Position and ROM of Lower limb joints Flashcards
What is the position of the ankle axis relate to the knee in the transverse plane
20-30 degrees externally rotated from the knee axis
Mechanical axis of the ankle
midline between apex of the medial malleoli and lateral malleoli
Normal dorsiflexion ROM of the ankle
20-30 degrees
Normal plantarflexion ROM of the ankle
20-50 degrees
Ankle ROM required for normal gait
10 degrees dorsiflexion
20 degrees of plantarflexion
Subtalar Joint postion
Anteriosuperomedially
41-45 degrees with respect to the horizontal
16 degrees with respect to the sagittal plane
Subtalar joint ROM
20 degrees calcaneal inversion with full supination
5 degrees calcaneal eversion
Subtalar ROM required for Normal Gait
4-6 degrees of calcaneal inversion and eversion
Hip Joint axis approximation
Joint is Multiaxial, therefore only one point of rotation is relevant
Externally approximated at eh level of the greater trochanter
Hip Joint Passive ROM for Flexion
120 with knee flexed
90 with knee extended
Hip Joint Passive ROM for exension
30 degrees
Hip Joint Passive ROM Abduction
45-50 degrees
HIp Joint Passive ROM Adduction
20-30 degrees
Hip Joint Passive External Rotation
45 degrees, 90 degrees with HIp Flexed
Hip Joint Passive Internal Rotation
35 degrees, 70 degrees with Hip Flexed
Hip Joint Normal Flexion ROM required for Gait
37 degrees
Hip Joint Normal Extension ROM required for Gait
45 degrees
Hip Joint Normal Abduction ROM required for Gait
7 degrees
Hip Joint Normal Adduction ROM required for Gait
5 degrees
Hip joint Normal External rotation required for Gait
9 degrees
Hip joint Normal Internal rotation required for Gait
4 degrees
Knee Joint
Changes throughout ROM (polycentric)
Radius of curvature of condyles decreases with flexion
Knee Axis approximation
Heigh of the adductor tubercle
Bisecting femoral condyles in the sagittal plane
Parallel to epicondyles in the frontal plane
Knee Flexion ROM
Passive
160
Active
140 with hip flexed
120 with hip extended
Knee Extension ROM
0 degrees
Knee Axial Rotation
0 degrees full extension
30 degrees internal rotation with 90 degrees of knee flexion
45 degrees of external rotation with 90 degrees knee flexion
less with greater knee flexion due to soft tissue restrictions
Mid Tarsal Joints
Comprised of Calcaneocuboid and Talonavicular joints
Calcaneocuboid - oblique axis
Responsible for aBd/aDd and Plantar/Dorsi
Talonavicular - longitudinal axis
Primarily Inversion/Eversion
In pronation, axes become more parallel, foot is more flexible and adaptive
In supination, oblique and longitudinal axes become less congruent, binding produces more rigid foot segment
ROM is 4-6 degrees inversion, compensates for 4-6 degrees calcaneal eversion required for normal gait
Calcaneocuboid joint axis
Oblique axis
Runs anteriosuperiomedially
Largely in frontal and horizontal planes
Dorsiflexion/aBduction
Plantarflexion/aDduction
First Ray
First cuneiform and first metatarsal
Second Ray
Middle cuneiform and second metatarsal
Third Ray
Lateral cuneiform and third metarsal
Fourth Ray
Fourth Metatarsal
Fifth Ray
Fifth Metatarsal
Talonavicular joint
Also runs anterosuperiomedially
But largely confined to sagittal and horizontal planes
Therefore abel to mostly inverts/everts
Tarsometatarsal joints
Rays of the foot
Multiaxial plane joints
Plantarflexion and dorsiflexion are main movements possible
However, 1st rays everts with dorsiflexion, inverst with plantarflexion
Keeps first met head in contact with ground during supination/push off
Metatarsophalangeal joints
Synovial Condyloid joint
Active Plantar/Dorsiflexion and Abd/Adduction
1st MTP is largest, only 2 phalanxes, and sesamoid bones
Adequate dorsiflexion is essential for late push off
65-75 degrees required for normal gait
Interphalangeal Joints
Synovial hinge joint
Results in plantar/dorsiflexion
Proximal IP joint does not allow dorsiflexion
Distal IP joint permits both
