It is felt as a dull, aching pain around the front of the knee and deep to the patella. The pain may be felt when walking or running, going up or down stairs, kneeling or squatting, or after sitting with the knee bent for an extended period.
Patellofemoral syndrome may be initiated by a variety of causes, including individual variations in the shape and movement of the patella, a direct blow to the patella, or flat feet or improper shoes that cause excessive turning in or out of the feet or leg. These factors may cause in an imbalance in the muscle pull that acts on the patella, resulting in an abnormal tracking of the patella that allows it to deviate too far toward the lateral side of the patellar surface on the distal femur.
Because the hips are wider than the knee region, the femur has a diagonal orientation within the thigh, in contrast to the vertically oriented tibia of the leg Figure 2. The Q-angle is a measure of how far the femur is angled laterally away from vertical. The Q-angle is normally 10—15 degrees, with females typically having a larger Q-angle due to their wider pelvis. During extension of the knee, the quadriceps femoris muscle pulls the patella both superiorly and laterally, with the lateral pull greater in women due to their large Q-angle.
This makes women more vulnerable to developing patellofemoral syndrome than men. Normally, the large lip on the lateral side of the patellar surface of the femur compensates for the lateral pull on the patella, and thus helps to maintain its proper tracking. However, if the pull produced by the medial and lateral sides of the quadriceps femoris muscle is not properly balanced, abnormal tracking of the patella toward the lateral side may occur. With continued use, this produces pain and could result in damage to the articulating surfaces of the patella and femur, and the possible future development of arthritis.
Treatment generally involves stopping the activity that produces knee pain for a period of time, followed by a gradual resumption of activity. Proper strengthening of the quadriceps femoris muscle to correct for imbalances is also important to help prevent reoccurrence.
The tibia shin bone is the medial bone of the leg and is larger than the fibula, with which it is paired Figure 3. The tibia is the main weight-bearing bone of the lower leg and the second longest bone of the body, after the femur. The medial side of the tibia is located immediately under the skin, allowing it to be easily palpated down the entire length of the medial leg. Figure 3. Tibia and Fibula. The tibia is the larger, weight-bearing bone located on the medial side of the leg.
The fibula is the slender bone of the lateral side of the leg and does not bear weight. The proximal end of the tibia is greatly expanded. The two sides of this expansion form the medial condyle of the tibia and the lateral condyle of the tibia. The tibia does not have epicondyles.
The top surface of each condyle is smooth and flattened. These areas articulate with the medial and lateral condyles of the femur to form the knee joint. Between the articulating surfaces of the tibial condyles is the intercondylar eminence , an irregular, elevated area that serves as the inferior attachment point for two supporting ligaments of the knee.
The tibial tuberosity is an elevated area on the anterior side of the tibia, near its proximal end. It is the final site of attachment for the muscle tendon associated with the patella. More inferiorly, the shaft of the tibia becomes triangular in shape. The anterior apex of this triangle forms the anterior border of the tibia , which begins at the tibial tuberosity and runs inferiorly along the length of the tibia.
Both the anterior border and the medial side of the triangular shaft are located immediately under the skin and can be easily palpated along the entire length of the tibia. A small ridge running down the lateral side of the tibial shaft is the interosseous border of the tibia. This is for the attachment of the interosseous membrane of the leg , the sheet of dense connective tissue that unites the tibia and fibula bones.
Located on the posterior side of the tibia is the soleal line , a diagonally running, roughened ridge that begins below the base of the lateral condyle, and runs down and medially across the proximal third of the posterior tibia.
Muscles of the posterior leg attach to this line. This forms the large bony bump found on the medial side of the ankle region. Both the smooth surface on the inside of the medial malleolus and the smooth area at the distal end of the tibia articulate with the talus bone of the foot as part of the ankle joint.
On the lateral side of the distal tibia is a wide groove called the fibular notch. This area articulates with the distal end of the fibula, forming the distal tibiofibular joint. The fibula is the slender bone located on the lateral side of the leg see Figure 3. The fibula does not bear weight. It serves primarily for muscle attachments and thus is largely surrounded by muscles.
Only the proximal and distal ends of the fibula can be palpated. The head of the fibula is the small, knob-like, proximal end of the fibula. You can consent to the use of these technologies by clicking "accept". Some of them require your consent. Click on a category of cookies to activate or deactivate it. These are cookies that ensure the proper functioning of the website and allow its optimization detection of navigation problems, connection to your IMAIOS account, online payments, debugging and website security.
The website cannot function properly without these cookies, which is why they are not subject to your consent. These are cookies intended to measure the audience: it allows to generate usage statistics useful for the improvement of the website.
Verify now. Toggle navigation. The cuboid articulates with the calcaneus on the lateral side. Three cuneiform bones medial, intermediate, and lateral articulate proximally with the navicular and cuboid bones and distally with the medial four metatarsals. The cuneiforms form an arch across the foot, medial to lateral, known as the transverse arch.
The longitudinal arch, which is formed by the articulation of the navicular and talus bones, is found on the medial side of the foot and is the arch with which most of us are familiar. The lateral side of the foot does not have much of an arch because the cuboid articulates with the calcaneus to the rear and the fifth metatarsal to the front, both of which in turn contact the ground. Immediately anterior to the tarsus is a row of five relatively longer bones, collectively called the metatarsus.
These are easy bones to remember, as each is simply called a metatarsal. The conventional nomenclature numbers the metatarsals from one to five, with the first metatarsal being the most medial behind the big toe and the fifth being the most lateral behind the little toe.
The metatarsals — specifically the second, third, and fourth — contribute to the structure of the longitudinal arch, as their position is relatively higher than the flanking first and fifth metatarsals. They also contribute to the transverse arch in the forefoot. The metatarsals are maintained in close proximity by several and various short ligaments.
Figure 5: Medial exploded view of the metatarsals. Phalanges — In the foot, the phalanges are the toes or digits , and like the metatarsals, they are referred to by number, medial to lateral. Each phalange, with the exception of the first, is comprised of three small bones. The same was true for the vertical tibial translation during supination. This finding that differently shaped feet also differ in biomechanical behaviour prompted an extra line of investigation with which we attempted to quantify this biomechanical behaviour by measuring moments and recording vertical tibial translations, combining the two and relating them to a new roentgenological classification of the tarsus.
The traditional specification criteria were found to be unsuitable. A strong correlation was found to exist between moment M and vertical tibial translation S.
0コメント