PANTOMATH

Arches of the Foot Functions

• Transmission of weight
• Distribution of weight
• Adds resilience
• Aids propulsion in gait
• Adaptability on uneven surfaces

Must know

• Bones of the foot
• Joints of the foot
• Ligaments
• Muscle attachments

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Functions of foot

• weight bearing
• propulsion
• a high degree of stability and flexibility.
• three arches.
  • Longitudinal
    • Medial
    • Lateral
  • Transverse

Function of the arches

1. form a stable support to stand on with minimal muscular effort.   
   •  for proportional  distribution of weight  to the ground
2. makes the foot flexible, so that it can adapt  to uneven surfaces.
3. make the foot a segmented effective lever as it pushes off the ground.
4. protect the structures in the foot.
5. act as a shock absorber when landing from a height. Adds resilience (elasticity).6) arched foot is dynamic & pliable.

Medial  longitudinal arch Lateral longitudinal arch

Factors maintaining the arch:

• Bones
• Inter segmental tiers
• Tie beams
• Acting from above

Transverse archFactors maintaining the arch

1. Bones: the intermediate cuneiform and lateral cuneiforms are wedge shaped and thus adapted to maintain this arch.
2. Inter segmental tiers: Ligaments – which hold the cuneiforms and metatarsal bases (plantar ligaments).
3. Tie beam:   Tendons of PL & TP.                  
4. Acting from above: 
   • PT & PB On lateral side.                                      
   • TA  on medial side.

• A shallow transverse arch is maintained at the metatarsal heads by
  • a) the deep transverse metatarsal ligament,
  • b) transverse fibres that hold together the digital slips of the plantar aponeurosis and
  • to a lesser extent by the transverse head of the adductor hallucis

Movements

• Plantar flexion / dorsiflexion
• Eversion / Inversion
• Forefoot adduction / abduction
• Pronation / supination

Applied Anatomy

• Pes planus/ pes cavus
• Congenital talipes equino varix (CTEV)
• Talipes calcaneus
• Talipes valgus 

Gait

• Stance
  • Heel strike
  • Midstance
  • Propulsion
• Swing

Hip joint

• Type
• Articulating surfaces
• Ligaments and Factors maintaining stability
• Relations and Bursae
• Vascular supply & Lymphatic drainage
• Innervation
• Movements & muscles producing the movements
• Applied anatomy

Ligaments

• Capsular ligament with synovial membrane.
• Ilio- femoral ligament.
• Pubo-femoral ligament.
• Ischio-femoral ligament.
• Acetabular labrum.
• Transverse acetabular ligament.
• Ligament of head of femur.

Capsule

Proximal

• Attached close to acetabular margin, extending 5-6 mm above labrum.     

Distal 

• Covers anterior surface of the femoral neck.
• Attached along the inter trochanteric line.
• Capsule fits like a tight collar along a line  which lies 1 cm medial to & parallel to the trochanteric crest.

Retinacular fibers

• From the intertrochanteric line few fibers are reflected upward and medially along the neck beneath the synovial membrane.
• They convey blood vessels to the neck and head of femur.

Zona orbicularis

• Deep fibers are circularly arranged.
• Spiral fibers of Ischiofemoral ligament are continuous.

Iliofemoral ligament

• Ligament of Bigelow.
• Strongest ligament.
• Strengthens the anterior part of the capsule.
• Prevents hyper-extension of the hip joint.

Iliofemoral ligament

• Apex : anterior inferior iliac spine.
• Base : diverges as medial & lateral bands.
  • Medial band  : attached to lower part of I.T line.
  • Lateral band : attached to a tubercle in the upper part of Intertrochanteric line         
  • Intermediate stratum :   thin, attached to the rest of the line

Pubo-femoral ligament

• Is triangular.
• Attached to the ilio pubic eminence, superior pubic ramus, obturator crest and  obturator membrane.

Pubo-femoral ligament

• Blends with the capsule,deep surface of medial band of ilio-femoral ligament.
• Prevents over abduction of the joint.

Ischio- femoral ligament

• Ligament of Bertin.
• Triangular band of strong fibers on the posterior side of the joint.
• From the ischium close to the acetabulum to blend with the circular fibers of the joint capsule and attach at the intertrochanteric line of the femur.

Acetabular labrum

• A fibro - cartilagenous rim attached to the acetabular margin

Transverse acetabular ligament

• Bridges the acetabular notch and blends with the base of the ligament of  the head of femur.

Ligament of head of femur

• Ligamentum teres femoris.
• Triangular fibrous band  -apex to fovea of femoral head
• Base to two ends of acetabular notch
• Blends with transverse Acetabular ligament.

Factors maintaining stability

• Deep insertion of femoral head into acetabulum.
• Acetabular labrum deepens the socket.
• Muscles around the joint.
• Thick capsule reinforced by 3 major ligaments and ligament of the head of femur.
• Increased stability causes decrease in range of movements.

Relations of the joint

Anterior:

• Lateral part of pectineus.
• Psoas major
• Iliacus
• Straight head of rectus femoris
• Femoral vein, artery, nerve.

Relations of the joint

Posterior:

• Obturator Externus, Piriformis, Obturator Internus, gemelli, Quadratus Femoris, gluteus maximus.
• superior and inferior gluteal vessels and nerves.
• Sciatic nerve, Posterior cutaneous nerve of thigh, nerve to quadratus femoris.

Relations of the joint

Superior :

• Gluteus medius, minimus and overlying maximus

Inferior:

• Pectineus and Obturator Externus

Bursae in relation to the Joint

• May communicate with sub tendinous Psoas bursa by a circular aperture between pubofemoral ligament & vertical band of iliofemoral ligaments.

Lymphatic Drainage

• Anterior part drains into deep inguinal nodes
• Medial and posterior aspect run with obturator and gluteal arteries respectively and drain into internal iliac nodes

Nerve supply

• Femoral nerve (muscular. Br.) 
• Obturator nerve        
• Accessory Obturator nerve
• Superior Gluteal nerve              
• Nerve to Quadratus femoris

Movements

• Flexion
• Extension
• Abduction
• Adduction
• Medial rotation
• Lateral rotation
• Circumduction

Flexion and Extension
(around transverse axis)

• FLEXION :  Ilio Psoas---Prime mover                         

                             Pectineus, Rectus Femoris, Sartorius                          
                             Adductor Longus, Brevis, Magnus, Gracilis 

• EXTENSION: Gluteus Maximus                                

                                  Hamstring muscles

Abduction and Adduction
(around anteroposterior axis)

• ADDUCTION : Adductor Longus, Adductor Brevis,             

                                    Adductor part of Adductor Magnus                                 
                                    Gracilis 

• ABDUCTION : Gluteus Maximus,

                                    Gluteus Medius,             
                                    Gluteus minimus                                                                                              
                                     Tensor Fasciae latae , Sartorius

Medial and Lateral rotation
(around vertical axis)

• MEDIAL ROTATION : Gluteus  Medius,                                       

                                               Gluteus Minimus,                                       
                                               Tensor Fasciae Latae 

• LAT. ROTATION : Gluteus Maximus                                         

                                         Short Lateral rotators-                                           
                                         Piriformis,obturator internus                                           
                                        and externus, gemelli,  
                                        quadratus femoris
 
Applied anatomy

• Fracture of neck of femur
• Dislocation of hip joint.               
  • Congenital                 
  • Acquired
• Coxa vara & coxa valga.
• Arthritis of hip joint
• Measurements