Knee (Tibiofemoral) Joint and Foot

1
Knee (Tibiofemoral) Jointand Foot

• By Chandie, Christina, Ed Sharon

2
(No Transcript)
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

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