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Knee (Tibiofemoral) Joint and Foot

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Presentation on theme: "Knee (Tibiofemoral) Joint and Foot"— Presentation transcript:

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

2

3 Right Tibia and Fibula

4 Knee Ligaments

5 Knee Ligaments

6 Knee Ligaments

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 Plantar Fasciitis Treatment
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

41 Exercises for Plantar Fasciitis

42 Surface Anatomy

43 Surface Anatomy

44


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