knee, ankle, foot

patella

•Is cartilaginous at birth→ ossifies between 3 & 6 years old

knee

•Synovial hinge joint

•Mainly flexion and extension

•3 articulations

•*strength and actions of the surrounding muscles*

Flexion (knee movement)

hamstrings

•Limited by calf and thigh

Extension (knee movements)

quadriceps

•Limited by cruciate and collateral ligaments

medial rotation (knee movements)

popliteus and semitendinosus

•Limited by the cruciate ligaments

lateral rotation (knee movements)

biceps femoris

•Limited by the collateral ligaments

Menisci of the knee joint

•Shock absorbers

Thick externally, thin internally

ACL

•Weaker of the cruciate ligaments

•Slacked with knee flexion

•Taut with knee extension

PCL

•Tight during flexion

•Stabilizes flexed knee- such as needed for walking down a hillside

Patellar Tendon

•Patellar reflex = knee jerk reflex

•Tests the L2-L4 nerves

genu valgum

•Knock-kneed

•Unequal distribution of weight onto the lateral knee

•Frequently occurs in children from 2-4 years old

genu varum

•Bowlegged

•Unequal distribution of weight onto the medial knee

•Knee cap is pulled laterally = vastus lateralis

•Frequently occurs in children until 2 years old

arthrosis

•Destruction of the knee cartilage

•Irregular angles lead to wear and tear of the articular surfaces

osteoarthritis

•Knee replacement

•Total knee replacement

Plastic and metal replacements that mimic the cartilage articulations

chrondromalacia patella

•patellofemoral syndrome= Runner’s knee

•Quadriceps imbalance

•Seen in athletes who participate in running sports (especially downhill), heavy lifting

Osgood Schlatter

Inflammation of the patellar tendon insertion into the tibia

•When growth plates are not closed, growing but not physically mature

•Imbalance with quads and poor flexibility

ACL rupture

Severe force anteriorly with knee semi-flexed

•Tibia slides anteriorly on the femur

anterior drawer sign

meniscal tears

•Most likely to occur when ACL or lateral collateral ligaments are torn

Heal on own, require surgery to repair, or are removed

Ankle movements

dorsiflexion (point foot up)

plantar flexion (point foot down)

Tibialis anterior

Origin:

–Tibia, interosseous membrane

Insertion:

–medial cuneiform bone, base of 1st metatarsal bone

Innervation:

–Deep peroneal nerve

Action:

–Dorsiflexion, inversion, arch support

extensor digitorum longus

•Origin:

–Fibula, interosseous membrane

•Insertion:

–dorsal surface of each toe, tendon enters in to extensor expansion

–Base of middle phalanx and two lateral parts insert into base of distal phalanx

•Innervation:

–Deep peroneal nerve

•Action:

–/ toes and dorsiflexes foot

peroneus tertius

•Origin:

–Fibula, interosseous membrane

•Insertion:

–Tendon follows tendons of EDL

–fifth metatarsal bone

•Innervation:

–Deep peroneal nerve

•Action

–Dorsiflexes foot, eversion

extensor hallucis longus

•Origin

–Fibula, interosseous membrance

•Insertion

–base of distal phalanx of great toe

•Innervation:

–Deep Peroneal Nerve

•Action:

–/ big toe, dorsiflex foot, inversion

extensor digitorum brevis

Origin:

•Calcaneus

Insertion:

•Proximal phalanx of great toe and digits 2, 3, and 4

Innervation:

•Deep peroneal nerve

Action:

/ toes

peroneus brevis

•Origin:

–fibula

•Insertion:

–base of fifth metatarsal bone

•Nerve supply:

–Superficial peroneal nerve

•Action:

–Plantar flexion, eversion, arch support

gastrocnemius

Origin:

–lateral condyle of femur

–popliteal surface of femur

Insertion:

–posterior surface of calcaneum

Innervation:

–Tibial nerve

Action:

–Plantar flexion, knee √

soleus

•Origin:

–posterior surface of tibia and shaft of fibula

•Insertion:

–joins anterior part of common tendon and posterior surface of calcaneum

•Innervation:

–Tibial nerve

•Action:

–Plantar flexion

gastrocnemius and soleus

Combine to form the Calcaneal tendon

•Achilles tendon

•Thickest and strongest

•Walking, weight shifting, acceleration, jumping…

plantaris

•Origin:

–Lateral supracondylar ridge of femur

•Insertion:

–posterior surface of calcaneus

•Innervaton:

–Tibial nerve

•Action:

– Assists plantar flexion , knee √= minimal

Muscle used in hand surgeries

popliteus

•Origin:

–lateral condyle of femur

•Insertion:

–tibia

•Innervation:

–Tibial nerve

•Action:

—medial rotation of tibia

flexor digitorum longus

•Origin:

–Medial tibia

•Insertion:

– Tendon passes behind medial malleolus, deep to flexor retinaculum, and enters sole of foot

–lateral four bases of distal phalanges

•Innervation:

–Tibial nerve

•Action:

–distal phalanges √, assists in plantar flexion, longitudinal arches

flexor hallucis longus

•Origin:

–shaft of fibula

•Insertion:

–base of distal phalanx of big toe

•Innervation:

–Tibial nerve

•Action:

–distal phalanx √of big toe, plantar flexion, longitudinal arch

tibialis posterior

•Origin:

–tibia, interosseous membrane, fibula

•Insertion:

–Small tendinous slips pass to cuboid, cuneiforms and bases of second, third, and fourth metatarsals

•Innervation:

–Tibial nerve

•Action:

–Plantar flexion, inverts foot, medial longitudinal arch in foot

nerves in lower leg

Saphenous and Sural

• cutaneous supply

  (just for sensation not for muscle function)

Foot drop

•Lesion of the peroneal (fibular) nerve (common or deep)

Fractured fibula, Knee injury

Shin splints

Tibialis Anterior pain

•Connection with bone becomes inflamed

•Poor stretching, running on hard surfaces

calcaneal tendon reflex

Triceps surae reflex

•Tests S1 and S2 nerve roots

1st metatarsal

large

supports weight of the body

sesamoid bones

•Additional bones of the great toe

•On plantar surface of 1st metatarsal

what are the Arches purpose

•Distribute weight over the surface of the foot

•Shock absorbers

•Propellers

types of arches

longitudinal arches

transverse arch

extensor digitorum brevis

•Origin:

•Calcaneus

•Insertion:

•Proximal phalanx of great toe and digits 2, 3, and 4

•Innervation:

•Deep peroneal nerve

•Action:

/ toes

extensor hallucis brevis

•Origin: calcaneus

•Insertion: proximal phalanx of the 1st toe

•Innervation: deep fibular n.

•Action: aids extensor halluces longus in 1st toe

Plantar fasciitis

Overuse of the plantar fascia

Caused by: Inappropriate footwear

Most painful during rest

platar reflex

•L4, L5, S1, S2

•To test: Stroke the lateral aspect of the foot

normal plantar reflex

•Normal response = toe flexion

abnormal platar reflex

•Abnormal response =fanning of the 2nd-5th toes, dorsiflexion of 1st toe

Sign of brain injury or cerebral disease

pes planus

Flat feet (lack of medial arch)

• okay if before 3 years old

club foot

•A foot that is twisted out of position

ALL are congenital (present at birth)

• Difficulty walking, pain, tightness on medial and posterior areas of foot