Knee, Ankle and Foot Flashcards Preview

OTA 130 - Kinesiology > Knee, Ankle and Foot > Flashcards

Flashcards in Knee, Ankle and Foot Deck (45)
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1

MMT for Legs

In order to stand/get out of bed (our biggest concern for legs with OT):
• Must have strength of at least 3 (non-negotiable!)
• Planter flexor strength of at least 3
• Hip flexors of at least 2

2

Knee Joint

• Largest joint in the body
• Places foot in space
• Uniaxial joint (with slight rotation of femur on tibia)
• Slide and Glide (J shape), Hinge joint
• Femur and Tibia held together by strong interosseous membrane
• ROM:
- Flexion 0˚ to 135˚
- Extension 135˚ to 0˚ (may extend up to 10˚ past 0˚ in hyperextension)

3

Bones of the Knee

1) Femur
2) Patella
3) Tibia
4) Fibula* (debatable: doesn’t actually touch femur)

4

Patella

Sesmoid bone that acts as a pulley in the front of the knee joint. Increases mechanical advantage of quads and aids in strength of contraction.
**It is debated whether the patella is embedded in/connects by ligament or tendon, but we are going to use Patellar Tendon!**

5

Q Angle

(PTs use this term, so we may hear it in field.)
• Angle formed by line drawn from ASIS to central patella, then central patella to tibial tubercle. Angle is increased by knock knees, etc.
• Angle greated in females.
• Ranges from 13˚ (males) to 18˚ (females)

6

Nerves of the Knee (What injuries affect)

• Femoral Nerve (L2-L4); extension of quads
• Sciatic Nerve (L5-S2); flexion of hamstrings
(Note: exception of short head of biceps femoris innervates by peroneal nerve)

7

Ligaments of Knee

• Cruciates (resemble cross)
- Located within joint capsule
- Provides stability in the sagittal plane
- Anterior Cruciate Ligament (ACL)
- Posterior Cruciate Ligament (PCL)

• Collateral Ligaments (frontal plane stability)
- Tight during extension, slack on flexion
- Medial (MCL)
- Lateral (LCL)

8

PCL

Posterior Cruciate Ligament
• Runs from posterior tibia to anterior femur
• Keeps femur from being displaced anteriorly on tibia
• Tightens during flexion
• Less likely to be injured than ACL

9

ACL

Anterior Cruciate Ligament
• Runs from anterior tibia to posterior femur
• Keeps femur from being displaced posteriorly on tibia, conversely prevents tibia from anterior displacement
• Tightens during extension
• Prevents hyperextension of knee
• If knee partially flexed, prevents tibia from moving anteriorly
** “Sliding Drawer” test used to check for ACL injuries

10

Meniscus

• Medial and lateral half-moon shaped fibrocartilage disks located on superior surface of tibia
• Actually ligaments
• Designed to absorb shock
• Medial meniscus more commonly torn

11

Bursa

• Synovial fluid sacs
• Multiple bursa located in knee joint to help reduce friction along bones, tendons, muscles
• Can become inflamed (bursitis)

12

Popliteal Space

• Area behind knee that contains blood vessels (popliteal artery) and nerves (tibial, common peroneal)
• More protected area than front of knee
** Watch this space that pts don’t sit, etc., in a way that occludes the vessels/nerves!

13

“Genu” Pathologies of Knee

Genu VALGUM: knock knees
Genu VARUM: bow legs
Genu RECURVATUM: hyperextension (may have had polio)

14

Chondromalacia Patella

Softening/degeneration of cartilage in posterior aspect of patella, causing anterior knee pain

15

Prepatellar Bursitis

Occurs with constant pressure between skin and patella (frequently happens with kneelers—nuns, mechanics)

16

Patellofemoral Pain Syndrome

Used to be called “fake” pain. Causes unknown; diffuse anterior knee pain.

17

Jumper’s Knee (Patellar Tendonitis)

Tenderness at patellar tendon from overstress (ie: jumping)

18

Unholy Triad

Knee injury to ACL, MCL and Medial Meniscus. Often caused by lateral blow to the knee.

19

Muscles of Knee

Anterior (knee extension):
• Rectus Femoris
• Vastus Lateralis
• Vastus Medialis
• Vastus Intermedialis

Posterior (knee flexion):
• Semimembranosus
• Semitendinosus
• Biceps Femoris
• Popliteus
• Gastrocnemius

Spanning Knee (stability):
• Gracilis
• Sartorius
• Tensor Faschiae Latae

20

Tarsal Bones of the Foot

7 Tarsal Bones (nearest to ankle):
• Calcaneus
• Talus
• Cuboid
• Navicular* (fallen arches)
• 1st Cuneiform (medial)
• 2nd Cuneiform (intermediate)
• 3rd Cuneiform (lateral)

21

Metatarsal Bones of the Foot

5 Metatarsals (middle bones):
• Numbered medial to lateral
• 1st and 5th are weight bearing

22

Phalanges of Foot

14 Phalanges (toe bones):
• Hallux (great toe) has 2 phalanges
• All others have 3

23

Hallux

Great (big) toe. Contains 2 phalanges.

24

Main Functions of Ankle and Foot

1) Shock absorber as heel strikes ground at beginning of stance phase/gait
2) Adapts to level of ground
3) Stable base from which to propel body forward

25

Ankle Motions

• Plantar Flexion (foot moves downward)
• Dorsiflexion (foot moves upward)
• Inversion (foot turns inward)
• Eversion (foot turns outward)
• Supination (combo of plantar flexion, inversion, aDduction)
• Pronation (combo of dorsiflexion, eversion, aBduction)

26

Ankle Joint

• Uniaxial Joint
• Contains distal tibia, lateral malleolus of fibula, and talus
• Close Packed position is in maximum dorsiflexion

Typical ROM (measured from 90˚ neutral start):
• 30 to 50˚ plantar flexion
• 20˚ dorsiflexion

27

Foot Joints

Metatarsophalangeal (MTP):
• Allow flexion, extension, hyperextension, abduction/adduction
• 1st MTP is most mobile; allows 45˚ hyperextension—very important during toe-off phase of gait

28

Shin Splints

Exercise induced pain along medial edge of tibia, inflammation of periosteum. Tx: get better shoes!

29

Hallux Rigidus

Degenerative condition of MTP of great toe, causing pain/decreased ROM. Tx: get a “rocker” for feet.

30

Pes Cavus vs. Pes Planus

Pes CAVUS = abnormally high arch (caused by nerve damage to lower leg)

Pes PLANUS = loss of medial longitudinal arch (flat feet); can happen with children with low tone. Tx: use brace (DAFO) for stability.

**Both of these can cause knee problems.