- how many?
- what axial, what degree, what function? what joints?
- convex surface of __dist/prox aspect of ___segment
articulating with concave surface of _dist/prox aspect of segment
9
uniaxial , 1, flex/ext, synovial
distal , proximal segment
proximal, distal segment
82
Plantar Arches: LONGITUDINAL, what plane?
- based posteriorly at ......and anteriorly at.....
- throughtout foot but more prominent ....where?
------
Plantar Arches: TRANSVERSE
- viewed at what plane? from ..... and anterior ....
- ....is keystone at tarsal
- what metatarsal is apex of arch?
Dr.scott asked, what is the key stone to an arch? very top.... so what is the key stone at tarsal? middle cuneiform, what is the key stone at MTS? .....
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Plantar arches , is maintained via:
shape and arragment of bones,
and ligamentous support
sagittal plane
calcaneus, metatarsal heads
medially
------
frontal plane: MET heads and anterior tarsals
middle cuneiform
2nd MET
2nd MET
83
Plantar arches Ligamentous Support: stabilize and provide mobility
- spring-plantar calcaneonavicular, especially medial longtiduinal
- long plantar- lateral longitudinal
- plantar aponeurosis- longitudinal
- short plantar - plantar calcaneocuboid- lateral longitudinal
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Plantar aponeurosis (fascia)- important for longitudinal arch
- dense fasica from .... to .....
- heel spurs 2 degree plantar fasciitis
- ....... leads to tightening of plantar aponeurosis?
- assists in locking up the foot
dr scott said, when sleep foot is plantarflex, short aponeurosis leads to stiff,... do dorsiflex, will be better
calcaneus to proximal phalanx of each toe
extension of MTP
84
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Plantar Arches:
Function:
I- stability-
- distribute of weight for......
- conversion of foot to a .....
----
Windlass effect..when walk in plantarflex, toes extend, tight aponeurosis
```
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Plantar Arches:
Function:
* II- Mobility
- dampening of _____during WB
- adaptation to supporting surface
- dampening of ________
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for proper WB
to a rigid lever
ground reaction force
superimposed rotations(er/ir) from the top down
