Knee, Ankle Foot-Fall10[1]

8/6/2019 Knee, Ankle Foot-Fall10[1]

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THE POPLITEAL FOSSA

A diamond shaped hollow

posterior to the knee

Boundaries

y Superolateral bicepsfemoris

y Superomedial semimembranosus &semitendinosus

y Inferolateral andinferomedial both

heads of gastrocnemius


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THE POPLITEAL FOSSA

CONTENTS

Contents include fat,

popliteal vessels,tibial and peroneal

nerves, small

saphenous vein, andpopliteal lymph

vessels


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THE POPLITEAL FOSSA


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THE POPLITEAL FOSSAPOPLITEALARTERY

Extension of the femoral artery,

divides into anterior and posterior

tibial arteries

POPLITEALVEIN Runs beside the popliteal artery,

originates at the anterior and posterior

tibial veins then drains into the

femoral veinSCIATICNERVE

divides at the superior end of the fossa

into tibial and peroneal nerves


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THE KNEEBONES

Femur

Tibia

Patella knee capJOINTS

Tibiofemoral

Joint between femur and tibia

Patellafemoral

Between patella and femur


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THE KNEE

ARTICULARCAPSULE

Strong fibrous capsule

Deficient on the lateral condyle to allow

passage of the popliteus out of the joint


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LIGAMENTS OF THE KNEECapsule strengthened by 5 intrinsic ligaments

Patellar ligament

Central portion of the quadricepts femoristendon

Tibial collateral/medial collateral(MCL)

Medial side of knee

Fibular collateral/lateral collateral

Lateral side of knee

Oblique Popliteal ligament

Broad flat fibrous band

Posterior femur to posterior margin of tibiaRealism - 87


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LIGAMENTS OF THE KNEEArcuate ligament (arc shaped

ligament)

Y shaped ligament

Cruciate ligaments

Anterior Cruciate ligment

Weaker of the two ligaments

Prevents anterior displacement of the

tibia

Posterior Cruciate Ligament

Stronger of the two

Prevents posterior displacement of the

tibia


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LIGAMENTS OF THE KNEE


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THE KNEESYNOVIAL MEMBRANE

Lines inner fibrous capsule

Most extensive in the body therefore

creating the largest joint spaceMENISCI

C-shaped plates of fibrocartilage on the

articular surface of the tibia

Allows for a deeper articulation andacts as a shock absorber


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BURSAE OF THE KNEEFront compartment

Suprapatellar between anterior surface offemur and deep surface of quadiceps femoris

Subcutaneous infrapatellar betweenpatella and skin

Deep infrapatellar between upper part oftibia and patellar ligament

Medial compartment

Anserine medially between MCL and the

sartorius, gracillis and semitendinosusSemimembranosa medially betweenMCL and semimembranosis

Gastrocnemius medial betweengastrocnemius and joint capsule


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BURSAE OF KNEE

Lateral compartmentGastrocnemius lateral

between gastrocnemius and joint

capsule

Posterior compartmentPopliteal bursae back part of

knee can get inflamed and

called a Bakers cyst


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THE LEGTIBIA

Tibial plateau

Medial and lateral condyles

Intercondylar eminence

Tibial tuberosity

Interosseous border Medial malleolus

Articular surface

FIBULA

Head Interosseous border

Lateral malleolusThese two bones are joined by an interosseous

membrane


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MUSCLES OF THE ANTERIOR

COMPARTMENT

Muscles

Tibialis anterior

Extensor hallucis longus

Extensor digitorum longus

Peroneus tertius

Nerve

Deep peroneal nerve

Artery

Anterior tibial artery


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TIBIALIS ANTERIOROLateral condyle of the tibia

upper half and lateral surface

interosseous membrane, deep fascia,

lateral intramuscular septum

I First cuneiform medial plantar

surface, base of first metatarsal

A Dorsiflexion of foot at ankle,

inversion of footN Deep peroneal nerveRealism 217


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EXTENSOR HALLUCIS LONGUSO Fibula anterior surface

and middle 1/2 adjacent

interosseous membrane

I Base of distal phalanx of

great toe dorsal surfaceA Extension of great toe,

assists in dorsiflexion of foot

at ankle, assists inversion of

foot

N Deep Peroneal nerve (L4,

L5, S1)

Realism - 228


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EXTENSOR DIGITORIUM LONGUSOLateral condyle of the tibia and

superior of fibula, interosseous

membrane and intramuscular septum

I Bases of middle and distal phalnages

dorsal surface via 4 slips to extensorexpansion of lateral 4 digits

A Extension of 2nd through 5th digits,

assists dorsiflexion of foot at ankle,

eversion of foot

N Deep peroneal nerve Situated on lateral side of front of the leg

Realism - 223


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PERONEUS TERTIUSO Fibula anterior margin

and distal 1/3, interosseous

membrane

I Base of 5th metatarsal

dorsal surfaceA Dorsiflexion of foot at

ankle, eversion of foot

N

Deep Peroneal nerve (L5,S1)

Realism - 227


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MUSCLE ORIGIN INSERTION ACTION INNERVATION

TIBIALIS

ANTERIOR

Lateral condyle of the

tibia upper half and

lateral surface

interosseousmembrane, deep

fascia, lateral

intramuscular septum

First cuneiform

medial plantar

surface, base of first

metatarsal

Dorsiflexion of foot

at ankle, inversion

of foot

Deep peroneal

nerve

EXTENSOR

HALLUCIS

LONGUS

Fibula anterior

surface and middle

1/2 adjacent

interosseous

membrane

Base of distal

phalanx of great toe

dorsal surface

Extension of great

toe, assists in

dorsiflexion of foot

at ankle, assists

inversion of foot

Deep Peroneal

nerve (L4, L5, S1)

EXTENSOR

DIGITORIUM

LONGUS

Lateral condyle of the

tibia and superior

of fibula, interosseousmembrane and


Bases of middle and

distal phalanges

dorsal surface via 4slips to extensor

expansion of lateral

4 digits

Extension of 2nd

through 5th digits,

assists dorsiflexionof foot at ankle,

eversion of foot

Deep peroneal

nerve

PERONEUS

TERTIUS

Fibula anterior

margin and distal

1/3, interosseous

Base of 5th

metatarsal dorsal

surface

Dorsiflexion of foot

at ankle, eversion of

foot

Deep Peroneal

nerve (L5, S1)


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DEEP PERONEAL NERVEDeep Peroneal Nerve

Also called deep fibular nerve

Supplies Anterior compartment of leg

Begins at bifurcation of common fibular

nerve between fibula and peroneus longus,passes deep to extensor digitorum longus

and comes into relation with anterior tibial

artery

Descends with tibial artery until ankle

joint where it divides into medial and

lateral terminal branches


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LATERAL COMPARTMENT OF LEGMuscles

Peroneus longus

Peroneus brevis

NervesSuperficial peroneal nerve

Arteries

Perforating branches from both

anterior tibial and fibular arteries

along with their veins supply this

compartment


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PERONEUS LONGUS

O

head of the fibula

upper 2/3s andlateral surface, intramuscular septum

I first cuneiform lateral aspect, base of 1st

metatarsal plantar surface

A Plantar flexion of foot at ankle andeversion

N Superficial peroneal nerve

The common peroneal nerve runs between

the peroneus longus and the fibula Ends in a long tendon that runs around the

lateral malleolus of the fibular

Realism - 220


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PERONEUS BREVISO Fibula lateral surface

and distal 2/3s, adjacent


I Tuberosity on 5th metatarsal

lateral aspectA Plantarflexion of foot at

ankle, eversion of foot

NS

uperficial peroneal nerve(L4, L5, S1)Realism - 225


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PERONEUS

LONGUS

head of the fibula

upper 2/3s and

lateral surface,

intramuscular

septum

first cuneiform

lateral aspect, base

of 1st metatarsal

plantar surface

Plantar flexion of

foot at ankle and

eversion

Superficial peroneal

nerve

PERONEUS

BREVIS

Fibula lateral

surface and distal

2/3s, adjacentintramuscular

septum

Tuberosity on 5th

metatarsal lateral

aspect

Plantarflexion of

foot at ankle,

eversion of foot

Superficial peroneal

nerve (L4, L5, S1)


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SUPERFICIAL PERONEAL NERVE

y Also called the superficial fibularnerve

y Passes between the peroneus muscles

and the extensor digitorum longus

y Divides into the medial dorsal

cutaneous nerve and intermediate

dorsal cutaneous nerve


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ARTERIES OF THE LATERAL

COMPARTMENT OF THE LEG

y Perforating branches of

the anterior tibial and

fibular arteries

yAlso veins


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POSTERIOR COMPARTMENT OF LEGMuscles

Gastrocnemius

Soleus

Plantaris

Popliteus

Flexor hallucis longus

Flexor digitorum longus

Tibialis posterior

Nerves

Tibial nerveArteries

Posterior tibila artery

Peroneal artery

Nutrient artery to the tibia


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GASTROCNEMIUSOMedial head femur-posterior

surface, medial condyle, underlying

capsule of knee joint

Lateral head femur posterior

surface, lateral condyle, underlyingcapsule of knee joint

I Calcaneus via achilles tendon

A

Plantar flex

ion of foot at ankle,assists in flexion of leg at knee

N Tibial nerve (S1, S2)Realism - 216


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SOLEUS

O

Head of fibula

posteriorsurface, body of fibula

proximal 1/3, soleal line, tibia

posterior and upper surface,

tendinous arch between tibiaand fibula

I Calcaneus via Achilles tendon

A Plantar flexion of foot at

ankle

N Tibial nerve (S1, S2)Realism - 221


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GASTROCNEMIUS MH femur-

posterior surface,

medial condyle,

underlying capsuleof knee joint

LH femur

posterior surface,

lateral condyle,

underlying capsule

of knee joint

Calcaneus via

achilles tendon

Plantar flexion of

foot at ankle, assists

in flexion of leg at

knee

Tibial nerve (S1,

S2)

SOLEUS Head of fibula

posterior surface,

body of fibula

proximal 1/3,

soleal line, tibia

posterior and upper

surface, tendinous

arch between tibia

and fibula

Calcaneus via

Achilles tendon

Plantar flexion of

foot at ankle

Tibial nerve (S1,

S2)


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PLANTARISO

Femur

superior to lateralcondyle, oblique popliteal

ligament of knee

I Calcaneus via Achilles tendon

A Plantarflexion of foot atankle, assists in flexion of leg at

knee

N

Tibial nerve (L4, L5, S1)Realism - 221


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POPLITEUS

OLateral condyle of femur

I Posterior shaft of tibia superior to

soleal line

A Medial rotation of tibia of femur

with thigh/origin fixed as when sitting

upright: flexion of leg at knee

With leg/insertion fixed as when

standing: flex

ion of leg at kneeLateral rotation of femur on tibia, to

unlock knee joint

N Tibial nerve (L4, L5, S1)

Realism - 222


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FLEXOR HALLUCIS LONGUSO Posterior fibula distal 2/3s,

interosseous membrane, adjacentintrmuscular septum

I Base distal phalanx of great toe

plantar surface

A Flexion of great toe, inversion of

foot, assists plantarflexion of foot at

ankle

N Tibial nerve (L5, S1, S2)

Deep muscles of the posterior

compartment of leg

Fibular side of leg

Realism - 233


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FLEXOR DIGITORIUM LONGUSOTibia medial posterior surface

I Bases of 2nd, 3rd, 4th and 5th distal

phalanges of digits plantar surface

A Flexion of proximal and distal

phalanges of lateral 4 digits, assistsplantarflexion of foot at ankle, assist

inversion of foot

N Tibial nerve (L5, S1)

On tibial side of leg

Deep muscle of the posterior

compartment Realism - 229


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TIBIALIS POSTERIORO Interosseous membrane, posterior

fibula medial surface, posterior tibia

lateral surface

I Tuberosity of navicular bone, calcaneus

plantar surface, cuneiform, cuboid, basesof 2nd, 3rd, and 4th metarsals

A Plantarflexion of foot at ankle,

inversion foot

N Tibial nerve (L5, S1) Deep muscle of posterior compartmentRealism - 231


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PLANTARIS Femur superior tolateral condyle, oblique

popliteal ligament of

knee

Calcaneus via Achilles

tendon

Plantarflexion of foot

at ankle, assists in

flexion of leg at knee

Tibial nerve (L4, L5,

S1)

POPLITEUS Lateral condyle of femur Posterior shaft of tibia superior to soleal

line

Medial rotation of

tibia of femur

Tibial nerve (L4, L5,

S1)

FLEXOR

HALLUCIS

LONGUS

Post fibula distal 2/3s,

interosseous membrane,

adjacent intrmuscularseptum

Base distal phalanx of

great toe plantar

surface

Flexion of great toe,

inversion of foot,

assists plantarflexionof foot at ankle

Tibial nerve (L5, S1,

S2)

FLEXOR

DIGITORIUM

LONGUS

Tibia medial posterior

surface

Bases of 2nd, 3rd, 4th

and 5th distal

phalanges of digits

plantar surface

Flexion of proximal

and distal phalanges of

lateral 4 digits, assists

plantarflexion of foot

at ankle, assistinversion of foot

Tibial nerve (L5, S1)

TIBIALIS

POSTERIOR

Interosseous membrane,

posterior fibula medial

surface, posterior tibia

lateral surface

Tuberosity of

navicular bone,

calcaneus plantar

surface, cuneiform,

cuboid, bases of 2nd,

3rd, and 4th metarsals

Plantarflexion of foot

at ankle, inversion

foot

Tibial nerve (L5, S1)


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TIBIAL NERVEy Branch of the sciatic nerve

y Goes through the popliteal fossa where it

innervates the gastrocnemius, soleus, plantaris

and popliteus

y Cutaneous branch becomes the sural nerve

y Below the soleus, the tibial nerve lies close to

the tibia and innervates the tibialis posterior,

flexor digitalis longus and flexor hallucis

longus

y Runs medially over the medial malleolus and

joins runs under the flexor retinaculum with

the posterior tibial artery


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ARTERIES OF THE POSTERIOR COMPARTMENT

Posterior tibial artery

Supplies blood to the posterior compartment of theleg and plantar surface of the foot

Arises from the popliteal artery and runs medially

over the medial malleolus

Accompanied by the deep tibial veinPeroneal artery

Branch of the tibial artery, runs deep close to the

fibula, laterally down the leg

Supplies lateral compartment of the legNutrient artery to the tibia

Largest nutrient artery in the body

Nutrient foramen is just inferior to soleal line


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CROSS SECTION OF THE LEG


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LYMPHATICS OF LOWER LEG

y Superficial lymph vessels from the lateral foot and

posterolateral leg follow the small saphenous vein

and drain into the popliteal nodes.

yThose on the medial foot and anteromedial leg

follow the great saphenous vein and drain into the

inguinal nodes


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LYMPHATICS OF THE LOWER LEG


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BONES OF THE FOOTBones

Talusy Head

Cuboid

Naviculary Navicular tuberosity

Calcaneusy Peroneal tubercley Sustentaculum tali

Cuneiformsy

1st

, 2nd

, 3rd

/ medial, middle, lateralMetatarsalsy 1st 5th

Phalangesy 1st 5th

yProximal phalanx, middle phalanx, distal phalanx


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JOINTS OF ANKLE AND FOOTJoints

Talocrural ankle joint made up of

distal tibia and fibula and talus

Subtalar articulation of talus and

calcaneusTarsometatarsal articulation of the

1st, 2nd and 3rd cuniform as well as

the cuboid with the metatarsal bones

Metatarsophalangeal

articulationbetween the metatarsal bones and the

bones of the toes or phalanges

Interphalangeal articulation

between phalanges of the toes


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LIGAMENTS OF THE FOOT

Ligaments:Deltoid medial ligament of the

talocrual joint

Anterior tibiotalarPosterior tibiotalar posterior

fibres run backward and lateral

and attach to inner side of talusTibiocalcaneal middle of the

deltoid

Tibionavicular most anterior

attaches to the navicular bone


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LIGAMENTS OF THE FOOTLigaments

Anterior talofibular

anterior from the fibular

malleolus to the talus bone

Posterior talofibular runshorizontally from the medial

part of the fibular malleolus to

the posterior surface of the

talus

Calcaneofibular fibular

malleolus downward and

backward to the calcaneus


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FASCIA OF THE FOOT

Fasciay It is thin on the dorsum of the foot

Plantar fascia

along the centre is a thickening called

theplantar aponeurosis. It helps support

the longitudinal arches of the foot

Arches

MedialLateral

Transverse


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MUSCLES OF THE FOOTMuscles: Intrinsic Foot

Extensor digitorum brevis

Abductor hallucis

Flexor digiti brevis

Abductor digiti minimi

Quadratus plantae

Muscles: Intrinsic Foot

Lumbricals

Flexor hallucis brevis

Adductor hallucis

Flexor digiti brevis

Dorsal interossei

Plantar interossei


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EXTENSOR DIGITORIUM BREVISOAnterior calcaneus superior

lateral surface, lateral

talocalcaneal ligament, inferior

extensor retinaculum

I

Prox

imal phalanx

of great toe dorsal surface, 2nd, 3rd, and

4th digits via extensor

digitorum longus tendon

A Extension of great toe,extension of 2nd, 3rd, 4th digits

N Deep peroneal nerve

(L5, S1)Realism - 235

ABDUCTOR HALLICUS


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ABDUCTOR HALLICUSOTuberosity of calcaneus, flexor

retinaculum of ankle, plantar

aponeurosis

I Base of proximal phalanx of great

toe medial side, medial sesamoidbone of great toe

A abduction of great toe, assists in

flexion of great toe

N Medial plantar nerve (L4, L5)Realism - 239


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FLEXOR DIGITORUM BREVIS

O

Tuberosity of calcaneus,plantar aponeurosis

I both sides of middle

phalanges of second through

5th digits

A Flexion of lateral 4 digits

N medial plantar nerve (L4,

L5)Realism - 237


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ABDUCTOR DIGITI MINIMI

OTuberosity of calcaneus, plantaraponeurosis

I Proximal phalanx of 5ht digit

lateral aspect

A Abduction of 5th digit, assists flexion

of 5th digit

N Lateral plantar nerve (S1, S2)

Realism - 238


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QUADRATUS PLANTAEOArises from 2 heads which are

separated from each other by the long

plantar ligament, the medial head attaches

to the medial surface of the calcaneus, the

lateral head arises from the lateral borderof the inferior surface of the calcaneus

and from the long plantar ligament

I tendon of the flexor digitorum longus

A flexion of the 2nd through 5th DIP joints

N lateral plantar nerve (S1, S2)Realism - 240


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LUMBRICALS

OTendons of flexor digitorum longusI Expansion of tendons to extensor

digitorum longus on 2nd to 5th digits

A

Flex

ion of prox

imal phalanges of 2

nd

through 5th digits, extension of distal

phalanges of 2nd through 5th digits

N Medial plantar nerve (L4,L5), first

lumbricalLateral plantar nerve (S1, S2), second,

third and 4th lumbricalsRealism - 240


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FLEXOR HALLUCIS BREVIS

O

Cuboid

plantar surface, lateralcuneiform, and prolongation of

tibialis posterior tendon

I Base of proximal phalanx of great

toe medial and lateral aspects

A flexion of great toe

N medial plantar nerve (L4, L5, S1)R

ealism - 242

ADDUCTOR HALLUCIS


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ADDUCTOR HALLUCISMade up of two heads

OOblique head Bases of 2nd, 3rd, and 4th

metatarsal bones, tendionous sheath of

peroneus longus

- Transverse head

Plantarmetatarsophalangeal ligaments and

transverse metatarsal ligaments of 3rd, 4th

and 5th digits

I base of phalanx of great toe lateral aspectA adducts hallux, assists in flexion

N - Lateral plantar nerve (S1, S2)

Realism - 243


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FLEXOR DIGITI BREVISOBase of Fifth metatarsal,

adjacent tendinous sheath of

peroneus longus

I Base of proximal phalanx of 5th

digit lateral aspectA Flexion of proximal phalanx of

5th digit

N

Lateral plantar nerve (S1, S2)Realism - 241

DORSAL INTEROSSEI


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DORSAL INTEROSSEIO adjacent sides of each of the metatarsal

bones

I 1st interossei base of proximal phalanx of

2nd digit medial side

2nd

to 4th

base of pro

ximal phalan

xof 2

nd

to4th digits lateral side

All dorsal extensor expansion of

respective digits

A abduction of 2nd through 4th digtis, assistsflexion and extension of lateral 4 digits

N lateral plantar nerve

Realism - 236


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PLANTAR INTEROSSEIO 3rd, 4th and 5th metatarsal bones

inferior and medial sides

I base of proximal phalanx of

corresponding digit medial sideA adduction of 3rd, 4th, 5th digits

toward 2nd digit, flexion of 3rd, 4th

and 5th digits

N Lateral plantar nerve (S1, S2)Realism - 244


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NERVES OF THE FOOT

Nerves

Tibial nerve divides into:

Medial plantar nerve largest

terminal branch Lateral plantar nerve

Sural nerve

supplies skin on lateral and

posteroinferior 1/3 of leg

Saphenous nerve

largest cutaneous branch of

femoral nerve


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ARTERIES OF THE FOOT

Arteries

Dorsalis pedis artery

y Dorsum continuation of

anterior tibial arteryMedial and lateral plantar

arteries

y Sole branches of posterior

tibial artery


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VEINS OF THE FOOT

Veins:

Dorsal digital veins

y All veins of the foot

communicate and drain into thegreat and small saphenous veins

Knee, Ankle Foot-Fall10[1]

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