Ankle and Foot
Chapter 6, pp. 223-238
Oatis, Ch 44 & 45
Floyd, Ch 11
The Knee Complex
Oatis, Ch 41 & 42
Floyd, Ch 9
Review
Muscles
Anterior muscles
Extend knee
Quadriceps
rectus femoris
vastus lateralis
vastus intermedius
vastus medialis
Rectus Femoris Muscle
hip flexion
knee extension
hip abduction
anterior pelvic tilt
Vastus Lateralis Muscle
knee extension
Vastus Intermedius Muscle
knee extension
Vastus Medialis Muscle
knee extension
Quadriceps Muscles
Strength & endurance is essential for
maintenance of patellofemoral
stability
often a problem
quads are particularly prone to atrophy
when injuries occur
may be developed by resisted knee
extension activities from a seated
position
functional weight bearing activities such
as step-ups or squats are particularly
useful for strengthening & endurance
Muscles
Posterior muscles
Flex the knee
Hamstrings
semitendinosus
semimembranosus
biceps femoris
Other knee flexors
Popliteus
Tensor fascia latae
Sartorius
Gracilis
Gastrocnemius
Semitendinosus Muscle
hip extension
knee flexion
hip internal rotation
knee internal rotation
posterior pelvic tilt
Semimembranosus Muscle
hip extension
knee flexion
hip internal rotation
knee internal rotation
posterior pelvic tilt
Biceps Femoris Muscle
hip extension
knee flexion
hip external rotation
knee external rotation
posterior pelvic tilt
Hamstring Muscles
Hamstring muscle strains very common
Running muscles function in acceleration
Antagonists to quadriceps muscles at knee
Named for cordlike attachments at knee
All originate on ischial tuberosity of pelvis
Semitendinosus inserts on anteromedial
tibia
Semimembranosus inserts on
posteromedial tibia
Biceps femoris inserts on lateral tibial
condyle & head of fibula
Popliteus Muscle
knee internal rotation
knee flexion
Key to the knee
Sartorius Muscle
hip flexion
hip abduction
hip external rotation
knee flexion
anterior pelvic tilt
Gracilis Muscle
hip adduction
hip internal rotation
weak knee flexion
Gastrocnemius Muscle
ankle plantarflexion
knee flexion
Knee Extension
Agonists
Rectus femoris
Vastus lateralis
Vastus intermedius
Vastus medialis
Knee Flexion
Agonists
Biceps femoris
(long & short heads)
Semitendinosus
Semimembranosus
Knee Internal Rotation
Agonists
Semitendinosus
Semimembranosus
Popliteus
Knee External Rotation
Agonists
Biceps femoris
(long & short heads)
Ankle and Foot
Chapter 6, pp. 223-238
Oatis, Ch 44 & 45
Floyd, Ch 11
The Ankle and Foot
26 bones
19 large muscles
Many small (intrinsic) muscles
More than 100 ligaments
Support & propulsion
Foot trouble - common ailment
Poor foot mechanics leads to foot discomfort
No substitute for adequate muscular
development, strength, & proper foot
mechanics
Distal tibia
Articular surface
Plafond
Saddle shaped
Concave in an AP
direction
Convex in a ML direction
Bears 90% of ankle load
Lateral aspect articulates
with the fibula
Distal tibia
Medial malleolus
Prominent projection on inferior
and medial aspect of tibia
Lateral surface articulates with
medial aspect of the talus
Virtually no weight bearing
Pulley for posterior tendons
Tom, Dick & Harry muscles
Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus
Tibial alignment
Distal end of the tibia is laterally rotated in
the transverse plane wrt proximal end of the
tibia
Lateral (external) tibial torsion
Normal ranges from 20o-40o
Distal fibula
Lateral malleolus
Medial surface articulates
with talus
Oriented laterally and
inferiorly allows some
weight bearing
Pulley for posterior tendons
Peroneus brevis
Peroneus longus
Tarsal bones
Foot is joined to leg
by complex
organization of bones.
7 tarsal bones
5 metatarsals
14 phalanges
Allow for considerable
mobility
Maintains stability for
weight bearing and
ambulation
Tarsal bones
Talus
Joins the foot to the leg
Trochlea (aka talar dome)
Convex in AP direction
Concave in ML direction
Anterior aspect is slightly
wider than posterior aspect
Lateral ridge is slightly wider
than medial ridge
Asymmetry explains motion of
the ankle
Tarsal bones
Calcaneus
heel bone
Largest of the tarsal bones
Sustains large impact
forces at heel contact
during gait
Provides long moment
arm for the Achilles
tendon
Tarsal bones
Navicular
Crescent-shaped bone
Posterior surface
articulates with head of
the talus
3 anterior facets
Cuboid
Posterior surface
articulates with calcaneus
2 anterior facets
3 cuneiform bones
Help form transverse arch
Bones of the digits
Metatarsal bones
Miniature long bones
Metatarsal of the great toe
Shortest and thickest
Sesamoid bones at head
provide mechanical
advantage for muscles
5th metatarsal projects
inferiorly
Provides attachment for the
peroneus brevis tendon
Bones of the digits
Phalanges
Shorter, but similar to
phalanges of the fingers
Lesser toes
Proximal
Middle
Distal
Great toe
Proximal
Distal
Tibiofibular joint
Proximal tibiofibular joint
Gliding joint
Supported by:
Synovial joint capsule
Anterior and posterior ligaments to the
head of the fibula
Distal tibiofibular joint
Fibrous, syndesmosis joint
Forms mortise (cavity) for the talus
Supported by
interosseous ligament (continuous with
membrane)
anterior tibiofibular ligament
posterior tibiofibular ligament
interosseous membrane
Site of High Ankle Sprains
Syndesmotic/H
igh Ankle
Sprain
Talocrural (Ankle) joint
Articulations between the talus and
the tibia and fibula
Supported by synovial joint capsule
and collateral ligaments
Lateral collateral ligament
Anterior talofibular
Posterior talofibular
Calcaneofibular
Medial collateral (deltoid) ligament
*Tibia TO talus, nacivular, calcaneus
Tibiocalcaneal
Tibionavicular
Ant/Post tibiotalar
Deltoid Ligament
Talocrural joint
Oblique joint axis
Runs medial to lateral
between malleoli
Oriented posterior and
inferior
Primary movements
Foot moves towards leg
Dorsiflexion
Foot moves away from leg
Plantarflexion
Movements of the foot
Dorsiflexion (flexion)
movement of foot toward anterior tibia
Plantarflexion (extension)
movement of foot away from tibia
Subtalar joint
Articulation of the talus and
calcaneus
Acts to translate motion of the
tibia to the foot
(or vise versa)
Allows humans to walk smoothly
over uneven surfaces)
Oblique axis
Allows triplanar motion
Foot rotates upward -pronation
Foot rotates downward supination
Movements of the foot
Pronation
combination of:
ankle dorsiflexion
subtalar eversion
forefoot abduction (toe-out)
Supination
combination of:
ankle plantarflexion
subtalar inversion
forefoot adduction (toe-in)
Movements of the foot
Eversion
turning foot outward
weight is on medial edge of foot
Inversion
turning foot inward
weight is on lateral edge of foot
Subtalar joint
If STJ axis lies closer to long axis of
the foot mostly inversion and
eversion
If STJ axis lies closer to long axis of
the leg mostly abduction and
adduction
Midtarsal/Transverse Tarsal
Joint
Talonavicular joint
Articulation of talus with navicular
Supported by:
Synovial joint capsule
Talonavicular ligament
Dorsal calcaneonavicular ligament
Plantar calcaneonavicular (spring)
ligament
Calcaneocuboid joint
Articulation of calcaneus with
cuboid
Saddle joint
Supported by:
Synovial joint capsule
Bifurcate ligament
Short and long plantar ligaments
Other joints of the midfoot
Distal intertarsal joints
Articulation between:
navicular and cuneiform bones
cuboid and lateral cuneiform
cuneiform bones themselves
Very limited movement
Tarsometatarsal (TMT) joints
1st TMT joint is most mobile
Primarily sagittal plane motion
Very limited frontal and transverse
plane motion
2nd TMT most limited
Mobility increases from 3rd-5th
TMT joints
Other joints of the foot
Metatarsophalangeal joints
Condyloid joints (bi-axial)
Supported by:
synovial joint capsule
collateral ligaments
plantar plates
Turf toe
Interphalangeal joints
Hinge joints (uni-axial)
Supported by:
synovial joint capsule
collateral ligaments
plantar plates
Other joints of the foot
Plantar Plates:
- fibrocartilaginous structures found in the MTP and
IP joints
- The plantar plate supports the weight of the body
and restricts dorsiflexion
- the main collateral ligament and the accessory
collateral ligament (together referred as the
Collateral Ligament Complex, CLC), prevent
motions in the transverse and sagittal planes.
- The plantar plate is firm but flexible fibrocartilage
with a composition similar to that found in the
menisci of the knee (composed roughly of 75%
type-I collagen) and can thus withstand
compressive loads and act as a supportive
articular surface.
Movements of the foot
Toe flexion
movement of toes toward
plantar surface of foot
Toe extension
movement of toes away from
plantar surface of foot
Arches of the foot
Lateral longitudinal arch
Includes calcaneus,
cuboid, and 5th
metatarsal
Medial longitudinal arch
Includes calcaneus,
talus, navicular, medial
cuneiform, and 1st
metatarsal
Transverse arch
Formed by the cuboid
and cuneiforms
Arches of the foot
Protect nerves, blood vessels, and
muscles on plantar surface from
compression during weight bearing
Absorbs shock during impact
Stores and releases mechanical
energy to improve efficiency
Pes planus
Diminished medial longitudinal arch
Flat foot
Pes cavus
Abnormally high medial longitudinal
arch
Deformities of Foot
Pes Planus
Pes Cavus
