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