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Chapter 8: The Lower Extremity: The Knee, Ankle, and Foot

Chapter 8: The Lower Extremity: The Knee, Ankle, and Foot. KINESIOLOGY Scientific Basis of Human Motion, 10 th edition Luttgens & Hamilton Presentation Created by TK Koesterer, Ph.D., ATC Humboldt State University. Objectives.

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Chapter 8: The Lower Extremity: The Knee, Ankle, and Foot

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  1. Chapter 8:The Lower Extremity:The Knee, Ankle, and Foot KINESIOLOGY Scientific Basis of Human Motion, 10th edition Luttgens & Hamilton Presentation Created by TK Koesterer, Ph.D., ATC Humboldt State University

  2. Objectives 1. Name, locate, & describe the structure & ligamentous reinforcements of the joints 2. Name & demonstrate movements possible 3. Name & Locate muscles & muscle groups, and name their primary actions 4. Analyze the fundamental movements with respect to joint & muscle actions 5. Describe common athletic injuries

  3. THE KNEE JOINT: Structure • Hinge joint • Two condyles of femur articulate with tibial plateaus • Patella articulates with patella surface of femur Fig 8.2anterior

  4. THE KNEE JOINTStructure • Menisci are circular rims of fibrocartilage • Lateral – is an incomplete circle • Medial – “C” shaped • Thick peripheral borders & taper to a thin inner edge Fig 8.4

  5. Ligaments of the Knee Fig 8.3

  6. Ligaments of the Knee Fig 8.5

  7. Movements Fig 8.6 Internal rotation External rotation Flexion Extension

  8. Anterior Quadriceps Group Rectus femoris Vastus intermedius Vatus lateralis Vastus medialis Posterior Hamstring Group Biceps femoris Semimembranosus Semitendinosus Sartorius Gracilis Popliteus Gastrocnemius Muscles of the Knee Joint

  9. Rectus Femoris Function: • Powerful knee extension Sartorius Function: • Flexion and internal rotation in non-weight bearing Fig 8.7

  10. Vastus intermedius Vastus lateralis Vastus medialis Function: • Powerful knee extension Fig 8.8

  11. Biceps femoris • Function: • Flexes knee & external rotation of tibia in non-weight bearing • Semimembranosus • Semitendinosus • Function: • Flexion and internal rotation in non-weight bearing Fig 8.10

  12. Gracilis • Function: • Flexes knee • Slightly active in internal rotation of tibia when knee is flexed • Popliteus • Function: • Internally rotates tibia • Helps flex knee Fig 8.11

  13. Gastrocnemius • Function: • Helps flex knee • Weight bearing can help maintain knee extension Fig 8.23

  14. MUSCULAR ANALYSIS OF FUNDAMENTAL MOVEMENTS OF THE LEG AT THE KNEE JOINT • Flexion: Hamstrings, sartorius, gracilis • Extension: Quadriceps • External Rotation: Biceps femoris • Can only occur when knee is flexed & non-weight bearing • Internal Rotation: Semimembranosus, Semitendinosus, popliteus • Can only occur when knee is flexed & non-weight bearing

  15. THE ANKLE AND THE FOOTStructure • Hinge joint • Articulation of talus with distal ends of tibia & fibula • Membranous capsule Fig 8.12

  16. Ligamentous Reinforcement Lateral side • Anterior talofibular • Calcaneofibular • Posterior talofibular Fig 8.14

  17. Ligamentous Reinforcement Medial side • Deltoid • Calcaneotibial • Anterior talotibial • Tibionavicular Posterior talotibial • Plantar calcaneonavicular • Deltoid • Calcaneotibial • Anterior talotibial • Tibionavicular • (Posterior talotibial )l Fig 8.13 Plantar calcaneonavicular

  18. Structure of the Foot • An elastic arched structure • Keystone being the talus Fig 8.15

  19. Structure of the Foot • Longitudinal arch • Heel to heads of five metatarsals • Transverse arch • Side-to-side concavity • Anterior tarsal bones & metatarsals Fig 8.16

  20. Subtalar Joint • Underside of talus and upper & anterior aspects of calcaneus • Plantar calcaneonavicular “Spring ligament” helps support talus Fig 8.17b

  21. Foot Joints Midtarsal Joints: Nonaxial – permits only gliding • Modified ball-and-socket – permits restricted motion Tarsometatarsal Joints: Movements are gliding Intermetatarsal Joints: spreading or flattening Metatarsophalangeal Joints: Modified condyloid joint Interphalangeal Joints: Hinge joints

  22. Movements of Foot at the Ankle, Tarsal, & Toe Joints Fig 8.20 Dorsiflexion Plantarflexion Inversion Eversion

  23. MUSCLES OF THE ANKLE & FOOT Location: • 22 muscle of the ankle & foot are intrinsic • 11 muscles are extrinsic

  24. Tibialis Anterior Function: dorsiflexes ankle & supinates foot Peroneus Brevis Function: plantarflexes, everts Extensor Hallucis Longus Extensor Hallucis Brevis Function: extends great toe Extensor Digitorum Brevis Function: extends toes Fig 8.21a

  25. Extensor Digitorum Longus Function: extends toes Peroneus Longus Function: plantarflexes, everts, abducts Peroneus Tertius Function: dorsiflexes & pronates Fig 8.22

  26. Gastrocnemius Function: powerful plantar flexor • Fast twitch • Dynamic plantar flexor Fig 8.23

  27. Soleus Function: plantar flexes • Slow twitch • Postural, static plantar flexion Fig 8.24

  28. Tibialis Posterior Function: plantar flexes, supination • Helps holds up longitudinal arch Fig 8.25

  29. Flexor Digitorum Longus Function: Flexes toes, plantar flexes, helps inversion Flexor Hallucis Longus Function: flexes great toe, plantar flexes, helps inversion Fig 8.26

  30. Intrinsic Muscles of the Foot Fig 8.27 & 8.28

  31. Intrinsic Muscles of the Foot Fig 8.29 & 8.30

  32. Muscular Analysis of Fundamental Movements of the Ankle • Dorsiflexion: tibialis anterior, peroneus tertius, extensor digitorum longus, extensor hallucis longus • Plantar flexion: gastrocnemius, soleus, peroneus • Possible help from tibialis posterior, peroneus brevis, flexor digitorum longus, flexor hallucis

  33. Muscular Analysis of Fundamental Movements of the Tarsal Joints • Dorsiflexion: same as ankle • Plantar flexion: tibialis posterior, flexor digitorum longus, flexor hallucis longus, peroneus longus • Supination: tibialis anterior (when foot dorsiflexed)& tibialis posterior (when foot plantar flexed) • Pronation: peroneus longus, brevis, & tertius

  34. Muscular Analysis of Fundamental Movements of the Toes • Flexion: flexor digitorum longus and flexor hallucis longus • Extension: extensor digitorum longus and extensor hallucis longus

  35. COMMON INJURIES OF THE LEG, KNEE AND ANKLE These areas may be presented for each injury • Mechanism of Injury (MOI): • How did the injury occur? • Pathology (PATH): • What tissues are damaged? • Sign & Symptoms (S&S): • What does the patient tell you? • What can be determined from an evaluation of the injury?

  36. The Leg: Shin Splints MOI: Overuse PATH: Repeated microtears where tibialis posterior or anterior attaches to tibia • Sprains in interosseous membrane S&S: Tenderness & pain on medial surface of tibia Treatment: Rest, softer surface and supporting the arch

  37. The Leg: Fracture MOI: Direct blow PATH: Most common to lower 2/3 of fibula • May result in instability of ankle joint S&S: Pain, Possible deformity Treatment: Rest, Ice, Compression, Elevation

  38. The Knee: Medial Collateral Ligament Sprain MOI: Direct blow to lateral aspect of knee PATH: Depending amount of force the following structures could be injured • Medial collateral ligament • Medial meniscus • Anterior Cruciate Ligament S&S: Pain, Instability

  39. The Knee: Chondromalacia MOI: Unknown, Overuse? PATH: Degeneration of cartilage on articulating surface of patella S&S: Pain, on movement, swelling, grating sensation Treatment: Through evaluation of lower body biomechanics, rehabilitative exercises, limiting activities

  40. The Knee: Osgood Schlatter Disease MOI: Repeated overuse of knee extensors PATH: tearing or avulsion of epiphysis of tibial tuberosity S&S: Swelling, pain on activity & kneeling Treatment: Rest, Ice, Rehabilitative exercises

  41. The Ankle: Strain MOI: Landing form jumping PATH: tearing at myotendinous junction S&S: Pain, weakness, possible deformity Treatment: Rest, Ice, Compression, Elevation

  42. The Ankle: Sprains MOI: Forceful inversion of the foot PATH: lateral ligaments stretched or torn S&S: Pain, Swelling, Disability Treatment: Rest, Ice, Compression, Elevation

  43. The Ankle: Fracture MOI: Same as ankle sprains PATH: majority occur to malleoli • More serious fracture sometimes dislocate S&S: Pain, Swelling, Disability, Point tenderness Treatment: Rest, Ice, Compression, Elevation

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