Knee and Ankle Exam

What are common forces that result in meniscus tears?

Occur due to significant compression and sheer forces during rotation while flexing or extending during quick directional changes in running.

Knee flexion

Bending or decreasing angle between femur and leg, characterized by heel moving toward buttocks

Knee extension

straightening or increasing angle between femur and leg

Knee external rotation

rotary movement of leg laterally away from midline

Knee internal rotation

rotary movement of lower leg laterally toward midline

Ligament stability ACL?

vital in maintaining anterior and posterior stability as well as rotary stability. Mechanism involves noncontact rotary forces associated with planting, cutting, hyperextension, or by violent quadriceps contraction which pulls tibia forward of femur

Ligament stability PCL?

Mechanisms of direct contact with an opponent or playing surface

Ligament stability MCL?

maintains medial stability by resting valgus forces or preventing knee from being abducted. Mechanism of teammate or opponent may fall against lateral aspect of knee or leg causing medial opening of knee joint and stress to medial ligamentous structures

What is Q angle?

Central line of pull for entire quadriceps runs from ASIS to the center of patella. Line of pull of patella tendons runs from center of patella to center of tibial tuberosity. Angle formed by the intersection of these two lines at the patella is the Q. Angle normally will be 15 degrees or less for males and 20 degrees or less for females.

Why do females have a higher Q angle?

due to wider pelvis

What activities do Q angles vary significantly in?

Planting and cutting

How do Q angles contribute to knee problems?

They can include lateral patellar sublaxation or dislocation, patellar compression syndrome, chondromalacia, and ligamentous injuries

What is important for people with high Q angles?

It is important to maintain high levels of strength and endurance in vastus medialis so as to counteract lateral pull of vastus lateralis

What are the hamstring muscles?

Strains are very common. “running muscles” function in acceleration. antagonists to quadricep muslces at knee. Posteriorly they are primarily knee flexion

What are the quadricep muscles?

Vital in jumping. Functions as a decelerator when decreasing speed to change direction and when coming down from a jump. Eccentric contraction during deceleration actions. Controls slowing of movements initiated in previous phases of the sports skill

What is strength and endurance for quadricep muscles?

Is essential for maintenance of patellofemoral stability. Often a problem (one side stronger). Are prone to atrophy when injuries occur. May be developed by resisted knee extension activities from a seated postion. Functional weight bearing activites such as step-ups or squats are particularly useful for strengthening and endurance

What type of muscle is the sartorius?

It is a two-joint muscle. Most effective when either origin or insertion is stabilized to prevent movement in direction of the contracting muscle. To a degree, muscles are able to exert greater force when lengthened than when shortened.

What happens to the sartorius when kicking?

Sartorius increases its total length and becomes a better flexor at knee when pelvis is rotated posteriorly and stabilized by the abdominal muscles. Exemplified by trying to flex knee and cross the legs in the sitting position. One usually leans backward to flex legs at knees. Football kicker invariably leans well backward to raise and fix the rectus femoris origin to make it more effective as a knee extensor. 

What is the stance phase of walking?

hell-strike, midstance, and toe-off

What is heel-strike?

occurs when landing on heel, foot should be in supination

What is midstance?

immediately follows with foot moving into pronation

What is toe-off?

follows midstance, foot returns to supination prior to and during push-off

What is the swing phase of walking?

occurs when foot leaves ground and leg moves forward to another point of contact

What is Achilles tendinitis?

It is an overuse injury that can cause stiffness and pain. It can result in swelling and thickening of the tendon.

What are the causes of Achilles tendinitis?

It can be caused by an increase in activity, such as running or training. Your footwear can cause it to flare up, tight calf muscles, and your age. As you get older, the tendon becomes less flexible and more susceptible.

How do you care for Achilles tendinitis?

Most of the time, it can be resolved at home. You can use the RICE method to help reduce inflammation and pain. There are anti-inflammatory drugs that you can use or supportive gear like walking boots. Some people use physical therapists to help with exercises to stretch it out. In extreme cases, people can get surgery if it persists for over 6 months. If not treated, it can lead to degeneration ot a complete tear. 

What are three exercises to help Achilles tendinitis?

Eccentric Heel Drops: Stand with your feet on the edge of a step with your heel hanging off. Raise up both of your feet, lift the unaffected foot, and slowly lower the affected foot. 

Towel Streth: Sit with legs straight and place a towel around the ball of your foot. Pull toward yourself to stretch the calf and tendon. 

Isometric Calf Holds: Stand facing a wall, rise onto the toes of your feet, and then shift your weight to the affected side to help reduce pain. 

Dorsiflexion of ankle, foot, and toes

movement of top of ankle and foot toward anterior tibia

Plantar flexion of ankle, foot, and toes

movement of ankle and foot away from tibia

Eversion of ankle, foot, and toes

turning ankle and foot outward, abduction, away from midline, weight is on medial edge of foot

Inversion of ankle, foot, and toes

Turning ankle and foot inward, adduction, toward midline, weight is on lateral edge of foot

Toe extension of ankle, foot, and toes

movement of toes away from plantar surface of foot

Pronation of ankle, foot, and toes

combination of ankle dorsiflexion, subtalar eversion, and forefoot abduction (toe-out)

Supination of ankle, foot, and toes

combination of ankle plantar flexion, subtalar inversion, and forefoo adduction (toe-in)

Plantar flexion muscles

fibularis longus, fibularis brevis

Dorsiflexion muscles

tibialis anterior, extensor digitorum longus

Inversion muscles

tibialis anterior, tibialis posterior

Eversion muscles

extensor digitorum longus, fibularis longus