1. Joints of the Lower Limb
The Dance Hall by Vincent van Gogh ,1888
Kaan Yücel M.D., Ph.D
5.February.2014 Wednesday

2. JOINTS OF LOWER LIMB Hip joint Knee joint Tibiofibular joints
Articulations of the pelvic girdle
Lumbosacral joints, sacroiliac joints & pubic symphysis
The remaining joints of the lower limb
Hip joint
Knee joint
Tibiofibular joints
Ankle joint
Foot joints
JOINTS OF LOWER LIMB

3. Feature 1: Connection between lower limb & pelvic girdle
Feature 2: 2nd most movable after the shoulder joint
Synovial Joint Type: Ball and socket (Head of the femur & acetabulum)
Weight transfer: To the heads and necks of the femurs

4. Ligaments
Transverse acetabular ligament continuation of acetabular labrum
3 intrinsic ligaments
Iliofemoral ligament anteriorly and superiorly , strongest ligament of the body
Pubofemoral ligament anteriorly and inferiorly
Ischiofemoral ligament posteriorly –weakest of the 3
Ligament of the head of the femur

5. Ligaments Iliofemoral ligament Y-shaped
From Ant. Inf. Iliac Spine &Acetabular rim To Intertrochanteric line
prevents hyperextension of the hip joint during standing by screwing the femoral head into the acetabulum
Pubofemoral ligament obturator crest of pubic bone
blends with the medial part of the iliofemoral ligament
tightens during both extension and abduction
prevents overabduction of the hip joint

6. Ligaments Ischiofemoral ligament
from the ischial part of the acetabular rim
spirals around the femoral neck, medial to the base of the greater trochanter.

7. Ligaments
The ligaments and periarticular muscles (the medial and lateral rotators of the thigh) play a vital role in maintaining the structural integrity of the joint.

8. Ligament of the head of the femur
Ligaments
Ligament of the head of the femur
primarily a synovial fold conducting a blood vessel
weak and of little importance in strengthening the hip joint.
wide end attaches to the margins of the acetabular notch and the transverse acetabular ligament
narrow end attaches to the fovea for the ligament of the head.

9. MOVEMENTS OF HIP JOINT Flexion-extension Abduction-adduction
Medial-lateral rotation
Circumduction

10. MOVEMENTS OF HIP JOINT
During extension of the hip joint, the fibrous layer of the joint capsule, especially the iliofemoral ligament, is tense.
The hip can usually be extended only slightly beyond the vertical except by movement of the bony pelvis (flexion of lumbar vertebrae).

11. MOVEMENTS OF HIP JOINT
From the anatomical position, the range of abduction of the hip joint is usually greater than for adduction.
About 60° of abduction is possible when the thigh is extended, and more when it is flexed.
Lateral rotation is much more powerful than medial rotation.

12. KNEE JOINT 2 femorotibial articulations (lateral and medial)
Feature 1: Largest & most superficial joint
Feature 2: Hinge movements (Ext/Flex) combined with gliding & rotation
Synovial Joint Type: Hinge
2 femorotibial articulations (lateral and medial)
between lateral & medial femoral and tibial condyles
1 intermediate femoropatellar articulation
between patella & femur
No fibula involvment in the knee joint

13. Extracapsular ligaments
Patellar ligament
Fibular (Lateral) collateral ligament
Tibial (Medial) collateral ligament
Oblique popliteal ligament
Arcuate popliteal ligament

21. INTRA-ARTICULAR LIGAMENTS
Cruciate ligaments & menisci
Anterior cruciate ligament (ACL)
Posterior cruciate ligament (PCL)

23. Start: anterior intercondylar area of tibia
just posterior to the attachment of the medial meniscus
End: Medial side of the lateral condyle of the femurr
Start: Posterior intercondylar area of tibia
End: Lateral surface of the medial condyle of femur

24. Limits posterior rolling (turning and traveling) of the femoral condyles on the tibial plateau during flexion.
Prevents posterior displacement of the femur on the tibia and hyperextension of the knee joint.

25. Llimits anterior rolling of the femur on the tibial plateau during extension.
Prevents anterior displacement of the femur on the tibia or posterior displacement of the tibia on the femur and helps
prevent hyperflexion of the knee joint.

26. In the weight-bearing flexed knee, Posterior Cruciate Ligament
the main stabilizing factor for the femur (e.g., when walking downhill).

28. Menisci of the knee joint are crescentic plates of fibrocartilage on the articular surface of the tibia that deepen the surface and play a role in shock absorption.

30. MOVEMENTS OF KNEE JOINT
Flexion and extension are the main knee movements; some rotation occurs when the knee is flexed.
When the knee is fully extended with the foot on the ground, the knee passively “locks” because of medial rotation of the femoral condyles on the tibial plateau (the “screw-home mechanism”). This position makes the lower limb a solid column and more adapted for weight-bearing.

31. BURSAE AROUND KNEE JOINT
There are at least 12 bursae around the knee joint because most tendons run parallel to the bones and pull lengthwise across the joint during knee movements.
The subcutaneous prepatellar and infrapatellar bursae are located at the convex surface of the joint, allowing the skin to be able to move freely during movements of the knee.
The large suprapatellar bursa is especially important because an infection in it may spread to the knee joint cavity.

33. TIBIOFIBULAR JOINTS (Superior) Tibiofibular joint
Syndesmosis (inferior tibiofibular) joint
In addition, an interosseous membrane joins the shafts of the two bones.

34. TIBIOFIBULAR JOINTS (Superior) Tibiofibular joint
Syndesmosis (inferior tibiofibular) joint
In addition, an interosseous membrane joins the shafts of the two bones.

36. Syndesmosis (inferior tibiofibular) joint stability of the ankle joint
keeps the lateral malleolus firmly against the lateral surface of the talus
interosseous tibiofibular ligament
anterior and posterior tibiofibular ligaments

37. LIGAMENTS OF ANKLE JOINT
Talocrural joint
Distal ends of the tibia & fibula & superior parts of the talus
Synovial Joint Type: Hinge
LIGAMENTS OF ANKLE JOINT
Lateral ligament of the ankle
Medial ligament of the ankle (deltoid ligament)

38. anterior talofibular ligament flat, weak band
Lateral ligament of the ankle
anterior talofibular ligament
flat, weak band
extends from lateral malleolus to neck of talus
posterior talofibular ligament
calcaneofibular ligament
round cord
passes from tip of lateral malleolus to lateral surface of calcaneus
thick, strong band
runs posteriorly from malleolar fossa to lateral tubercle of talus

39. strong and triangular in shape
ANKLE JOINT
Medial (Deltoid) ligament of the ankle
strong and triangular in shape
apex attached above to medial malleolus
broad base attached below to a line extends from the tuberosity of the navicular bone in front to medial tubercle of talus behind.

40. strong and triangular in shape
ANKLE JOINT
Medial (Deltoid) ligament of the ankle
strong and triangular in shape
tibionavicular part
tibiocalcaneal part
posterior tibiotalar part
anterior tibiotalar part

42. FOOT JOINTS
The major joints at which movements occur
Subtalar
Talocalcaneonavicular
Calcaneocuboid joints
Intertarsal joints between the cuneiforms and between the cuneiforms and the navicular allow only limited movement.
Transverse tarsal joint

43. Inversion and eversion of the foot are the main movements
FOOT JOINTS
Subtalar (talocalcaneal) joint
Transverse tarsal joint (calcaneocuboid and talonavicular joints)
Inversion and eversion of the foot are the main movements

44. SUBTALAR JOINT between
posterior calcaneal facet on inferior surface of talus
corresponding posterior talar facet on superior surface of calcaneus

45. SUBTALAR JOINT
allows gliding and rotation, involved in inversion and eversion of the foot.

46. SUBTALAR JOINT
Lateral, medial, posterior, and interosseous talocalcaneal ligaments stabilize the joint.
Interosseous talocalcaneal ligament
Lies within the tarsal sinus.
Separates the subtalar and talocalcaneonavicular joints.
Especially strong.

47. SUBTALAR JOINT Orthopedic surgeons
anatomical subtalar joint + talocalcaneal part of talocalcaneonavicular joint
The subtalar joint (by either definition) is where the majority of inversion and eversion occurs, around an axis that is oblique.

48. TRANSVERSE TARSAL JOINT
compound joint formed by two separate joints aligned transversely:
Talocalcaneonavicular
Calcaneocuboid joints

49. TRANSVERSE TARSAL JOINT
At this joint, the midfoot and forefoot rotate as a unit on the hindfoot around a longitudinal (AP) axis, augmenting the inversion and eversion movements occurring at the clinical subtalar joint.
Transection across the transverse tarsal joint
a standard method for surgical amputation of the foot

50. TALOCALCANEONAVICULAR JOINT
complex joint
head of the talus articulates with
calcaneus
plantar calcaneonavicular ligament
(spring ligament) below
navicular in front.

51. TALOCALCANEONAVICULAR JOINT
allows gliding and rotation movements, which together with similar movements of the subtalar joint are involved with inversion and eversion of the foot.

52. TALOCALCANEONAVICULAR JOINT
Capsule reinforced
posteriorly by interosseous talocalcaneal ligament
superiorly by talonavicular ligament
inferiorly by plantar calcaneonavicular ligament (spring ligament)

53. TALOCALCANEONAVICULAR JOINT
Lateral part reinforced
calcaneonavicular part of the bifurcate ligament
a Y-shaped ligament superior to the joint
Base attached to anterior aspect of superior surface of calcaneus
Arms attached to:
dorsomedial surface of the cuboid (calcaneocuboid ligament)
dorsolateral part of the navicular (calcaneonavicular ligament).

54. CALCANEOCUBOID JOINT synovial joint between:
facet on the anterior surface of the calcaneus
corresponding facet on the posterior surface of the cuboid.

55. CALCANEOCUBOID JOINT
allows sliding and rotating movements involved with inversion and eversion of the foot.
reinforced by
bifurcate ligament
long plantar ligament
plantar calcaneocuboid ligament (short plantar ligament).

56. Short plantar ligament plantar calcaneocuboid ligament
Short, wide, and very strong
Connects calcaneal tubercle to the inferior surface of the cuboid.
Supports the calcaneocuboid joint
Assists the long plantar ligament in resisting depression of the lateral arch of the foot

57. Long plantar ligament Longest ligament in the sole of the foot.
Lies inferior to the plantar calcaneocuboid ligament.
Between calcaneus and cuboid bone (inferior surfaces)
More superficial fibers extend to the bases of the metatarsal bones.
Supports the calcaneocuboid joint.
Strongest ligament, resisting depression of lateral arch of the foot.

58. Metatarsophalangeal joints
Ellipsoid synovial joints between heads of metatarsals and bases of proximal phalanges.
Allow extension and flexion, and limited abduction, adduction, rotation, and circumduction.
Four deep transverse metatarsal ligaments link heads of metatarsals together and enable the metatarsals to act as a single unified structure.
Interphalangeal joints
Hinge joints
Reinforced by medial and lateral collateral ligaments and by plantar ligaments.

59. Tarsometatarsal joints
between metatarsal bones and adjacent tarsal bones
plane joints
limited sliding movements.
The range of movement of tarsometatarsal joint between metatarsal of great toe and medial cuneiform
greater than that of other tarsometatarsal joints
allows flexion, extension, and rotation.

60. MAJOR LIGAMENTS OF FOOT
Plantar calcaneonavicular ligament (spring ligament)
Long plantar ligament
Plantar calcaneocuboid ligament (short plantar ligament)

61. MAJOR LIGAMENTS OF FOOT
Plantar calcaneonavicular ligament (spring ligament)
Long plantar ligament
Plantar calcaneocuboid ligament (short plantar ligament)

62. FOOT JOINTS
In the foot, flexion and extension occur in the forefoot at the metatarsophalangeal and interphalangeal joints. Inversion is augmented by flexion of the toes (especially the great and 2nd toes), and eversion by their extension (especially of the lateral toes).

63. ARCHES OF FOOT
Spreading the weight

64. Longitudinal arch of the foot
ARCHES OF FOOT
Spreading the weight
Longitudinal arch of the foot
Medial longitudinal arch
Calcaneus, talus, navicular, 3 cuneiforms & 3 metatarsals.
higher and more important than the lateral longitudinal arch.
talar head keystone of the medial longitudinal arch.
Lateral longitudinal arch
much flatter, rests on ground during standing. Calcaneus, cuboid, and lateral two metatarsals. 2 3

65. Transverse arch of the foot
ARCHES OF FOOT
Spreading the weight
Transverse arch of the foot
Runs from side to side
Formed by cuboid, cuneiforms & bases of metatarsals