Knee Tibiofemoral Joint and Foot By Chandie Christina

Knee (Tibiofemoral) Joint and Foot By: Chandie, Christina, Ed & Sharon

Right Tibia and Fibula

Knee Ligaments

Bursae • • Suprapatellar bursa Prepatellar bursa Deep infrapatellar bursa Subcutaneous infrapatellar bursa

Bursae

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

Lateral and Medial Meniscus

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

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

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

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

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 headsciatic nerve; Short headcommon peroneal nerve – Vascular Supply: Inferior gluteal artery

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

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

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

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

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

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

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

Tarsal Bones BONES OF THE FOOT

Ligaments: Lower Leg and Foot

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

Ankle and Foot Muscles • Soleus – Origin: Posterior tibia and fibula – Insertion: Posterior calcaneus – Action: Ankle plantarflexion – Innervation: Tibial nerve – Vascular supply: Posterior tibial artery

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

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

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

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

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

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

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

Ankle and Foot Muscles • • Tibialis posterior Flexor digitorum longus Flexor hallucis longus “Tom, Dick & Harry

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

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

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

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

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

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

Exercises for Plantar Fasciitis

Surface Anatomy

• www. rad. washington. edu/atlas 2/extdiglong. html