Knee (Tibiofemoral) Jointand Foot

By: Chandie, Christina, Ed & Sharon

Right Tibia and Fibula

Knee Ligaments

Knee Ligaments

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 head-sciatic nerve; Short head-common 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

• 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

Exercises for Plantar Fasciitis

Surface Anatomy

Surface Anatomy

• www.rad.washington.edu/atlas2/extdiglong.html