Leg&Foot 2


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  • Leg&Foot 2

    1. 1. Triceps surae; Gastrocnemius <ul><li>Action </li></ul><ul><ul><li>Flex the knee, plantar flex the ankle </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Condyles of the femur, posterior surfaces </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Calcaneus via calcaneal tendon </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Tibial (S1-2) </li></ul></ul>
    2. 2. Triceps surae; soleus <ul><li>Action </li></ul><ul><ul><li>Plantar flex the ankle </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Soleal line, post. surface of tibia and prox. post. surface of fibula </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Calcaneus via calcaneal tendon </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Tibial (S1-2) </li></ul></ul>
    3. 3. Gastrocnemius and Soleus- standing <ul><ul><li>Ask pt. to stand on her toe </li></ul></ul><ul><ul><li>Palpate the posterior leg, sculpting out the gastrocnemius’s oval head </li></ul></ul><ul><ul><li>Move distal to the gastrocnemius and palpate the distal portion of soleus </li></ul></ul><ul><ul><li>Both muscles blend into the calcaneal tendon </li></ul></ul>( Triceps surae)
    4. 4. Gastrocnemius and Soleus- standing <ul><ul><li>Accessible from an anterior direction </li></ul></ul><ul><ul><li>Locate tibial shaft </li></ul></ul><ul><ul><li>Slide medially off the shaft and feel the wad of muscle </li></ul></ul>
    5. 5. Gastrocnemius and Soleus- prone <ul><ul><li>Bend the knee to 90° </li></ul></ul><ul><ul><li>When the knee is flexed, gastronemius muscle is ineffectual as a plantar flexor </li></ul></ul><ul><ul><li>Isolate the soleus by asking pt. to gently plantar flex against your resistance </li></ul></ul>
    6. 6. Plantaris <ul><li>Action </li></ul><ul><ul><li>Weak plantar flexion of the ankle, weak flexion of the knee </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Lateral condyle of the femur </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Calcaneus via calcaneal tendon </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Tibial (S1-2) </li></ul></ul>
    7. 7. Plantaris <ul><ul><li>Prone with knee flexed </li></ul></ul><ul><ul><li>Locate the head of fibula </li></ul></ul><ul><ul><li>Move thumb medial into the popliteal space b/w gastrocnemius heads </li></ul></ul><ul><ul><li>Slowly sink into the tissue of the posterior knee </li></ul></ul>
    8. 8. Test for gastrocnemius and plantaris <ul><li>Patient: Standing </li></ul><ul><li>Test: Rising on toes, pushing the body weight directly upward </li></ul><ul><li>Pressure: Body weight </li></ul>
    9. 9. Test for soleus
    10. 10. Test for soleus <ul><li>Patient: Prone with the knee flexed at least 90° </li></ul><ul><li>Fixation: The examiner supports the leg, proximal to the ankle </li></ul><ul><li>Test: Plantar flexion of the ankle, without inversion or eversion of the foot </li></ul><ul><li>Pressure: Against the calcaneus, pulling the heel in a caudal direction. </li></ul>
    11. 11. Popliteus <ul><ul><li>Prone with knee flexed </li></ul></ul><ul><ul><li>Explore the posterior surface of the tibia by pushing the overlying edge of the soleus and gastrocnemius to the side </li></ul></ul>
    12. 12. Test for popliteus <ul><li>Patient: Sitting with the knee flexed at a right angle and with leg in lateral rotation of tibia on femur </li></ul><ul><li>Test: Medial rotation of the tibia on femur </li></ul><ul><li>Resistance: Seldom is resistance or pressure applied. </li></ul>
    13. 13. Peroneus longus and brevis <ul><ul><li>Locate the head of fibula and the lateral malleolus </li></ul></ul><ul><ul><li>Peroneal bellies are located b/w these landmarks </li></ul></ul><ul><ul><li>Ask pt. to alternately evert and relax her foot </li></ul></ul>
    14. 14. Test for peroneus longus & brevis <ul><li>Patient: Supine, with the extremity medially rotated, or side-lying (on the opposite side) </li></ul><ul><li>Fixation: The examiner supports the leg, above the ankle joint </li></ul><ul><li>Test: Eversion of the foot, with plantar flexion of the ankle joint </li></ul><ul><li>Pressure : Against the lateral border and sole of the foot, in the direction of inversion of the foot and dorsiflexion of the ankle joint </li></ul>
    15. 15. Anterior compartment <ul><li>Tibialis anterior </li></ul><ul><li>Extensor digitorum longus </li></ul><ul><li>Extensor hallucis longus </li></ul>
    16. 16. Tibialis anterior <ul><li>Action </li></ul><ul><ul><li>Invert the foot , dorsifelx the ankle </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Prox. lat. surface of tibia and interosseous membrane </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Medial cuneiform and base of 1 st metatarsal </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Deep peroneal </li></ul></ul>
    17. 17. Tibialis anterior <ul><ul><li>Supine </li></ul></ul><ul><ul><li>Locate the shaft of the tibia and slide off it laterally </li></ul></ul><ul><ul><li>Ask pt. to dorsiflex his ankle and palpate its long, inch-wide belly </li></ul></ul>
    18. 18. Test for tibialis anterior
    19. 19. Test for tibialis anterior <ul><li>Patient: Spine or sitting (with knee flexed if any gastrocnemius tightness is present) </li></ul><ul><li>Fixation: The examiner supports the leg, just above the ankle joint </li></ul><ul><li>Test: Dorsiflexion of the ankle joint and inversion of the foot, without extension of the great toe </li></ul><ul><li>Pressure: Against the medial side, dorsa surface of the foot, in the direction of plantar flexon of the ankle joint and eversion of the foot </li></ul>