Knee (Tibiofemoral) Joint
and 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 HeadLateral 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
Surface Anatomy
• www.rad.washington.edu/atlas2/extdiglong.
html