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Knee (Tibiofemoral) Joint and Foot By: Chandie, Christina, Ed & Sharon.

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Presentation on theme: "Knee (Tibiofemoral) Joint and Foot By: Chandie, Christina, Ed & Sharon."— Presentation transcript:

1 Knee (Tibiofemoral) Joint and Foot By: Chandie, Christina, Ed & Sharon

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3 Right Tibia and Fibula

4 Knee Ligaments

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7 Bursae Suprapatellar bursa Prepatellar bursa Deep infrapatellar bursa Subcutaneous infrapatellar bursa

8 Bursae

9 Lateral and Medial Meniscus Medial meniscus is more “c”-shaped and larger Lateral meniscus is more circular and smaller Purpose – Act as cushions – Conforms to the shape of the articulating surfaces as the femur changes position – Provides lateral stability to the knee joint

10 Lateral and Medial Meniscus

11 Knee Muscles - Quadriceps Rectus femoris – Origin: Anterior inferior iliac spine – Insertion: Tibial tuberosity – Action: Hip flexion, knee extension – Innervation: Femoral nerve – Vascular Supply: Lateral circumflex femoral artery

12 Knee Muscles - Quadriceps Vastus lateralis – Origin: Linea aspera – Insertion: Tibial tuberosity via patellar tendon – Action: Knee extension – Innervation: Femoral nerve – Vascular Supply: Lateral circumflex femoral artery

13 Knee Muscles – Quadriceps Vastus intermedialis – Origin: Anterior femur – Insertion: Tibial tuberosity via patellar tendon – Action: Knee extension – Innervation: Femoral nerve – Vascular Supply: Lateral circumflex femoral artery

14 Knee Muscles - Quadriceps Vastus medialis – Origin: Linea aspera – Insertion: Tibial tuberosity via patellar tendon – Action: Knee extension – Innervation: Femoral nerve – Vascular Supply: Lateral circumflex femoral artery

15 Knee Muscles - Hamstrings Biceps femoris – Origin: Long Head- ischial tuberosity; Short Head- Lateral lip of linea aspera – Insertion: Fibular head – Action: Long head- extend hip and flex knee Short head- flex knee – Innervation: Long head- sciatic nerve; Short head- common peroneal nerve – Vascular Supply: Inferior gluteal artery

16 Knee Muscles - Hamstrings Semimembranosus – Origin: Ischial tuberosity – Insertion: Posterior surface of medial condyle of tibia – Action: Extend hip and flex knee – Innervation: Sciatic nerve – Vascular Supply: Inferior gluteal artery

17 Knee Muscles – Hamstrings Semitendinosus – Origin: Ischial tuberosity – Insertion: Anteromedial surface of proximal tibia – Action: Extend hip and flex knee – Innervation: Sciatic nerve – Vascular Supply: Deep femoral artery

18 Knee Muscles Popliteus – Origin: Lateral condyle of femur – Insertion: Posteriorly on medial condyle of tibia – Action: Initiates knee flexion – Innervation: Tibial nerve – Vascular Supply: Popliteal artery

19 Clinical Concerns: Torn ACL Purpose of ACL – Prevents anterior translation of the tibia (the tibia moving forward on the femur) – Help maintain alignment of femoral and tibial condyles Tears can occur due to hyperextension of the knee or excessive inward rotation Can be due to outside force or non-contact injury Hear a pop when ACL tears – not all cases A tear in one of the meniscus is common with ACL tears

20 Diagnosis and Treatment of ACL Tears Diagnosis of ACL tears – MRI (magnetic resonance imaging) – X-rays, manual stress tests Surgical Treatment – Arthroscopic ACL reconstruction – Typically patellar tendon or hamstring grafts – Immobilization brace

21 Post-Surgery Treatment First 2 weeks Post-Op – Non-weight bearing – Minimize swelling and regain ROM Quad sets, straight leg raise, heel slides, knee extensions, CPM machine 2-6 weeks Post-Op – ROM: continue knee extension and start increasing knee flexion – Exercises: Stationary bike, weight bearing exercises After 6 weeks Post-Op – Increase strength – No longer need immobilization brace

22 Post-Surgery Treatment Conservative and Accelerated rehab protocols – Weight-bearing, ROM, strengthening, agility and brace use vary between the two methods Custom ACL braces available for physically active or at-risk patients

23 Tarsal Bones BONES OF THE FOOT

24 Ligaments: Lower Leg and Foot

25 Ankle and Foot Muscles Gastrocnemius – Origin: Medial & lateral condyles of femur – Insertion: Posterior calcaneus – Action: Knee flexion, ankle plantar flexion – Innervation: Tibial nerve – Vascular supply: Popliteal artery

26 Ankle and Foot Muscles Soleus – Origin: Posterior tibia and fibula – Insertion: Posterior calcaneus – Action: Ankle plantarflexion – Innervation: Tibial nerve – Vascular supply: Posterior tibial artery

27 Ankle and Foot Muscles Extensor digitorum longus – Origin: Fibula, interosseous membrane, tibia – Insertion: Distal phalanx of four lesser toes – Action: Extends four lesser toes, assists in ankle dorsiflexion – Innervation: Deep peroneal nerve – Vascular supply: Anterior tibial artery

28 Ankle and Foot Muscles Extensor hallucis longus – Origin: Fibula and interosseous membrane – Insertion: Distal phalanx of great toe – Action: Extends first toe; assists in ankle inversion and dorsiflexion – Innervation: Deep peroneal nerve – Vascular supply: Anterior tibial artery

29 Ankle and Foot Muscles Plantaris – Origin: Posterior lateral condyle of femur – Insertion: Posterior calcaneus – Action: Very weak assist in knee flexion; ankle plantar flexion – Innervation: Tibial nerve – Vascular Supply: Popliteal artery

30 Ankle and Foot Muscles Tibialis anterior – Origin: Lateral tibia and interosseous membrane – Insertion: First cuneiform and metatarsal – Action: Ankle inversion and dorsiflexion – Innervation: Deep peroneal nerve – Vascular Supply: Anterior tibial artery

31 Ankle and Foot Muscles Tibialis posterior – Origin: Interosseous membrane, adjacent tibia and fibula – Insertion: Navicular and most tarsals and metatarsals – Action: Ankle inversion; assists plantar flexion – Innervation: Tibial nerve – Vascular Supply: Fibular artery

32 Ankle and Foot Muscles Flexor hallucis longus – Origin: Posterior fibula and interosseous membrane – Insertion: Distal phalanx of the great toe – Action: Flexes great toe; assists in inversion and plantar flexion of the ankle – Innervation: Tibial nerve – Vascular Supply: Fibular artery

33 Ankle and Foot Muscles Flexor digitorum longus – Origin: Posterior tibia – Insertion: Distal phalanx of four lesser toes – Action: Flexes the four lesser toes; assists ankle inversion and plantar flexion – Innervation: Tibial nerve – Vascular Supply: Posterior tibial artery

34 Ankle and Foot Muscles Tibialis posterior Flexor digitorum longus Flexor hallucis longus “Tom, Dick & Harry

35 Ankle and Foot Muscles Peroneus longus – Origin: Lateral proximal fibula and interosseous membrane – Insertion: Plantar surface of first cuneiform and metatarsal – Action: Ankle eversion; assists ankle plantar flexion – Innervation: Superficial peroneal nerve – Vascular Supply: Fibular artery

36 Ankle and Foot Muscles Peroneus brevis – Origin: Lateral distal fibula – Insertion: Base of the fifth metatarsal – Action: Ankle eversion; assists plantar flexion – Innervation: Superficial peroneal nerve – Vascular Supply: Fibular artery

37 Ankle and Foot Muscles Peroneus tertius – Origin: Distal medial fibula – Insertion: Base of the fifth metatarsal – Action: Assists somewhat in ankle eversion and dorsiflexion – Innervation: Deep peroneal nerve – Vascular Supply: Anterior tibial artery

38 Clinical Concerns: Plantar Fasciitis Plantar fascia – fibrous band that runs from the calcaneus to the base of the toes Plantar Fasciitis – Inflammation of the plantar fascia – Causes heel pain and can make walking difficult Risk Factors: – Foot arch problems (flat feet and high arches) – Running – Obesity – Tight Achilles tendon

39 Plantar Fasciitis Signs and Symptoms – Sharp pain inside portion of heel – Heel pain that is worse first few steps after awakening, climbing stairs, after long periods of standing – Pain after exercise but not usually during – Mild swelling in heel

40 Apply ice – ice pack or ice massage Arch supports or orthotics Night splints Stretches for plantar fascia and Achilles tendon Strengthening for lower leg muscles Plantar Fasciitis Treatment

41 Exercises for Plantar Fasciitis

42 Surface Anatomy

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44 www.rad.washington.edu/atlas2/extdiglong. html www.rad.washington.edu/atlas2/extdiglong. html


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