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Skeletal System and Muscular System Considerations

3/26/2017

Margo Prim Haynes, PT, DPT, MA, PCS, C/NDTPlease do not reproduce without permission 1


Margo Prim Haynes, PT, DPT, MA, PCS, C/NDT

Ankle & Foot

Ankle & Foot Function

1. Absorb shock

2. Allow the lower extremity to conform to different surface

inclinations


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The foot is divided into 3

general regions:

Hindfoot

Lateral viewRight foot & ankle

Midfoot

Forefoot

Fibula

Tibia

65% of weight is on the hindfoot

tibiafibula

calcaneustalus

cuboidnavicularlateral, middle, &

medial cuneiforms

Metatarsals

Phalanges

26 bones in the foot

Skeletal system considerations

Bones of the foot:

• ossify as late as 4 yrs

• continue to grow thru teen years


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Subtalar jointtalus, calcaneus

Talocrural joint(ankle joint)

tibia, fibula, talus

Midtarsal jointcalcaneocuboid,

talonavicular

Tarsometatarsaljoints

Metatarsophalangealjoints

Talocrural joint: ankle jointtibia, fibula, talus

Movement: dorsiflexion, plantarflexion

Subtalar joint: talus, calcaneus

allows the foot to moveindependent of the leg

Movements:Inversion/eversion

Abduction/adduction

STJ helps maintain the arches of the foot: evaluate the foot in “subtalar neutral”.


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Midtarsal jointtalonavicular

calcaneocuboid Movement:Pronation

(mainly eversion)Supination

(mainly inversion)

Movement:Pronation (mainly abduction & dorsiflexion)

Supination (mainly adduction & plantarflexion)

Tarsometatarsaljoints

Movements:DorsiflexionPlantarflexionInversionEversion

Metatarsophalangeal Joints

(also called MP joints)Movements:Extension (Dorsiflexion)to 65°

Flexion (Plantarflexion) to40 °


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3 Arches in the Foot

Anterior Arch :

between the heads of the 1st and 5th

metatarsals


Lateral Arch:

between the head of the 5th metatarsal and lateral tubercle of calcaneous


Medial Longitudinal Arch:

between the head of the 1st metatarsal and the posteromedial tubercle of the calcaneus


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Ankle Dorsiflexors

Tibialis Anterior

Extensor digitorum longus

Extensor hallucis longus

Muscular system considerations

Ankle Plantarflexors

Gastrocnemius

Soleus


Ankle Evertors

Peroneals

Longus

Brevis

Ankle Invertors

Tibialis Posterior

Flexor digitorum longus

Flexor hallucis longus



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Skeletal system considerations

• A hinge joint…little boney stability

• Ligaments & muscles provide stability

• Always impacted above by hip alignment and below by ankle alignment

Anterior viewRight knee

Typical Changes in

Genu Varum & Genu Valgum

Birth: Lower limb positioned in varum

Age 6-months: minimal varus remains

Age 18-months: aligned vertical in frontal plane

Age 30 to 36-months: valgus reaches maximal degree

Age 4 to 6-years: limb is aligned vertical in frontal plane

After age 7-years: typically developing children do not show a change in degree of valgus/varus correction

Quadriceps

(Knee extensors)

rectus femoris

vastus medialis

vastus lateralis

vastus intermedialis


Anterior view right thigh

From: Novartis Interactive Atlas

Frank Netter artist

Rectus femoris:


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Hamstrings

Biceps femoris

Semitendinosus

Semi membranosus

Concept:

With a 2 joint muscle, tightness can be expressed at either end depending on

position of both joints

Hip & Pelvis


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Hip & Pelvis

1. Weight bearing

2. Movement of the hip joint

allows translation of the trunk unit through space

3. Pelvis is the base for the spine

Built for strength

Ball and socket joint

Acetabulum covers ½ the

head of the femur

Femur is:

longest bone in the body

¼ total height

strongest bone in the

body

Hip Structure:

Angle of Inclination

Angle between the:

•long axis &

•Neck

Typically 126° in

adults


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Hip/Pelvic

Musculature

Hip Flexors

Iliopsoas

Tensor facia latae

Rectus femoris

Sartorius

Anterior viewRight lower extremity

Concept: Free segment moves on the fixed segment

Movement of hip flexors:

Pelvis on Femur

or

Femur on pelvis

Hip/Pelvic Musculature

Hip Extensors

Gluteus maximus

Hamstrings

• biceps femoris

• semitendinosus

• semimembranosus

Adductor magnus(posterior head)

Posterior viewLeft lower extremity


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Hip Abductors

Gluteus medius

Gluteus minimus

Tensor fascia lataePosterior view

right lower extremity

Anterior viewright lower extremity

Concept: Muscle action may change depending on joint position

Gluteus medius

Gluteus minimus


Hip Adductors

Adductor brevis

Adductor longus

Adductor magnus

(both heads) Anterior viewright lower extremity


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Muscle action may

change depending on joint position

Adductor Longus

Anterior rightPelvis & femur

Posterior right femur

Hip/Pelvic

Musculature

Hip External Rotators

Gluteus maximus

Piriformis

Gemeilus superior

Obturator internus

Gemeilus inferior

Quadratus femoris

SartoriusPosterior view

Left lower extremity

Spine & Trunk


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Spine & Trunk

1. Connect the Upper body

Lower body

2. Position the head for interaction

3. Support and position UEs for

purposeful function

Points of transition – Spine

C7

T1

T7, T8 Point of

counter-rotation in the Thoracic spine


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“True Ribs”

Ribs 1-7

“False Ribs”

Ribs 8-10

attached to cartilage

Ribs 11, 12

free floating

Diaphragm:

Lowest 4 ribs

Lowest 6 costal cartilages

Role of Trunk Muscles

Rectus

abdominus

External

Obliques

Internal

Obliques

Transverse

abdominusRectus

Abdominus

External Oblique Internal Oblique

Role of Trunk Muscles

Rectus: Brings rib cage and sternum down = flexion in

saggital plane

All Obliques Connect to same band

External and internal obliques: Work in tandem to perform same action

External obliques: Are opposite - side rotators

Internal obliques: Are same-side rotators

Rotation to Left included Right external oblique and

Left internal oblique


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Reference

Hansen JT, Lambert DR. Netter’s Clinical Anatomy. 1st ed. 2006. Icon Learning System LLC; 2006.

Netter, F. Interactive Atlas of Clinical Anatomy: The Clear, Easy Way to Put Anatomy into Practice. Icon Learning Systems.

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