Kinesiology Module IV

Overall, the lower extremity does what for dynamic and static activities?

Supports the HAT segment of the body

What are some basic properties of the hip as described in the module?

Base joint for LE
Proximal stability
Weight bearing function

What are some basic properties of the knee as described in the module?

Force Transmission
Shortens swing limb for gait
Shock absorption

What are some basic properties of the anke/foot as described in the module?

Accommodates variety of surfaces / activities
Rigid lever vs mobile adapter for gait
Manages weight bearing forces

The hip has motion in what plane(s)?

Sagittal, Frontal and Transverse

What motions occur at the hip joint?

flexion/extension, abduction/adduction, internal/external rotation

What is the typical ROM for flexion of the hip joint?

120 degrees

What is the typical ROM for extension of the hip joint?

20 degrees

What is the typical ROM for abduction of the hip joint?

40 degrees

What is the typical ROM for adduction of the hip joint?

20 degrees

What is the typical ROM for internal and external rotation of the hip joint?

45 degrees

The tibiofemoral joint has motion in what plane(s)

Sagittal

What is the typical ROM for flexion of the tibiofemoral joint?

130-150 degrees

What is the typical ROM for extension of the tibiofemoral joint?

5-10 degrees past zero/neutral

What segment of the leg is moving during an open chain movement involving the tibiofemoral joint?

tibia

What segment of the leg is moving during a closed chain movement involving the tibiofemoral joint?

femur

How many degrees of external rotation are needed to "lock" the knee in full extension?

10 degrees

What is the concept called that locks the knee into full extension?

screw-home mechanism

True or False: There is NO motion available around superior/inferior axis at the tibiofemoral joint.

FALSE, there is motion available; HOWEVER, it is NOT a voluntary motion

The freedom of axial motion is increased at the tibiofemoral joint around the superior/inferior axis when

There is an increase in knee flexion. Little axial motion occurs in full extension

The patellofemoral joint functions as

a "Spacer" that increases the moment arm of the quads and a "pulley" for knee extension

Although the moment arm will vary through ROM at the knee, the greatest moment arm is found between

20-60 degrees of knee flexion

The patellofemoral joint attaches to

Patellar tendon (Distally)
Quadriceps tendon (proximally)

True or False. The patellofemoral tendon transmits forces for knee extension

True

True or False. As flexion becomes greater at the knee, the moment arm becomes shorter

True

What are the major joints of the foot and ankle?

Talocrural, subtalar, transverse tarsal

What are the osteokinematics for the talocrural joint in the sagittal plane?

Dorsiflexion and plantarflexion

What are the osteokinematics for the subtalar joint in the frontal plane?

Inversion and Eversion

During inversion

the calcaneus tilts medially relative to midline/tibia

During eversion

the calcaneus tilts laterally relative to midline/tibia

What are the osteokinematics for the subtalar joint in the transverse plane?

Adduction (forefoot moves medially)
Abduction (forefoot moves laterally)

Pronation and supination of the foot include

a combination of joint motions due to an oblique axis

Supination is a combination of

adduction and inversion

Pronation is a combination of

abduction and eversion

True or false: The subtalar joint rotates the transverse tarsal joints into different positions

True

The transverse tarsal joint includes what two anatomic joints?

Talonavicular and Calcaneocuboid

The transverse tarsal joint can function

in the same or opposite direction as subtalar joint

True or False: The transverse tarsal joint accomplishes work of mobility of the foot and ankle

True

What are the osteokinematics of the Tarsometatarsal Joints?

Primarily plantarflexion and dorsiflexion

The greatest range of plantarflexion and dorsiflexion is found at the

1st 4th and 5th digits

The least amount of plantarflexion and dorsiflexion is found at the

2nd and 3rd digits

What are the osteokinematics of the Metatarsal-phalangeal joints?

Flexion and Extension
Abduction and Adduction

The 1st MTP has how many degrees of extension?

85 degrees

The 2nd-5th MTPs have how many degrees of extension?

65 degrees

What is the standard motion and axis of the subtalar joint?

Inversion and Eversion around the AP axis

What is the deviation of the subtalar joint axis?

The anterior side of the axis is deviated superiorly

What is the outcome of the anterior side of the subtalar joint axis being deviated superiorly?

This adds abduction to eversion of the foot and adduction to inversion of the foot

Alignment of the lower extremity involves

Feet directly under hip joint giving stable base for upright posture and dynamic function

Are the hip, knee, and ankle joints in line with each other?

No

True or False: There is a difference in anterior coverage compared to posterior coverage of the femoral head

True

What are the two static alignment angles used to describe coverage of the femoral head?

Acetabular anteversion angle
Center-edge angle

What angle described the extent that the acetabulum projects anteriorly relative to the femoral head in the transverse plane?

Acetabular Anteversion Angle

An increased acetabular anteversion angle means \_____ coverage of the femoral head

Less

If the angle of the acetabular anteversion is greater than normal range (~20 degrees), then...

the femoral head is more prone to dislocation

What angle describes the extent the acetabulum projects laterally/superiorly relative to the femoral head in the frontal plane?

Center-edge angle

A decreased center-edge angle does what?

Can reduce the contact area of the femoral head and acetabulum up to 35%

Both the Acetabular Anteversion Angle and Center-Edge angle

Can alter the stability of the joint and change the contact area of articular surfaces

What is the Angle of Inclination?

Frontal plane angle between the neck and medial side of the femoral shaft

What is the typical degree measurement of the Angle of Inclination

125 degrees

Coxa Valga can be described as

Angle of Inclination value markedly greater than 125 degrees

Coxa Vara can be described as

Angle of Inclination value markedly less than 125 degrees

What is a result of Coxa Valga?

Brings force of weight vector closer to femoral shaft

What is a result of Coxa Vara?

Increases stability and superior coverage of the femoral head

Describe the Femoral Torsion Angle

Transverse plane angle between the femoral head and neck, relative to a line through the femoral condyles

What are the typical measurements of femoral torsion?

-10-20 degrees of anteversion
-Females (18 deg) slightly greater than males (15 deg)

What is the typical femoral torsion of a newborn?

30-40 degrees

Approximately how much does femoral torsion decrease per year until skeletal maturity?

1.5 degrees

Describe "increased anteversion"

When the angle of femoral torsion is greater than 15-20 degrees

Describe "Retroversion"

When the angle of femoral torsion is less than 15-20 degrees

What is joint stability of the Tibiofemoral joint primarily due to?

passive restraints, NOT bony congruence

Describe the Tibiofemoral Joint Alignment

Frontal plane alignment of the long axis of femur and long axis of tibia

What are the typical values of Tibiofemoral Joint Alignment?

170-175 degrees knee valgus. You may also see this reported as 5-10 degrees

The femoral angle of inclination

orients the femur more medially

True or False. The lateral femoral condyle is more distal than the medial femoral condyle

FALSE. The medial femoral condyle is more distal.

Because the medial femoral condyle is more distal than its lateral counterpart..

it allows for an almost horizontal mechanical joint axis

Increased knee (genu) valgus is described by values...

less than 165 degrees

Decreased valgus "genu varum" is described by values...

greater than 180 degrees

What is another name for excessive genu valgum?

knock-knee

What is another name for genu varum?

bow legged

True or False. Typical development will include times of genu varum, increased genu valgum and then typical alignment

True

Tibial torsion is measured by

foot-thigh angle

Describe tibial torsion

Transverse plane angle between long axis of thigh and long axis of the foot (At 2nd toe)

What are typical values for tibial torsion?

About 15 degrees of external rotation

What are the major joints of the foot and ankle?

talocrural, subtalar, transverse tarsal

What bone is involved in all 3 major joints of the foot and ankle?

Talus

True or False. There is no direct muscle attachment to the talus

True

What are the two major arches of the foot?

Longitudinal Arch and Transverse Arch

What is the "keystone" for the longitudinal arch of the foot?

Talus

What is the "keystone" for the transverse arch of the foot?

Middle Cuneiform

Why do we have arches in our feet?

Because of wedge shaped bone structures and an inclination of the calcaneus and 1st metatarsal

The longitudinal arch has an additional clinical focus on what side of the foot?

Medial

What type of support is primarily found in the longitudinal arch?

Passive support from the plantar fascia along with thick longitudinal and transverse bands.

Plantar fascia is stretched via what osteokinematic movement?

Toe extension

True or False. A healthy foot can rely on passive support with little muscle activity needed.

True

What is the shape of the trochlea of the talus?

Convex

True or False. There is multiple points of bony and capsule contact in the distal tibiofibular joint

False, there is NO bony contact or capsule

What will affect the alignment of the axis of rotation of the ankle?

Joint morphology

On what side of the talus wider?

the Anterior portion, the lateral facet is also wider than the medial facet

What are the 3 articulating facet surfaces of the subtalar joint?

posterior, anterior, medial

The subtalar joint helps to

minimize rotation from above segments