Knee (Tibiofemoral) Joint and Foot
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Transcript of Knee (Tibiofemoral) Joint and Foot
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Knee (Tibiofemoral) Jointand Foot
By: Chandie, Christina, Ed & Sharon
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Right Tibia and Fibula
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Knee Ligaments
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Knee Ligaments
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Knee Ligaments
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Bursae
• Suprapatellar bursa• Prepatellar bursa• Deep infrapatellar bursa• Subcutaneous
infrapatellar bursa
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Bursae
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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
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Lateral and Medial Meniscus
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Tarsal Bones
BONES OF THE
FOOT
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Ligaments: Lower Leg and Foot
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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
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Ankle and Foot Muscles
• Soleus– Origin: Posterior tibia
and fibula– Insertion: Posterior
calcaneus– Action: Ankle
plantarflexion– Innervation: Tibial
nerve– Vascular supply:
Posterior tibial artery
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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
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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
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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
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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
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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
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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
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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
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Ankle and Foot Muscles
• Tibialis posterior• Flexor digitorum longus • Flexor hallucis longus• “Tom, Dick & Harry
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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
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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
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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
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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
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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
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• 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
Plantar Fasciitis Treatment
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Exercises for Plantar Fasciitis
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Surface Anatomy
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Surface Anatomy
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• www.rad.washington.edu/atlas2/extdiglong.html