The Muscular System Manual: The Skeletal Muscles of the Human ...

The Muscular System Manual: The Skeletal Muscles of the Human ...

KINESIOLOGY: The Skeletal System and Muscle Function Second Edition Joseph E. Muscolino, DC Instructor, Purchase College State University of New York Owner, The Art and Science of Kinesiology Stamford, Connecticut Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 1 Chapter 8: Joints of the Lower Extremity Joseph E. Muscolino, DC Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Lesson 8.1 Objectives

Define the key terms of this chapter and state the meanings of the word origins of this chapter. Describe the structure of the pelvis and explain the difference between intrapelvic motion and motion of the pelvis relative to an adjacent body part. Describe the sacral movements of nutation and counternutation. Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 3

Lesson 8.1 Objectives (contd.) Describe and compare movements of the pelvis at the lumbosacral and hip joints. Explain the reverse action relationships between pelvic movements and movements of the trunk and thighs. Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4

Joints of the Lower Extremity Symphysis pubis joint Sacroiliac joints Lumbosacral joint Hip joints

Knee joint complex Tibiofibular joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 5 Joints of the Lower Extremity (contd.)

Talocrural (ankle) joint Tarsal joints Tarsometatarsal joints Intermetatarsal joints Metatarsophalangeal (MTP) joints Interphalangeal (IP) joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

6 Section 8.1Introduction to the Pelvis Figure 8-1 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 7

Section 8.1Introduction to the Pelvis (contd.) Joints Located within the Pelvis: Symphysis pubis joint Sacroiliac joints Pelvic Motion: Intrapelvic motion Motion of pelvis as a unit relative to an adjacent body part Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 8

Section 8.2Intrapelvic Motion Figure 8-2 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 9 Section 8.2Intrapelvic Motion (contd.) Symphysis Pubis Joint:

Structure: Cartilaginous joint Symphysis joint Function: Amphiarthrotic Major motions: Nonaxial gliding Major ligaments: Arcuate pubic ligament Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 10 Section 8.2Intrapelvic Motion

(contd.) Sacroiliac Joints: Structure: Mixed synovial/fibrous joint Plane joint Function: Mixed diarthrotic/amphiarthrotic Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 11 Section 8.2Intrapelvic Motion

(contd.) Sacroiliac Joints (contd.): Major motions allowed: Nonaxial gliding Nutation and counternutation Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 12 Section 8.2Intrapelvic Motion (contd.)

Sacroiliac Joints (contd.): Major ligaments of the SI joint: Sacroiliac ligaments Sacrotuberous ligament Sacrospinous ligament Iliolumbar ligament Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 13 Section 8.2Intrapelvic Motion

(contd.) Sacroiliac Joints (contd.): Figure 8-5 Modeled from Kapandji IA: Physiology of the joints: the trunk and the vertebral column, ed 2, Edinburgh, 1974, Churchill Livingstone. Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 14 Section 8.3Movement of the Pelvis at the Lumbosacral Joint

Figure 8-6 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 15 Section 8.3Movement of the Pelvis at the Lumbosacral Joint (contd.) Figure 8-6 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 16 Section 8.3Movement of the Pelvis at the Lumbosacral Joint (contd.) {Insert Fig. 8-6 E and F only} Figure 8-6 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

17 Section 8.4Movement of the Pelvis at the Hip Joints Figure 8-7 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 18 Section 8.4Movement of the Pelvis at

the Hip Joints (contd.) Figure 8-7 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 19 Section 8.4Movement of the Pelvis at the Hip Joints (contd.) Figure 8-7

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 20 Section 8.5Movement of the Pelvis at the Lumbosacral and Hip Joints Average Ranges of Motion: Anterior tilt 30 degrees Posterior tilt 15 degrees

Right depression 30 degrees Left depression 30 degrees Right rotation 15 degrees Left rotation 15 degrees Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 21

Section 8.5Movement of the Pelvis at the Lumbosacral and Hip Joints (contd.) Figure 8-8 (Modified from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby.) Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

22 Section 8.6Relationship of Pelvic/Spinal Movements at the Lumbosacral Joint Sagittal plane movements Frontal plane movements Transverse plane movements Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 23

Section 8.6Relationship of Pelvic/Spinal Movements at the Lumbosacral Joint (contd.) Figure 8-9 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 24 Section 8.6Relationship of Pelvic/Spinal Movements at the Lumbosacral Joint

(contd.) Figure 8-9 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 25 Section 8.6Relationship of Pelvic/ Spinal Movements at the Lumbosacral Joint (contd.) {Insert Fig. 8-10 A, B, C}

Figure 8-10 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 26 Section 8.6Relationship of Pelvic/Spinal Movements at the Lumbosacral Joint (contd.) Figure 8-11

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 27 Section 8.7Relationship of Pelvic/Thigh Movements at the Hip Joint Sagittal plane movements Frontal plane movements Transverse plane movements Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 28 Section 8.7Relationship of Pelvic/Thigh Movements at the Hip Joint (contd.) Figure 8-12 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 29

Section 8.7Relationship of Pelvic/Thigh Movements at the Hip Joint (contd.) Figure 8-12 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 30 Section 8.7Relationship of Pelvic/Thigh Movements at the Hip Joint (contd.)

Figure 8-13 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 31 Section 8.7Relationship of Pelvic/Thigh Movements at the Hip Joint (contd.) Figure 8-13

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 32 Section 8.7Relationship of Pelvic/Thigh Movements at the Hip Joint (contd.) Figure 8-14 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 33

Section 8.7Relationship of Pelvic/Thigh Movements at the Hip Joint (contd.) Figure 8-14 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 34 Lesson 8.2 Objectives Explain the relationship between pelvic

posture (and, specifically, the sacral base angle) and spinal posture. Discuss the meaning of open-chain and closed-chain activities and give examples of each. Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 35 Lesson 8.2 Objectives (contd.)

Explain the concepts of the femoral angle of inclination and femoral torsion angle, and explain the possible consequences of these femoral angulations. Describe and give an example of the concept of femoropelvic rhythm. Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 36 Joints of the Lower Extremity

Symphysis pubis joint Sacroiliac joints Lumbosacral joint Hip joints Knee joint complex Tibiofibular joints

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 37 Joints of the Lower Extremity (contd.)

Talocrural (ankle) joint Tarsal joints Tarsometatarsal joints Intermetatarsal joints Metatarsophalangeal (MTP) joints Interphalangeal (IP) joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 38

Section 8.8Effect of Pelvic Posture on Spinal Posture Sacral base angle Lumbopelvic rhythm Righting reflex Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 39 Section 8.8Effect of Pelvic

Posture on Spinal Posture (contd.) Figure 8-15 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 40 Section 8.9Hip Joint {Insert Fig. 8-16} Figure 8-16

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 41 Section 8.9Hip Joint (contd.) Structure Classification: Synovial joint Ball-and-socket Function Classification:

Diarthrotic Triaxial Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 42 Section 8.9Hip Joint (contd.) Major Motions Allowed: Flexion and extension of thigh Abduction and adduction of thigh

Medial rotation and lateral rotation of thigh Reverse Actions: Movement of pelvis Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 43 Section 8.9Hip Joint (contd.) Open-chain activity Distal bone of joint free to move

Closed-chain activity Distal bone of joint fixed Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 44 Section 8.9Hip Joint (contd.) {Insert Fig. 8-17 A and B only}

Figure 8-17 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 45 Section 8.9Hip Joint (contd.) {Insert Fig. 8-17 C and D only}

Figure 8-17 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 46 Section 8.9Hip Joint (contd.) Figure 8-17 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 47 Section 8.9Hip Joint (contd.) Average Ranges of Motion: Flexion 90 degrees Extension 20 degrees Abduction 40 degrees

Adduction 20 degrees Medial rotation 40 degrees Lateral rotation 50 degrees Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 48 Section 8.9Hip Joint

(contd.) Major Ligaments of the Hip Joint: Fibrous joint capsule Iliofemoral ligament Pubofemoral ligament Ischiofemoral ligament Ligamentum teres Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 49

Section 8.9Hip Joint (contd.) Figure 8-18 C, Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 50

Section 8.9Hip Joint (contd.) Closed-Packed Position: Full extension Major Muscles of the Hip Joint: Anterior muscles Posterior muscles Medial muscles Lateral muscles Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 51

Section 8.10Angulations of the Femur Femoral Angles of Inclination: Figure 8-19 Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 52

Section 8.10Angulations of the Femur (contd.) Femoral Torsion Angles: Figure 8-20 Modeled from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 53

Section 8.11Femoropelvic Rhythm Figure 8-21 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 54 Lesson 8.3 Objectives Explain the concepts of the angulations of the knee joint, namely, genu valgus, genu

varum, Q-angle, and genu recurvatum. Describe and give an example of the concept of bowstringing. Describe tibial torsion. Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 55 Joints of the Lower Extremity

Symphysis pubis joint Sacroiliac joints Lumbosacral joint Hip joints Knee joint complex Tibiofibular joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 56 Joints of the Lower Extremity (contd.)

Talocrural (ankle) joint Tarsal joints Tarsometatarsal joints Intermetatarsal joints Metatarsophalangeal (MTP) joints Interphalangeal (IP) joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 57 Section 8.12Overview of the

Knee Joint Complex Tibiofemoral joint Patellofemoral joint Figure 8-22 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 58 Section 8.13Tibiofemoral (Knee) Joint Structure Classification:

Synovial joint Modified hinge joint Function Classification: Diarthrotic Biaxial Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 59 Section 8.13Tibiofemoral

(Knee) Joint (contd.) Major Motions Allowed: Flexion and extension of leg Medial rotation and lateral rotation of leg Reverse Actions: Flexion and extension of thigh Lateral rotation and medial rotation of thigh Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 60

Section 8.13Tibiofemoral (Knee) Joint (contd.) {Insert Fig. 8-23 A and B only} Figure 8-23 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 61

Section 8.13Tibiofemoral (Knee) Joint (contd.) {Insert Fig. 8-23 C and D only} Figure 8-23 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 62 Section 8.13Tibiofemoral

(Knee) Joint (contd.) Average Ranges of Motion: Flexion 140 degrees (Hyper)extension 5 degrees Medial rotation 15 degrees Lateral rotation 30 degrees Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

63 Section 8.13Tibiofemoral (Knee) Joint (contd.) Major Ligaments of the Knee Joint: Fibrous joint capsule Medial collateral ligament Lateral collateral ligament Anterior cruciate ligament Posterior cruciate ligament Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 64 Section 8.13Tibiofemoral (Knee) Joint (contd.) Figure 8-24 Modified from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

65 Section 8.13Tibiofemoral (Knee) Joint (contd.) Figure 8-24 Modified from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 66

Section 8.13Tibiofemoral (Knee) Joint (contd.) Figure 8-24 Modified from Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 67 Section 8.13Tibiofemoral

(Knee) Joint (contd.) Closed-Packed Position: Full extension Major Muscles of the Knee Joint: Anterior muscles Posterior muscles Medial muscles Lateral muscles Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 68

Section 8.13Tibiofemoral (Knee) Joint (contd.) Menisci Medial meniscus Lateral meniscus Major bursae Screw-home mechanism Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

69 Section 8.14Patellofemoral Joint Figure 8-25 Figure 8-26 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 70

Section 8.14Patellofemoral Joint (contd.) Structure of the Patella: Medial facet Lateral facet Articular cartilage Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 71

Section 8.14Patellofemoral Joint (contd.) Major Motions Allowed: Superior and inferior gliding (nonaxial) movements Closed-Packed Position: Flexion (of the knee joint) Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 72

Section 8.14Patellofemoral Joint (contd.) Functions of the Patella: Acts as an anatomic pulley Reduces friction Protects the femoral condyles Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 73 Section 8.15Angulations of

the Knee Joint Knee Joint Angulation Measurements: Genu valgum/varum Q-angle Genu recurvatum Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 74 Section 8.15Angulations of the Knee Joint (contd.)

Knock-Knees Bowleg {Insert Fig. 8-27} Figure 8-27 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Figure 8-28

75 Section 8.15Angulations of the Knee Joint (contd.) Q-Angle: Figure 8-28 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 76

Section 8.15Angulations of the Knee Joint (contd.) Bowstring Force: Figure 8-29 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 77 Section 8.15Angulations of the Knee Joint (contd.)

Genu Recurvatum: Figure 8-30 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 78 Section 8.16Tibiofibular Joints Tibiofibular Joints: Proximal tibiofibular joint Middle tibiofibular joint

Distal tibiofibular joint Figure 8-31 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 79 Section 8.16Tibiofibular Joints (contd.) Interosseus membrane Two purposes

Tibial torsion Lateral twist of shaft of tibia Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 80 Lesson 8.4 Objectives List the regions of the foot and the joints of the foot.

Compare and contrast the role of stability and flexibility of the foot. Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 81 Lesson 8.4 Objectives (contd.) Describe the structure and function of the arches of the foot; also, relate the windlass mechanism to the arches of the foot.

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 82 Joints of the Lower Extremity

Symphysis pubis joint Sacroiliac joints Lumbosacral joint Hip joints Knee joint complex Tibiofibular joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 83

Joints of the Lower Extremity (contd.) Talocrural (ankle) joint Tarsal joints Tarsometatarsal joints Intermetatarsal joints

Metatarsophalangeal (MTP) joints Interphalangeal (IP) joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 84 Section 8.17Overview of the Ankle/Foot Region Figure 8-32

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 85 Section 8.17Overview of the Ankle/Foot Region (contd.) Regions of the Foot: Hindfoot Midfoot Forefoot Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 86 Section 8.17Overview of the Ankle/Foot Region (contd.) Functions of the Foot: Provides stability Bears weight of body Absorbs shock from motion Propels body through space Provides flexibility

Adapts to uneven ground Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 87 Section 8.17Overview of the Ankle/Foot Region (contd.) Joints of the Ankle/Foot Region: Talocrural (ankle) joint Tarsal joints Subtalar joint

Transverse tarsal joint Distal intertarsal joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 88 Section 8.17Overview of the Ankle/Foot Region (contd.) Joints of the Ankle/Foot Region (contd.): Tarsometatarsal (TMT) joints Intermetatarsal joints

Metatarsophalangeal (MTP) joints Interphalangeal (IP) joints Proximal interphalangeal (PIP) joints Distal interphalangeal (DIP) joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 89 Section 8.17Overview of the Ankle/Foot Region (contd.) Arches of the Foot:

Medial longitudinal arch Lateral longitudinal arch Transverse arch Figure 8-33 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 90 Section 8.17Overview of the

Ankle/Foot Region (contd.) Evaluating the Arches of the Foot: Pes cavus (excessive arch) Pes planus (decreased arch) Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 91 Section 8.17Overview of the Ankle/Foot Region (contd.) Plantar Fascia:

Superficial layer Deep layer Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 92 Section 8.17Overview of the Ankle/Foot Region (contd.) Windlass Mechanism: Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 93 Section 8.17Overview of the Ankle/Foot Region (contd.) Retinacula Hold down and stabilize tendons Bowstringing The lifting of a tendon away from its joint when a muscle contracts

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 94 Lesson 8.5 Objective Define pronation and supination of the foot; list and explain the component cardinal plane actions of pronation and supination. Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

95 Joints of the Lower Extremity Symphysis pubis joint Sacroiliac joints

Lumbosacral joint Hip joints Knee joint complex Tibiofibular joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 96 Joints of the Lower Extremity (contd.)

Talocrural (ankle) joint Tarsal joints Tarsometatarsal joints Intermetatarsal joints Metatarsophalangeal (MTP) joints Interphalangeal (IP) joints

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 97 Section 8.18Talocrural (Ankle) Joint Figure 8-34 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

98 Section 8.18Talocrural (Ankle) Joint (contd.) Structure Classification: Synovial joint Hinge joint Function Classification: Diarthrotic Uniaxial Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 99 Section 8.18Talocrural (Ankle) Joint (contd.) Major Motions Allowed: Dorsiflexion and plantarflexion of foot Reverse Actions: Dorsiflexion and plantarflexion of leg Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

100 Section 8.18Talocrural (Ankle) Joint (contd.) Figure 8-35 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 101

Section 8.18Talocrural (Ankle) Joint (contd.) Average Ranges of Motion: Dorsiflexion 20 degrees Plantarflexion 50 degrees * The amount of dorsiflexion varies based on the position of the knee joint. Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

102 Section 8.18Talocrural (Ankle) Joint (contd.) Major Ligaments of the Ankle Joint: Fibrous joint capsule Medial collateral ligament Lateral collateral ligament complex Anterior talofibular ligament Posterior talofibular ligament Calcaneofibular ligament Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 103 Section 8.18Talocrural (Ankle) Joint (contd.) Figure 8-36 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 104

Section 8.18Talocrural (Ankle) Joint (contd.) Figure 8-36 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 105 Section 8.18Talocrural (Ankle) Joint (contd.) Closed-Packed Position:

Dorsiflexion Major Muscles of the Ankle Joint: Anterior muscles Posterior muscles Medial muscles Lateral muscles Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 106 Section 8.18Talocrural

(Ankle) Joint (contd.) Figure 8-37 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 107 Section 8.19Subtalar Tarsal Joint Lateral View:

Medial View: Figure 8-38 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 108 Section 8.19Subtalar Tarsal Joint (contd.) Figure 8-39

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 109 Section 8.19Subtalar Tarsal Joint (contd.) Structure Classification: Synovial joint(s) Function Classification: Diarthrotic Uniaxial

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 110 Section 8.19Subtalar Tarsal Joint (contd.) Major Motions Allowed: Pronation and supination of foot Reverse Actions: Medial rotation and lateral rotation of leg Closed-Packed Position:

Supination Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 111 Section 8.19Subtalar Tarsal Joint (contd.) Figure 8-40 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 112 Section 8.19Subtalar Tarsal Joint (contd.) Component Cardinal Plane Actions: Pronation Supination Eversion Dorsiflexion

Abduction Inversion Plantarflexion Adduction Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 113 Section 8.19Subtalar Tarsal Joint (contd.)

Figure 8-40 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 114 Section 8.19Subtalar Tarsal Joint (contd.) Figure 8-40

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 115 Section 8.19Subtalar Tarsal Joint (contd.) Figure 8-40 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

116 Section 8.19Subtalar Tarsal Joint (contd.) Average Ranges of Motion: Eversion 10 degrees Inversion 20 degrees Dorsiflexion 2.5 degrees Plantarflexion 5 degrees

Abduction 10 degrees Adduction 20 degrees Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 117 Section 8.19Subtalar Tarsal Joint (contd.) Major Ligaments of the Subtalar Joint: Fibrous joint capsule(s)

Talocalcaneal ligaments Cervical ligament Spring ligament Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 118 Section 8.20Transverse Tarsal Joint Figure 8-41

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 119 Section 8.20Transverse Tarsal Joint (contd.) Compound Joint: Talonavicular joint Calcaneocuboid joint Structure Classification: Synovial joint(s)

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 120 Section 8.20Transverse Tarsal Joint (contd.) Major Motions Allowed: Pronation and supination of foot Closed-Packed Position: Supination

Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 121 Section 8.20Transverse Tarsal Joint (contd.) Ligaments of the Transverse Tarsal Joint: Fibrous joint capsule(s) Spring ligament Long plantar ligament Short plantar ligament Dorsal calcaneocuboid ligament

Bifurcate ligament Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 122 Lesson 8.6 Objective List the regions of the foot and the joints of the foot. Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

123 Joints of the Lower Extremity Symphysis pubis joint Sacroiliac joints Lumbosacral joint

Hip joints Knee joint complex Tibiofibular joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 124 Joints of the Lower Extremity (contd.)

Talocrural (ankle) joint Tarsal joints Tarsometatarsal joints Intermetatarsal joints Metatarsophalangeal (MTP) joints Interphalangeal (IP) joints Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 125 Section 8.21Tarsometatarsal Joints {Insert Fig. 8-42} Figure 8-42 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

126 Section 8.21Tarsometatarsal Joints (contd.) Major Motions Allowed: Dorsiflexion and plantarflexion of foot Inversion and eversion of foot Ligaments of the Tarsometatarsal Joints Fibrous joint capsule Tarsometatarsal ligaments Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

127 Section 8.22Intermetatarsal (IMT) Joints Figure 8-43 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 128

Section 8.22Intermetatarsal (IMT) Joints (contd.) Figure 8-43 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 129 Section 8.22Intermetatarsal (IMT) Joints (contd.) Major Motions Allowed: Nonaxial gliding motion of one metatarsal

relative to the adjacent metatarsal(s) Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 130 Section 8.23 Metatarsophalangeal Joints Figure 8-44 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 131 Section 8.23 Metatarsophalangeal Joints (contd.) {Insert Fig. 8-45 A and B only} Figure 8-45 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. 132 Section 8.23 Metatarsophalangeal Joints (contd.) Figure 8-45 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

133 Section 8.23 Metatarsophalangeal Joints (contd.) Figure 8-45 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 134

Section 8.23 Metatarsophalangeal Joints (contd.) Ligaments of the MTP Joints: Fibrous joint capsule Collateral ligaments Plantar plate Closed-Packed Position: Extension Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 135

Section 8.23 Metatarsophalangeal Joints (contd.) Figure 8-46 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 136 Section 8.24Interphalangeal

Joints of the Foot Figure 8-47 Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 137 Section 8.24Interphalangeal Joints of the Foot (contd.) Major Motions Allowed: Flexion and extension of toes

Ligaments of the IP Joints of the Foot: Fibrous capsule Medial collateral ligament Lateral collateral ligament Plantar plate Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 138

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