Position and ROM of Lower limb joints

Question 1

What is the position of the ankle axis relate to the knee in the transverse plane

Answer 1

20-30 degrees externally rotated from the knee axis

Question 2

Mechanical axis of the ankle

Answer 2

midline between apex of the medial malleoli and lateral malleoli

Question 3

Normal dorsiflexion ROM of the ankle

Answer 3

20-30 degrees

Question 4

Normal plantarflexion ROM of the ankle

Answer 4

20-50 degrees

Question 5

Ankle ROM required for normal gait

Answer 5

10 degrees dorsiflexion

20 degrees of plantarflexion

Question 6

Subtalar Joint postion

Answer 6

Anteriosuperomedially

41-45 degrees with respect to the horizontal

16 degrees with respect to the sagittal plane

Question 7

Subtalar joint ROM

Answer 7

20 degrees calcaneal inversion with full supination

5 degrees calcaneal eversion

Question 8

Subtalar ROM required for Normal Gait

Answer 8

4-6 degrees of calcaneal inversion and eversion

Question 9

Hip Joint axis approximation

Answer 9

Joint is Multiaxial, therefore only one point of rotation is relevant

Externally approximated at eh level of the greater trochanter

Question 10

Hip Joint Passive ROM for Flexion

Answer 10

120 with knee flexed

90 with knee extended

Question 11

Hip Joint Passive ROM for exension

Answer 11

30 degrees

Question 12

Hip Joint Passive ROM Abduction

Answer 12

45-50 degrees

Question 13

HIp Joint Passive ROM Adduction

Answer 13

20-30 degrees

Question 14

Hip Joint Passive External Rotation

Answer 14

45 degrees, 90 degrees with HIp Flexed

Question 15

Hip Joint Passive Internal Rotation

Answer 15

35 degrees, 70 degrees with Hip Flexed

Question 16

Hip Joint Normal Flexion ROM required for Gait

Answer 16

37 degrees

Question 17

Hip Joint Normal Extension ROM required for Gait

Answer 17

45 degrees

Question 18

Hip Joint Normal Abduction ROM required for Gait

Answer 18

7 degrees

Question 19

Hip Joint Normal Adduction ROM required for Gait

Answer 19

5 degrees

Question 20

Hip joint Normal External rotation required for Gait

Answer 20

9 degrees

Question 21

Hip joint Normal Internal rotation required for Gait

Answer 21

4 degrees

Question 22

Knee Joint

Answer 22

Changes throughout ROM (polycentric)

Radius of curvature of condyles decreases with flexion

Question 23

Knee Axis approximation

Answer 23

Heigh of the adductor tubercle

Bisecting femoral condyles in the sagittal plane

Parallel to epicondyles in the frontal plane

Question 24

Knee Flexion ROM

Answer 24

Passive

160

Active

140 with hip flexed
120 with hip extended

Question 25

Knee Extension ROM

Answer 25

0 degrees

Question 26

Knee Axial Rotation

Answer 26

0 degrees full extension 30 degrees internal rotation with 90 degrees of knee flexion 45 degrees of external rotation with 90 degrees knee flexion less with greater knee flexion due to soft tissue restrictions

Question 27

Mid Tarsal Joints

Answer 27

Comprised of Calcaneocuboid and Talonavicular joints Calcaneocuboid - oblique axis Responsible for aBd/aDd and Plantar/Dorsi Talonavicular - longitudinal axis Primarily Inversion/Eversion In pronation, axes become more parallel, foot is more flexible and adaptive In supination, oblique and longitudinal axes become less congruent, binding produces more rigid foot segment ROM is 4-6 degrees inversion, compensates for 4-6 degrees calcaneal eversion required for normal gait

Question 28

Calcaneocuboid joint axis

Answer 28

Oblique axis Runs anteriosuperiomedially Largely in frontal and horizontal planes Dorsiflexion/aBduction Plantarflexion/aDduction

Question 29

First Ray

Answer 29

First cuneiform and first metatarsal

Question 30

Second Ray

Answer 30

Middle cuneiform and second metatarsal

Question 31

Third Ray

Answer 31

Lateral cuneiform and third metarsal

Question 32

Fourth Ray

Answer 32

Fourth Metatarsal

Question 33

Fifth Ray

Answer 33

Fifth Metatarsal

Question 34

Talonavicular joint

Answer 34

Also runs anterosuperiomedially But largely confined to sagittal and horizontal planes Therefore abel to mostly inverts/everts

Question 35

Tarsometatarsal joints

Answer 35

Rays of the foot Multiaxial plane joints Plantarflexion and dorsiflexion are main movements possible However, 1st rays everts with dorsiflexion, inverst with plantarflexion Keeps first met head in contact with ground during supination/push off

Question 36

Metatarsophalangeal joints

Answer 36

Synovial Condyloid joint Active Plantar/Dorsiflexion and Abd/Adduction 1st MTP is largest, only 2 phalanxes, and sesamoid bones Adequate dorsiflexion is essential for late push off 65-75 degrees required for normal gait

Question 37

Interphalangeal Joints

Answer 37

Synovial hinge joint Results in plantar/dorsiflexion Proximal IP joint does not allow dorsiflexion Distal IP joint permits both