KINES

• General Features


  • 28 bones
  • 25 joints
  • Has a flexible-rigid characteristics
• Functions


  • Support of superincumbent weight
  • Control and stabilization of the leg on the planted foot
  • Adjustment to irregular surfaces
  • Elevation of the body
  • Shock absorption
  • Operation of machine tools
  • Substitution for hand functions
• Terminologies


  • Planes and axis for:
  • Dorsiflexion and plantarflexion
  • Inversion and eversion
  • Abduction and adduction
  • Pronation and supination
• Bones


  • Leg
  • Tibia
  • Fibula
  • Foot
  • Hindfoot
  • Midfoot
  • Forefoot
• Calcaneum


  • Largest bone of the foot
  • Articulation above: talus
  • Articulation in front: cuboid
• Surfaces of the Calcaneum

  • Anterior surface
  • Posterior surface
  • Superior surface
  • Inferior surface
  • Medial surface
  • Lateral surface
• The apex of plantar aponeurosis is attached to lateral and medial tubercle
• Talus


  • The only bone without muscular attachment
  • Parts: Head, Neck, Body
• Talus


  • Articulation above: tibia and fibula
  • Articulation below: calcaneum
  • Articulation in front: navicular
• Head of Talus


  • Convex for articulation with navicular bone
  • Sustentaculum tali and plantar calcaneonavicular ligament - supports the head
  • Plantar calcaneonavicular ligament - from sustentaculum tali to navicular tuberosity - stretch, head moves down and in: Flat foot
• Neck of Talus


  • Posterior to the head
  • Inferior surface of neck: sulcus tali
  • Sulcus tali + sulcus calcanei = sinus tarsi
  • Interosseous talocalcaneal ligament located inside the sinus tarsi - The primary bond between the talus and calcaneus at the subtalar joint (Snell) - Attached to the sulcus tali and sulcus calcanei - The "proprioceptive center of the foot"
• Body of Talus


  • Superior(trochlear surface): articulates with the tibia
  • Lateral surface: with triangular articular facet for the lateral malleolus (larger)
  • Medial surface: with comma-shaped articular facet for medial malleolus
  • Posterior surface: with two tubercles separated by a groove for flexor hallucis longus tendon
• Navicular Bone


  • Important feature: navicular tuberosity
  • To palpate: 1 inch in front and below the medial malleolus
  • Serves as distal attachment for the tibialis posterior tendon
  • Its tuberosity is also the attachment for spring ligament
  • More inferior in flat foot - Feiss Line
• Cuboid


  • Has a groove: lodges the peroneus longus tendon
  • Proximal articulation: calcaneus
  • Distal articulation: base of 4th and 5th metatarsal
  • Medial articulation: lateral cuneiform
• Cuneiform


  • 3 Cuneiforms: Proximal articulation: navicular
  • Distal articulation: base of first three metatarsal bones
  • Lateral articulation: cuboid
• Metatarsals and Phalanges


  • has head, shaft and base
  • First metatarsal - has a major role for weight bearing
  • Inferior surface of head: has two sesamoid bones in tendons of flexor hallucis brevis
  • Tubercle of Fifth metatarsal - distal attachment of the peroneus brevis
• Joints


  • Proximal Tibiofibular Joint
  • Distal Tibiofibular Joint
  • Talocrural Joint
  • Subtalar Joint
  • Talocalcaneonavicular joint
  • Calcaneocuboid Joint
  • Tarsometatarsal and intermetatarsal Joints
  • Metatarsophalangeal and Interphalangeal Joints
• Ankle (Talocrural) Joint


  • Distal tibia, malleoli - body of the talus
  • Synovial Hinge Joint
  • Transverse Axis/Oblique Axis
  • Note: the body of the talus is wider anteriorly
  • Dorsiflexion - more stable
• Ankle (Talocrural) Joint


  • 1 ° of freedom: dorsiflexion/plantarflexion
  • Most congruent joint in the body
  • Ankle Mortise
  • Adjustable, relying on the proximal and distal tibiofibular joints
• Proximal Tibiofibular Joint


  • Plane synovial joint
  • Articulating surfaces: Head of the fibula, Posterolateral aspect of tibia
  • Stabilizers: Anterior and posterior ligaments and interosseous membrane
• Distal Tibiofibular Joint


  • Syndesmosis or fibrous union
  • Aka "forgotten joint"
  • Articulating surfaces: Fibular notch at the lower end of the tibia, Lower end of the fibula
  • Separated by a fibroadipose tissue
• Ligaments


  • Crural tibiofibular interosseous ligament*
  • Anterior and posterior tibifibular ligament
  • Interosseous membrane
  • Inferior transverse ligament
• Medial/Deltoid Ligament


  • "Antati, Potati, Cati, Tina"
  • Injury?
  • Apex = tip of medial malleolus
  • medial side of talus - Antati and Potati
  • Sustentaculum tali - Cati
  • Navicular tuberosity - Tina
• LCL/ Seperated Ligaments


  • "Antafi, Cafi, Potafi"
  • Weakest? Strongest
  • Antafi - lateral malleolus to lateral surface of talus
  • Cafi - lateral malleolus to lateral surface of calcaneum
  • Potafi - lat malleolus to posterior tubercle of the talus
• Bones of the Pelvis

  • Sacrum
  • Coccyx
  • Innominate bone
• Ankle (Talocrural) Joint


  • Function: Capable of talar rotation within the mortise both transverse and frontal plane
  • Medial rotation = 7°
  • Lateral rotation = 10°
  • Inversion-Eversion = 5°
  • Predominantly dorsiflexion and plantarflexion motions but does not occur purely on sagittal plane - Due to obliquity of the axis
• Ankle (Talocrural) Joint


  • Axis: Passes through lateral malleoulus, body of talus, and slightly inferior the medial malleoulus
  • Tibial torsion: 20 to 30° laterally
  • Therefore, DF bring the toes up and laterally and PF bring the toes down and medially
• Sacrum


  • Base of spine
  • Sacral Promontory - landmark for describing movements of sacrum
  • Sacral canal - tunnel at posterior part, pathway for some nerve roots
  • Sacral hiatus - end part of sacral canal
  • Sacral Cornua - projection near sacral hiatus, attachment of ligament that connects coccyx to sacrum
  • Lateral mass
  • Anterior and posterior sacral foramina - pathway of nerve roots
• Coccyx


  • Transverse process
  • Body
  • Coccygeal cornu - partners with sacral cornua through sacrococcygeal ligament
• Ankle (Talocrural) Joint


  • During DF: Talus abducts (ER) in non weight-bearing position, Fibula slides anteriorly on talus, The leg medially rotates in weight-bearing position
  • During PF: Talus adducts (IR) in non weight-bearing position, Fibula slides posteriorly on talus, The leg laterally rotates in weight-bearing position
• Ankle (Talocrural) Joint


  • Dorsiflexion
  • Plantarflexion
• Ankle (Talocrural) Joint


  • During DF: Fibula slides superiorly on proximal tibiofibular, Lateral malleolus laterally rotates, The malleoli distracts
  • During PF: Fibula slides inferiorly on proximal tibiofibular, Lateral malleoulus medially rotates, The malleoli approximates
• Ankle (Talocrural) Joint


  • Open-packed and closed-packed position: OPP: plantarflexed, CPP: full dorsiflexion
  • Range of motion: 20° of DF from neutral (0-30° from Brunnstrom), 30 to 50° of PF from neutral (0-58° from Brunnstrom)
• Subtalar Joint


  • A.k.a. Talocalcaneal joint
  • Plane synovial
  • 1° of freedom: pronation/supination
  • Triplanar motion
  • Has 3 separate articulations: Posterior, Middle, Anterior
• Innominate bone


  • Acetabulum - cup-like depression that receives the head femur
  • Acetabular fossa - depression at center of acetabulum
  • Lunate surface - articulates with head of femur
  • Acetabular notch
  • Greater sciatic notch - Lesser sciatic notch - passage for the roots of sciatic nerve
  • Body of ischium
  • Ischial spine
  • Ramus of ischium
  • Ischial tuberosity - sit bone
  • iliac crest - highest point of innominate bone, L4
  • Iliac fossa - large open area, iliacus
  • Iliac tubercle - origin of abdominal muscles
  • ASIS - landmark for identifying pelvic asymmetry
  • PSIS - nasa may auricular surface, S2, coerced by sacroiliac joint
  • AIIS - origin of rectus femoris
  • PIIS
  • Auricular surface - articulates with sacrum
  • Arcuate line - iliopectineal line, true or false elvis
  • Body of pubis - anterior-inferiorly located, and has the Superior and Inferior rami
  • Pubic crest - sharp part, lateral
  • Pubic tubercle - medial, origin of adductors (adductor longus, pectineus, gracilis)
  • Obturator foramen
• Subtalar Joint


  Posterior talocalcaneal articulation: Largest of the 3 articulations, Concave inferior surface of the body of talus and convex facet on the body of calcaneus, Has its own capsule
• Joints formed by the Pelvic Bones

  • Lumbosacral - L5 and sacrum
  • Sacroiliac - two (right n left)
  • Sacrococcygeal - sacrum and coccyx
  • Symbiosis pubis - moves during labor
  • Hip - acetabulum
• Subtalar Joint


  Anterior and middle talocalcaneal articulation: Two convex facets of the inferior body and neck of talus and two concave facets on the calcaneus, Has a shared joint capsule with talonavicular joint
• Subtalar Joint


  Tarsal canal or sinus tarsi: Formed by sulci which divides the posterior from the middle and anterior talocalcaneal articulation
• Function of Pelvis


  • Provides a strong and stable connection between the trunk and lower extremities
  • Transmit the weight of the body from the vertebral column to the femurs
  • Contain, support, and protect the pelvic viscera
  • Provide attachment for trunk and lower limb muscles