lower leg and ankle- applied kinesiology

what is a complex arrangement of 26 bones and 34 joints?

the lower leg and ankle

what is the function of the lower leg?

functions as both as a mobile adaptor and as a rigid lever

• within 1 second

what is the most common orthopedic injuries sustained?

ankle injuries

what are the bones of the lower leg?

• tibia

• fibula

which contains the medial malleoli?

tibia

which contains the lateral malleoli?

fibula, it is longer and projects further than medial

which of the lower leg is the major weight bearing bone?

tibia

how much weight does the fibula bear?

about 10% of body weight

what are the tarsal bones?

• cuneiforms

• cuboid

• navicular

• calcaneus

• talus

*go in shape of a C and start with C

how many cuneiforms are there?

1. medial (1st)

2. intermediate (2nd)

3. lateral (3rd)

what are the landmarks of the tarsal bones?

• talus

• calcaneus

• navicular tuberosity

does the talus have any muscular attachments?

no muscular attachments, but has ligaments

what is the talus composed of?

• head

• neck

• body

what is the calcaneus?

longest and strongest tarsal bone

what is an important landmark of the calcaneus?

sustentaculum tali

what is the sustentaculum tali?

shelf of calcaneus where tali sits on

what is the navicular tuberosity?

attachment sites for tibialis posterior

what happens if you're flat footed?

basically walking on navicular tuberosity

what are the bones of the foot?

• metatarsals

• phalanges

what do the metatarsals look like?

what are the landmarks of the metatarsals?

• base

• shaft

• head

what is the styloid process of the 5th metatarsal?

insertion site for peroneus brevis

how are the phalanges of the foot based on?

• distal

• middle

• proximal

what are the landmarks of the phalanges of the foot?

• base

• shaft

• head

what do the phalanges of the foot look like?

are there sesamoid bones at the foot?

yes, there are sesamoid bones at the foot

where can the sesamoid bone at the foot be found?

head of first metatarsal and lie in the tendons of the flexor hallucus brevis

can we fracture our sesamoid bones at the foot?

yes they can be fractured

what are the joints of the ankle complex?

• distal tibiofibular joint

• talocrural joint

• subtalar joint

what type of joint is the tibiofibular joint?

syndesmosis joint

what are the ligaments of the tibiofibular joint?

• anterior inferior tibiofibular (AITF)

• posterior inferior tibiofibular (PITF)

what is the talocrural joint?

known as the ankle joint

what can the talocrural joint also be classified as?

• mortise joint

• tibiotalar joint

• fibulotalar joint

what are the motions of the talocrural joint?

• plantar flexion

• dorsiflexion

how many DOF does the talocrural joint have?

1 DOF

what are the lateral ligaments of the talocrural joint?

• anterior talofibular (ATF)

• posterior talofibular (PTF)

• calcaneofibular (CF)

which ligament of the talocrural joint will be the 1st to be injured in an ankle sprain?

anterior talofibular (ATF)

which ligament of the talocrural joint will be 2nd to be injured in an ankle sprain?

calcaneofibular (CF)

what does a grade 3 ankle sprain mean?

DOESNT mean you have tore all 3

what are the medial ligaments of the deltoid ligament?

• anterior tibiotalar

• tibionavicular

• tibiocalcaneal

• posterior tibiotalar

what is the deltoid ligament?

what does the deltoid ligament do?

restrict eversion

where do we have more ankle injuries?

more ankle injuries laterally than medial

what is the subtalar joint?

below talis

what are the 3 articulations of the subtalar joint?

• anterior

• middle

• posterior

what are the motions of the subtalar joint?

• inversion

• eversion

• rotation

what is the sinus tarsi?

small bony cancel that separates anterior to posterior articulations

when we sprain our ankle, where does the swelling go?

sinus tarsi

what are the ligaments of the subtalar joint?

• interosseous ligament

• cervical ligament

what does the interosseous ligament of the subtalar joint do?

end range inversion

what does the cervical ligament of the subtalar joint do?

end range eversion

what are the joints of the foot?

• interphalangeal joints

  (DIP, PIP)

• metatarsophalangeal joints

• intermetatarsal joints

what are the other joints of the foot?

• intermetatarsal joints

• tarsometatarsal joints

  (lisfranc joint)

• intertarsal joints

where is the tarsometatarsal joints of the foot?

they form transverse metatarsal arch

what does the intertarsal joints look like?

“s” shaped, start from talonavicular joint to the calcaneocuboid joint

what do the 1,3,4,5th metatarsals do?

they all rotate around the stable 2nd metatarsal

which metatarsal joint is the most stable?

2nd is the most stable joint

what is the lisfranc joint?

medial cuneiform to base of 2nd metatarsal

what are the intertarsal ligaments?

• spring ligament

• short plantar ligament

• long plantar ligament

• bifurcate ligament

what is the bifurcate ligament?

supports transverse tarsal metatarsal joint

what are the movements of the bifurcate ligament?

• eversion

• inversion

what is plantar fascia?

plantar aponeurosis

plantar fascia

O: medial tubercle of calcaneus

what does the plantar fascia look like?

will band out and bands out to base of toes

what are the arches of the foot?

• medial longitudinal arch

• lateral longitudinal arch

• transverse tarsal arch

• transverse metatarsal arch

which arch of the foot is the longest and highest?

medial longitudinal arch

in what plane does dorsiflexion and plantar flexion occur?

sagittal plane

in what plane does inversion and eversion of the foot occur?

frontal plane

in what plane does abduction and adduction of the foot occur?

transverse plane

how many DOF does the foot have of pronation and supination?

1 DOF

what are the motions of pronation of the foot?

• everesion

• abduction

• dorsiflexion

what are the motions of supination of the foot?

• inversion

• adduction

• plantaflexion

motion of pronation and supination occurs in how many planes?

occurs in 3 planes

how many extrinsic muscles are there of the foot?

12

how many compartments of the extrinsic muscles are there?

4 well defined compartments

what are the 4 muscular compartments?

• anterior

• lateral

• deep posterior

• superficial posterior

what are the muscular compartments separated by?

intramuscular septa

what muscles are on the anterior compartment?

• anterior tibialis

• extensor hallucis long

• extensor digitorum long

• peroneus tertius

what nerves are on the anterior compartment?

• deep peroneal nerve

• anterior tibial artery

what does the tibialis anterior look like?

tibialis anterior

O: lateral condyle of tibia and prox ½ of lateral tibia

I: 1st cuneiform and base of 1st metatarsal

A: ankle dorsiflexion and inversion

N: deep peroneal

tibialis anterior origin?

lateral condyle of tibia and prox ½ of lateral tibia

tibialis anterior insertion?

1st cuneiform and base of 1st metatarsal

tibialis anterior action?

ankle dorsiflexion and inversion

tibialis anterior nerve?

deep peroneal nerve

what does the extensor digitorum longus look like?

extensor digitorum longus

O: lateral condyle of tibia, proximal fibula

I: bases of the middle and distal phalanges of 4 lesser toes

A: dorsiflexion, eversion, extension of toes

N: deep peroneal

extensor digitorum longus origin?

lateral condyle of tibia, proximal fibula

extensor digitorum longus insertion?

bases of middle and distal phalanges of 4 lesser toes

extensor digitorum longus action?

dorsiflexion, eversion, extension of toes

extensor digitorum longus nerve?

deep peroneal nerve

what does the extensor hallucis Longus look like?

extensor hallucis longus

O: middle 1/3 of fibula

I: base of distal phalanx of great toe

A: dorsiflexion, inversion, extension of great toe

N: deep peroneal

extensor hallicus Longus origin?

middle 1/3 of fibula

extensor hallicus Longus insertion?

base of distal phalanx of great toe

extensor hallicus longus action?

dorsiflexion, inversion, extension of great toe

extensor hallicus Longus nerve?

deep peroneal nerve

what does the peroneus Tertius look like?

peroneus Tertius

O: distal 1/3 of fibula

I: dorsal aspect of base of 5th metatarsal

A: dorsiflexion and eversion

N: deep peroneal

peroneus Tertius origin?

distal 1/3 of fibula