Knee, Leg and Foot
1) Pigeon pose and Seated Twist
- Pigeon pose – hyperflex in the thigh – stretch the piriformis and the hamstrings
- Seated twist – hyperflex in the thigh – gluteus maximus and you feel the stretching
way to the knee as the gluteus maximus insert into the IT band that extends all the
way along the lateral aspect of the thigh and insert below the knee.
2) Characteristics of a Synovial Joint (include glenoid and hip joint)
- A joint consists of 2 bones that articulate or move on each other and at the
ends of the bones:
a. Articular cartilage – protect the bone, smooth surface
b. Articular capsule – extra shock absorber
+ Fibrous capsule
+ Synovial membrane
c. Synovial Fluid – oily fluid for frictionless movement
d. Articular disc (may be present) – adding stability mechanism for the joint (keep the
bones aligned properly + provide extra cushion between the joint)
e. Intracapsular and extracapsular ligaments (may be present)
3) Clinical condition: Osteoarthritis
- Damage to articular cartilage covering bone surface (no more cartilage) -> bone
grinding on bone (painful)
- Very difficult to repair because this tissue (articular cartilage) is avascular (không
mạch) (no blood supply and innervation) (receiving blood through passive diffusion)
-> slow to repair
- Treatment involves pain management and prevention of further damage. Using joint
replacement to cover the head of femur and acetabulum
4) The knee joint
- An example of a complex synovial joint consisting of both a hinge (femoro-tibial)
(one direction: flexion and extension) and a plane(femoro-patellar) joint (slide up
and down).
5) Patella
- A sesamoid bone that is embedded within a tendon. The anterior view is kinda
smooth while the posterior is sort of prominent which fit nicely into the groove of
femur
- Increases mechanical advantage of quadriceps by approximately 30% (since the
quadricep tendon insert in patella)
- Holds quadriceps tendon more anterior for additional leverage
- Bony surface to withstand compression on quad. tendon while kneeling
- Reduces friction on tendon during flexion/extension – ie during running
,6) Knee Joint Stability
- Femur and tibia sit nicely on top of others.
- Dependent upon:
a. Strength and actions of surrounding muscles
b. Ligaments connecting femur to tibia and fibula
- Stability from the surrounding muscles
+ Anteriorly, quadriceps tendon
+ Laterally, the IT band
+ Medially, the Sartorius + Gracilis + Semitnedinosus
+ Posteriorly, semimembranosus in the Tibia and the biceps femoris in the
fibula.
- Ligaments of the fibrous capsule (external to the fibrous capsule)
+ Patellar ligament (from the patella to the tibia)
+ Lateral fibular collateral ligament (LCL) not attach to its menisci
+ Medial tibial collateral ligament (MCL) also attach to the menisci
----> Prevent side to side movement of tibia wrt femur
- Fibrous capsule surround the knee joint to reinforce the stability
- Looking down internally to the knee joint and in the superior view of the tibia:
+ There is a tibial plateau including the medial and lateral condyles
+ Between the plateau is the intercondylar region – where the bones don’t articulate
+ There is an additional disk between the two bones and these in the knee called the
meniscus (plural: menisci)
+ The fibrous capsule surrounds all the knee joints. In the medial side, this capsule is
attached to the medial meniscus which is important when we talk about injuries
because if you have an injury to the capsule, on the medial side, chances are it’s also
going to impact the medial meniscus.
- Everything is surrounded by the synovial membrane – a specialized tissue that
produces the synovial fluid
- The synovial membrane extends beyond the patella therefore, the knee injection for
inflammation can inject there without trying to go interiorly.
7) Cruciate Ligaments - Intracapsular
- These are intracapsular ligaments that provide additional support.
- The knee not only has an extra capsule but it also has an intracapsular.
- Between the tibial plateau in the intercondylar region, there are Posterior cruciate
ligament and Anterior cruciate ligament (this is a common damage) cross.
+ Anterior cruciate ligament extend from the anterior aspect of the tibia to the
posterior aspect of the femur -> prevent the sliding of tibia on the femur
(forward movement)
+ Posterior cruciate ligament extend from the posterior aspect of the femur to
the anterior aspect of the tibia ( prevent downward movement of the tibia) (ie.
when walking down hill, the PCL prevent the tibia to slide)
8) Functions of Cruciate Ligaments
- During knee flexion, both ACL and PCL are tight, ACL prevent forward movement of
the tibia and PCL prevents posterior movement of tibia
, - In the extended knee, both ACL and PCl become taut and lock the knee
- Being a complex joint, the knee is subject to injuries such as tearing of ligaments
9) The unhappy Triad
- A blow from the lateral side can result in separation of the femur and tibia medially
and damage to the tibial collateral ligament (MCL), the medial meniscus and the
anterior cruciate ligament.
- Testing of Cruciate Ligament by using the drawer test.
10) ACL/PCL ligament testing
- Anterior drawer sign (ACL) and Posterior drawer sign (PCL)
- Positive tests indicate torn ligament which allows motion that is normally prevented
by that ligament.
- Thinking about walking downhill – PCL prevents femur from sliding forward
11) Wiring diagram: Innervation of lower limb
- Lumbar plexus :
+ Femoral nerve – Ant. Comp. of thigh muscles
+ Obturator nerve – Med. Comp. of Thigh Muscles
- Sacral plexus :
+ Gluteal nerve
● Inf. Gluteal nerve = Glut. Maximus
● Sup. Gluteal N = Glut. Med & Min
+ Sciatic nerve
● Tibial Nerve – Post. Comp. of leg; intrinsic foot muscles
● Common Peroneal Nerve – Superficial branch = Lat. Comp. of Leg.
Deep branch = Ant. Comp. of leg
12) Osteology of the ankle
- Lateral Malleolus goes a little more inferior than then medial malleolus
- There is articulation between the Tibia and the talus create the ankle joint
- There is also articulation between the Talus and the Calcaneus (which is your heel
bone)
+ The inversion (medial) and eversion (lateral outward) movement of the
foot. Which movement is easier? Inversion is easier since we have a little
more lateral malleolus in the fibula which limits the eversion.
13) osteology of the foot
- Phalanges:
+ Distal Middle (except for big toe)
+ Proximal
- Metatarsals (1-5)
- Tarsals (7)
+ Distal row: Cuneiform (3), Cuboid
, + Intermediate Row: Navicular
+ Proximal Row: Talus, calcaneus (more posterior)
- On the lateral view, there is a notch in the Cuboid and in the fifth metatarsal has a
big projection (important for insertion of muscles)
- Movement of the foot:
+ Inversion and eversion
+ Dorsiflexion and Plantar flexion
14) Compartments of the leg
- Anterior compartment
+ Primarily dorsiflexors of foot & extensors of the toes
- Lateral compartment
+ Evert the foot
- Posterior compartment
+ Primarily plantar flexors of foot & flexors of the toes
15) Posterior compartment – Superficial group
- have 3 muscles which is created a Calcaneal tendon
15.1 gastrocnemius
- O: 2 heads: from the medial and lateral condyles of the femur (cross the knee joint)
- I: Calcaneus bone via the Calcaneal tendon
- A: Main job is plantar flexors the foot when the knee is extended, bit can also flex
the knee since it cross the knee joint
- I: tibial n.
15.2. Soleus
- O: below the gastrocnemius, in the superior tibia, fibula and interosseous membrane
- I: same as Gastrocnemius
- A: Plantar flexor the foot, important postural and locomotor muscle during running
and walking. (When standing too long, the soleus making adjustment to the posture)
- I: Tibial nerve.
15.3. Plantaris
- Plantaris is a small, weak muscle that may or may not be absent in the leg. What
forearm muscle does it remind you of? - Palmaris longus
- O: Posterior femur above the lateral condyle (cross the knee joint)
- I: Via long thin tendon into the calcaneus bone via calcaneal tendon
- A: Assists in knee flexion and plantar flexion of foot
- I: Tibial N.
1) Pigeon pose and Seated Twist
- Pigeon pose – hyperflex in the thigh – stretch the piriformis and the hamstrings
- Seated twist – hyperflex in the thigh – gluteus maximus and you feel the stretching
way to the knee as the gluteus maximus insert into the IT band that extends all the
way along the lateral aspect of the thigh and insert below the knee.
2) Characteristics of a Synovial Joint (include glenoid and hip joint)
- A joint consists of 2 bones that articulate or move on each other and at the
ends of the bones:
a. Articular cartilage – protect the bone, smooth surface
b. Articular capsule – extra shock absorber
+ Fibrous capsule
+ Synovial membrane
c. Synovial Fluid – oily fluid for frictionless movement
d. Articular disc (may be present) – adding stability mechanism for the joint (keep the
bones aligned properly + provide extra cushion between the joint)
e. Intracapsular and extracapsular ligaments (may be present)
3) Clinical condition: Osteoarthritis
- Damage to articular cartilage covering bone surface (no more cartilage) -> bone
grinding on bone (painful)
- Very difficult to repair because this tissue (articular cartilage) is avascular (không
mạch) (no blood supply and innervation) (receiving blood through passive diffusion)
-> slow to repair
- Treatment involves pain management and prevention of further damage. Using joint
replacement to cover the head of femur and acetabulum
4) The knee joint
- An example of a complex synovial joint consisting of both a hinge (femoro-tibial)
(one direction: flexion and extension) and a plane(femoro-patellar) joint (slide up
and down).
5) Patella
- A sesamoid bone that is embedded within a tendon. The anterior view is kinda
smooth while the posterior is sort of prominent which fit nicely into the groove of
femur
- Increases mechanical advantage of quadriceps by approximately 30% (since the
quadricep tendon insert in patella)
- Holds quadriceps tendon more anterior for additional leverage
- Bony surface to withstand compression on quad. tendon while kneeling
- Reduces friction on tendon during flexion/extension – ie during running
,6) Knee Joint Stability
- Femur and tibia sit nicely on top of others.
- Dependent upon:
a. Strength and actions of surrounding muscles
b. Ligaments connecting femur to tibia and fibula
- Stability from the surrounding muscles
+ Anteriorly, quadriceps tendon
+ Laterally, the IT band
+ Medially, the Sartorius + Gracilis + Semitnedinosus
+ Posteriorly, semimembranosus in the Tibia and the biceps femoris in the
fibula.
- Ligaments of the fibrous capsule (external to the fibrous capsule)
+ Patellar ligament (from the patella to the tibia)
+ Lateral fibular collateral ligament (LCL) not attach to its menisci
+ Medial tibial collateral ligament (MCL) also attach to the menisci
----> Prevent side to side movement of tibia wrt femur
- Fibrous capsule surround the knee joint to reinforce the stability
- Looking down internally to the knee joint and in the superior view of the tibia:
+ There is a tibial plateau including the medial and lateral condyles
+ Between the plateau is the intercondylar region – where the bones don’t articulate
+ There is an additional disk between the two bones and these in the knee called the
meniscus (plural: menisci)
+ The fibrous capsule surrounds all the knee joints. In the medial side, this capsule is
attached to the medial meniscus which is important when we talk about injuries
because if you have an injury to the capsule, on the medial side, chances are it’s also
going to impact the medial meniscus.
- Everything is surrounded by the synovial membrane – a specialized tissue that
produces the synovial fluid
- The synovial membrane extends beyond the patella therefore, the knee injection for
inflammation can inject there without trying to go interiorly.
7) Cruciate Ligaments - Intracapsular
- These are intracapsular ligaments that provide additional support.
- The knee not only has an extra capsule but it also has an intracapsular.
- Between the tibial plateau in the intercondylar region, there are Posterior cruciate
ligament and Anterior cruciate ligament (this is a common damage) cross.
+ Anterior cruciate ligament extend from the anterior aspect of the tibia to the
posterior aspect of the femur -> prevent the sliding of tibia on the femur
(forward movement)
+ Posterior cruciate ligament extend from the posterior aspect of the femur to
the anterior aspect of the tibia ( prevent downward movement of the tibia) (ie.
when walking down hill, the PCL prevent the tibia to slide)
8) Functions of Cruciate Ligaments
- During knee flexion, both ACL and PCL are tight, ACL prevent forward movement of
the tibia and PCL prevents posterior movement of tibia
, - In the extended knee, both ACL and PCl become taut and lock the knee
- Being a complex joint, the knee is subject to injuries such as tearing of ligaments
9) The unhappy Triad
- A blow from the lateral side can result in separation of the femur and tibia medially
and damage to the tibial collateral ligament (MCL), the medial meniscus and the
anterior cruciate ligament.
- Testing of Cruciate Ligament by using the drawer test.
10) ACL/PCL ligament testing
- Anterior drawer sign (ACL) and Posterior drawer sign (PCL)
- Positive tests indicate torn ligament which allows motion that is normally prevented
by that ligament.
- Thinking about walking downhill – PCL prevents femur from sliding forward
11) Wiring diagram: Innervation of lower limb
- Lumbar plexus :
+ Femoral nerve – Ant. Comp. of thigh muscles
+ Obturator nerve – Med. Comp. of Thigh Muscles
- Sacral plexus :
+ Gluteal nerve
● Inf. Gluteal nerve = Glut. Maximus
● Sup. Gluteal N = Glut. Med & Min
+ Sciatic nerve
● Tibial Nerve – Post. Comp. of leg; intrinsic foot muscles
● Common Peroneal Nerve – Superficial branch = Lat. Comp. of Leg.
Deep branch = Ant. Comp. of leg
12) Osteology of the ankle
- Lateral Malleolus goes a little more inferior than then medial malleolus
- There is articulation between the Tibia and the talus create the ankle joint
- There is also articulation between the Talus and the Calcaneus (which is your heel
bone)
+ The inversion (medial) and eversion (lateral outward) movement of the
foot. Which movement is easier? Inversion is easier since we have a little
more lateral malleolus in the fibula which limits the eversion.
13) osteology of the foot
- Phalanges:
+ Distal Middle (except for big toe)
+ Proximal
- Metatarsals (1-5)
- Tarsals (7)
+ Distal row: Cuneiform (3), Cuboid
, + Intermediate Row: Navicular
+ Proximal Row: Talus, calcaneus (more posterior)
- On the lateral view, there is a notch in the Cuboid and in the fifth metatarsal has a
big projection (important for insertion of muscles)
- Movement of the foot:
+ Inversion and eversion
+ Dorsiflexion and Plantar flexion
14) Compartments of the leg
- Anterior compartment
+ Primarily dorsiflexors of foot & extensors of the toes
- Lateral compartment
+ Evert the foot
- Posterior compartment
+ Primarily plantar flexors of foot & flexors of the toes
15) Posterior compartment – Superficial group
- have 3 muscles which is created a Calcaneal tendon
15.1 gastrocnemius
- O: 2 heads: from the medial and lateral condyles of the femur (cross the knee joint)
- I: Calcaneus bone via the Calcaneal tendon
- A: Main job is plantar flexors the foot when the knee is extended, bit can also flex
the knee since it cross the knee joint
- I: tibial n.
15.2. Soleus
- O: below the gastrocnemius, in the superior tibia, fibula and interosseous membrane
- I: same as Gastrocnemius
- A: Plantar flexor the foot, important postural and locomotor muscle during running
and walking. (When standing too long, the soleus making adjustment to the posture)
- I: Tibial nerve.
15.3. Plantaris
- Plantaris is a small, weak muscle that may or may not be absent in the leg. What
forearm muscle does it remind you of? - Palmaris longus
- O: Posterior femur above the lateral condyle (cross the knee joint)
- I: Via long thin tendon into the calcaneus bone via calcaneal tendon
- A: Assists in knee flexion and plantar flexion of foot
- I: Tibial N.
