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Look here at the DC of Lester and I'm one of the education reps um on up to. So today, we've got Gitana who's also a 40 a medic at Corpus Christi Cambridge. She, you know, she enjoys being a lot of sports and being outdoors and that's kind of feel the interest in sports and exercise, medicine. Today, she's here to deliver a lecture to you on trauma and orthopedic lower limb anatomy. And I hope you guys enjoy uh session before I pass it on to her. Just a big shoutout to RCs, England. They're one of our new sponsors. So thank you for, you know, all their support. Uh Thank you, thank you risky for the introduction. So as we, she has said, I'm going to be giving a presentation on the lower limb anatomy today, which will be followed by a clinical session with Justin tomorrow. So I'm going to meet this, this talk quite interactive. It'd be great if you guys can answer questions in the chat box or just think amongst yourselves what the answers are. But if you interact, it makes it more fun slash less boring with less information overload. Um So without further or do. Let's go. So the scope of this session. So I'll be talking about the hip joint, the knee joint and the ankle joint alongside the associated anatomy, muscles and your vascular structures. So, starting off with the hip joint. So just a bit of recap or just testing your own knowledge. How about you guys? Take maybe a minute or so, just to think amongst yourselves, what are these various parts of the hip? Um Just test yourselves what you think the answers are. And it's good just to see what you remember and then figure out what you actually need to go over. So I'll just give you a minute or so. Just be quiet. Hopefully, that was enough time, if not, I'm sorry, but the answers are revealed here as you can see. So I'm going to ask you some questions now. So what type of joint is the hip joint? Can anyone answer that? Otherwise it's going to be? Thank you, Melinda. Do. It is a ball and socket joint. Do you have any other descriptions for this type of joint? There are multi descriptions you can use. Well, I shall move on then. Um So it's also known as a multi actual die arthrodia will joint I E it's true slash movable synovial joint. So it's a freely moving joint and it's characterized by its mobility and the joint cavity being within a sign of your membrane encased in the joint capsule. And achieve stability through its osseous components and articulations. And it's also the second largest weight bearing joint. Does anyone know what the largest weight bearing joint is? So the largest weight, brain joint is the knee. So what are the bones of the hip joint? So, as you can see here, the bones of the hip joint are, the ileum is skim, the pubis and the femur, the femur being the longest bone in the body. The articular services are shown here in the bottom, right. So it's the head of the femur, the and the acetabulum of the pelvis, which as I said, the pelvis is made up of the ileum, the skim and the pubic bones, the acetabulum lunate surface is covered by highland um okay articular cartilage and it's an incomplete ring I eat, it's missing in theory early. So this the acetabulum lunate surface is broadest and terrace imperially where most of the weight bearing occurs. Whilst it's deficient inferior early where the inferior bit forms the acetabular notch. And I thought I'd just give a quick background on cartilage because we can easily forget what types of cartilage there are. So, cartilage is a flexible connective tissue um which keeps the joint and motion fluid by coating the services of the bones in joint and cushions against impact. So we got three types of uh cartilage elastic which supports and maintains shape of flexible body parts. This is the ear or larynx. We've got highland, which is also known as articular cartilage, which I just mentioned. So it's the most abundant type of cartilage and it reduces friction, joints. And we've got fibrocartilage which is uh flexible elastic and tough incursions. The joints um absorbing approximately a third of the joints impact load, mostly uh mostly cottage do not contain blood vessels or nerves and it supplies, it's supplied with nutrients through its compressive compression and flexion of tissue therefore, cannot repair itself easily compared with other types of connective tissue. So it's something to bear in mind when we look at injuries and things which will be covered tomorrow. So how is stability achieved in the hip? Can anyone answer that question? It's not going to be attractive. I'm going to move on them. Um So stability is achieved in the hip through its ligaments which connect the ball to the socket uh enabling a lot of stability and I'll talk a bit more about the ligaments later on. So how is the anatomy supportive of its function? What is the function of the hip joint? I think the best way to go about learning any sort of anatomy to think what is the function of this joint? What is the function of this muscle? And it will help you think connect the dots and think more about how the function relates to the anatomy and vice versa. So the function of the hip joint is to provide a dynamic support of the weight of the trunk whilst also allowing low transmission from the actual skeleton to the lower limbs, allowing mobility. And as I said earlier, it's a multi actual joint and it enables movement in all three axes. The hip joint prioritizes stability of mobility. As it is designed for weight bearing, it's the most stable joint in the human body. So as I said, movement in all three axes, that's complicated. So what stabilizes the hip joint? It's the anatomy, the strong ligaments and the muscles of the joint damage to a single part of these can negatively effect its function. So the two main bits of anatomy to consider in terms of stability in the hip joint is the shape of the acetabulum and the acetabular labrum itself. So what is special about the shape of the acetabulum? It's depth means that it um can encompass almost the entire head of the femur. And the acetabular labrum is a fiber cartilaginous collar surrounding the acetabulum. It's around 2 to 3 millimeters thick. So note that it's different to the lunate surface, which I mentioned earlier, which forms the articular surface of the hip joint. The actual Abrams like a rim around the edge, it lines the acetabular socket and attaches to the bony rim of the acetabulum. It enables low transmission, a negative pressure maintenance. I your vacuum seal and regulation of the sign of your fluids hydrodynamic properties. It increases the containment of the femoral head deepens the joint by 21% and increases the surface area by 28%. Thus, it enables a wider area of force distribution and a better resistance of lateral and vertical motion within the acetabulum. So, anatomy is important in its stability, especially with the capsule being thicker and juris appear early when most of the weight bearing occurs. And no top part of the femoral neck is intracapsular and part is extracapsular. So moving on to the caps your ligaments. So you can see here that the capture ligaments have been highlighted. So the capital ligaments are the iliofemoral shown here. The pew, both femoral shown there and the ischiofemoral. So the iliofemoral is also known as the Y ligament of bigelow. You can see here, it's got, it's almost y shaped and that's sort of split into two. It's the strongest ligament of the body. It's and it's attached the anterior aspect of the hip joint. So if you imagine that attached the anterior aspect of the hip joint, if you think about function, it's to prevent hyperextension and you can try and connect it to way it's attached. The pubis femoral joint lies anterior inferior early and it also prevents excessive extension but also abduction as well. Then we've got ischiofemoral here which is the weakest of these three ligaments. It's a triangular band of fibers which forms the posterior hip joint capsule. It attaches, it is skin behind the acetabulum and attaches the base of the greater trochanter and it, it to also prevents excessive extension. So he got the right hand image which shows the labrum and the intracapsular ligaments there. These, oh I can't, isn't that it's slightly easier. Um So there's a round ligament also known as ligament and Terry's, it's ligament of the head of the femur, its intracapsular and attaches to the apex of the chondroid crystalloid notch to the favor of the femoral head. Um which is a familiar capitals, which is the only bit of the femoral head, not covered in articular I E highland cartilage. So what's special about this ligament is that it carries a for vail artery, which is the posture division of the obturator artery which supplies the femoral head in the infant slash pediatric population population. So, injuries and dislocations can result in osteonecrosis of the femoral head. Here, we've got a transverse acetabular ligament and it's a strong flat ligament and as the inferior continuation of the acetabular labrum. As you can see there, it bridges the acetabular notch and transforms the notch into foramen through which neurovascular structures and the hip joint. So now let's move on to innovation. So the innovation of the hip joint is why via the branches of the lumbosacral joint, uh lumbosacral plexus. So L 22 s one. So innovation of each region of the joint corresponds to innovation of the muscle back crosses it. So if you think about it, the femoral nerve supplies the anterior aspect, the obturator nerve supplies into your aspect. The superior gluteal nerve supplies the superior aspect and the nerve to Cuadrado's feminist supplies the posterior aspect and something important to note is that pain from the vertebral column can be referred to the hip joint. Whilst primary hip pain may be referred to the knee due to similar innovation, all the three main sites of intramascular inject of intramuscular injection. There are two in the lower limb and these are the venture gluteal sight as shown here and the fastest lateralis as shown. Yeah. So that's vastus lateralis is what most people know because that's where lots of um like the use of epipens is an on this site mostly. So at the at the middle third of the thigh. So moving on to blood supply. So the blood supply of the hip joint is via the medial and lateral circumplex femoral arteries which are branches of the departed three of the thigh, the obturator artery as shown here and the superior and inferior gluteal arteries. And these former periarticular anastomosis around the hip joint, which gives rise to retinacular arteries, which applies its greatest volume to the head and neck of the femur. And as I mentioned before, there is, it's the obturator artery who's posture division, which gives rise to the vale artery that runs through the ligamentum. Terry's now moving on to the muscles of the hip joint and their function. So as you can see there are lots and lots of muscles to remember. But if you think about the attachments and try and picture in your head, it will help you figure out what muscles are responsible for which actions. So flexes are shown here. So as major, so as minor ilya kiss and rectus femoris, assisted by pectineus tensor, fasciae latae and start tourists. The extensors are as you can imagine posteriorly. So gluteus maximus, the hamstring muscles, I E semitendinosus, semimembranosus, the long head of the biceps memories and the adductor magnus. The at doctors are so called. So the adductor magnus longest and brevis um as well as gracilis and it's assisted by pettiness, Cuadrado's memories and the in very fibers of gluteus maximus, the abductors are gluteus medius and minimize, assisted by performers, sartorius and tensor fasciae latae. Whereas the internal rotators are the anterior fibers of the gluteus medius and minimus, assisted by tensor fasciae, lotta and most of the adductor muscles and the external rotators, a gluteus maximus and six more muscles which are the superior inferior gemelli, the operator, internus, quadratus memories and piriformis. So it's often known by this acronym. Patched goods often go and quilts. It's a good way to remember it and it's assisted by ultratech sternness and sartorius. So there's a lot of muscles to remember and the best thing to do is just sit down and figure out what attaches where and how you can relate that to its function. Now, we can move on to the hip joint. So, what type of joint is not the hip joints or knee joints? So, what type of joint is the knee joint? Let's ask another question. See if anyone responds. What type of joint is the knee joint? Mhm. Thanks Malindi. It is. Yep, a complex financial hinge joint as Melinda is correctly pointed out and it's uni actual with flexion and extension in the sagittal plane and has got to articulations which are the tibiofemoral and the patellofemoral joints which are lined with highland cartilage. It's the largest joint in the body, as I mentioned earlier and it undergoes a lot of by mechanical stress. So, as mentioned earlier, highland cartilage is important for shock absorption. The patella is formed and resides within the quadriceps memories and it provides a fulcrum to increase the power of the knee extensor and stabilizes to reduce friction on the femoral condyles. The knee joint allows flexion extension of the knee and but also slight medial rotation during flexion and the last stage of extension of the knee as well as the lateral rotation when unlocking the knee. So a good way to figure this out or think about this is also just trying testing out in yourself saying when does my knee rotate? Um and you can think you think about the locked position as well. So the bones of the knee joint are the femur, the tibia and the patella and the articular surfaces are the lateral and medial condoms of the femur and the tibial plateau that as well as the patellar surface of the femur and the posture surface of the patella. So what other structures are crucial to the functioning of the knee joint? These are the mini sky ligaments and the best I. So let's go on to the mini sky first. So as you can see in the left hand image, this is a posture of you um with the joint capsule removed while the right hand side is a superior surface of the tibia. So the Ministry I R C shaped fibrocollagenous structures and they're attached at both ends to the intercondylar era of the tibia. The medial meniscus is also attached to tibial collateral ligament which you can see here um and as well as the joint capsule and blending with the anterior cruciate ligament. Whereas lateral meniscus partially only partially blends with the anterior cruciate ligament. And based on the description, you can think about the function of the meniscus based on how their shape is their shape. Their function is to deepen the articular surface of the tibia. So increasing stability and increasing the surface area. So dissipating forces and thus acting as shock absorbers. As we mentioned earlier, the knee undergoes a lot of stress so that these structures are very, very important as such the minusca held in place by several ligaments which therefore indirectly prevent displacement of the knee joint. And these are the transverse ligaments, minusca femoral ligament and the minusca tibial, also known as coronary ligaments. The other notable ligaments of the knee joint are ligamentum yukos, um puppeteer fibula, tibia and fibula fibula. But I won't go into too much detail and I won't go too much detail here but feel free to do some research on your own time. Otherwise we'll be here for a long time. But yes, now moving on it to die. So you might think the knee joint has quite a strong capsule, but that's not true. The joint capsule is relatively leak, relatively weak. It's attached to the margins of the femoral antiviral articular services and and surely it has a gap who's margins attached to the patella borders and lateral prostrate. There's also a gap through which the popliteus muscle passes. The capsules form from an outer fibrous layer and an inner synovial membrane. And the capsule forms several fluid pill pouch is uh found between moving structures. And as you can imagine, this is for reducing friction. So the notable bursa, there are several bursa, but the notable ones are the super patella bursa, pre patellar bursa, infrapatellar, bursa, semimembranosus, as well as semitendinosus, which are. So in here. So super patella bursa as name shows it means above the bursa above the patella story. So it's an extension of the sign of a cavity between uh quadriceps memories and the fema pre patellar bursa as the name says in front of the patella is between the patella apex and the skin in for patella. It as a name shows below, the patella has deep and superficial parts with a deep between the tibia and patellar ligament. Whereas superficial is between the patella ligament and the skin. Then you've got semimembranosus, which isn't shown here, but it's postural e between the semimembranosus muscle and the medial head of the gastrocnemius. And here we've got semi tender notes, uh semitendinosus versa as well, or sub tendinosis versa, moving on to the ligaments of the knee. So, ligaments of the knee function to prevent dislocation. So you've got intracapsular and extra capsule ligaments, extracapsular, I eat outside the joint capsule and intracapsular i inside the joint capsule. So the extracapsular ligaments are the patella ligament, the medial, uh the medial collateral ligament, lateral collateral ligament of the oblique popliteal ligament, the arc your popliteal ligament and the antral lateral ligament. So the Patel ligament, as I mentioned, there's a continuing continuation of the quadriceps, uh families tendon from running from the patella apex to superior area of the tibial tuberosity. And it blends with the medial and lateral patellar reticular, which is, which are extensions of the vastus medialis and lateralis respectively. Um as well as with the overlying fashion. So, the patella ligament functions to stabilize the patella and prevent its displacement. Then you've got the collateral ligament ligaments which are to strap like ligaments and they stabilize the hinge motion of the knee. So the medial, take a uh tibial ligament is wide and flat and it's on the medial side of the joint, it's attached the medial epicondyle of the femur and that of the tibia lateral, also known as fibula is thinner and rounder and it's attached to lateral epicondyle femur and to do the depression on the lateral surface of the fibula um where it splits the biceps feminist muscle into too. The two, the interception ligaments of notes are the cruciate and as the name suggests, they cross. So you've got the two crew shirts which connect the femur and tibia and cross each other. So the ACL, so the anterior cruciate ligament attaches to the anterior intercondylar region of the tibia where it blends with the medial meniscus and it ascends postural early to attach the fema in the intercondylar fossa. So when you think about its position, you can think about what its function is. And since it sounds posteriorly, you can think of if it's straight, it won't straighten up ever. So it's like this. So if it does straighten up, it means that the, there's an anti dislocation of the tibia on the femur. So that's what it prevents essentially. And similarly, similarly, the posterior cruciate ligament which attaches to the posterior intercondylar region of the tibia in a sense and terry to attach to the anterior femoral condyle prevents posterior dislocation of the tibia onto the femur. So moving on to innovation So innovation of the knee joint is via the femoral nerve, via softness nerve and the muscular branches. It's also got innovation from the tibial and common fibula, I E perennial nerves as well as the posture, very division of the obturator nerve moving on to blood supply. So the blood supply of the the knee, as you can see here is very rich and it's from a genicular anastomosis formed around 10 arteries, genicular so called because Jen you from organ you, which means knee in Latin. So we've got the descending branch is the a sending branches and the popular tail artery branches. So these sending branches are the descending branch of the lateral circumplex, femoral artery, the descending genicular branch of the femoral artery. And then we've got the ascending branches which are the circumflex fibula branch of the posterior tibial artery, the anterior and posterior tibial recurrent branches of the anterior tibial artery. And then finally, you've got the popliteal artery branches which are lateral, superior and inferior genicular arteries, the medial, superior and inferior genicular arteries and the middle genicular artery. So there's a lot of arteries remember. Um but do bear in mind there's a lot of into individual variation as well in terms of what arteries. Uh So moving on to the muscles, again, a lot of muscles to remember. But hopefully, again, you can relate it to your own function of your knee. The expenses are the quadriceps, main one, the quads quadriceps, memories. So, rectus, femoris, vastus, lateralis, vastus, medialis and vastus intermedius. And then it inserts into tibial tuberosity and the extension is assisted by tensor fasciae latae which runs laterally, then you gotta flex is which are found posteriorly. So, biceps memories, semitendinosus and semimembranosus. And the movement of flexion itself is initiated by popular tous as well as being assisted by graceless and sartorius lateral rotators are biceps. Feminists is bisys femoral again. Um But natural rotation only occurs when the knees flex. So if you think about if you try and rotate your knee laterally, whilst your leg is straight, you won't really be able to do that only because when your knee is flexed, then you've got media rotator's. Um And you've got to remember that it only occurs, media rotation only occurs in the last stage of extension with some also when the knee is flexed. So this is via prophetess, semimembranosus, semi tendinosis and it's assisted by chrysalis and sartorius. And here you can see to the diagrams of the bones of the knee joint as the lower leg. And you can see them several muscle attachments which have been mentioned already. It's now moving on to the ankle joint. So another interactive question because I don't want to overload you with interactive questions. Seeing as million do seem to be the only one answering. Um How many bones are there in the foot? Anyone have an answer? It can be any guest. Don't worry if you're wrong. Yep. That's right. Richie. It 20 close, Katie is very close to 26. So there are 26 bones in the foot and you can divide these into three groups. So you've got the tassel bones, which of which there are seven, you've got the metatarsal, I with the tassel bones which, which there are five and you've got the phalanges of which there are 14. You can also subdivide the foot into three regions. So you've got the hindfoot shown here in orange. So the talus and Calcaneus, then you've got the mid foot shown here in blue. So navicular cuboid and the kuna forms and then you've got the forefoot shown in green. So the metatarsals and phalanges. And again, here's another diagram which shows the foot with the many muscle attachments which you should just sit down and try and think through uh when you get the time. So moving on to the ankle joint, what type of joint is the ankle joint which is also known as a tallow cruel joint. Any answers? Maltese is a good description as well? Yeah, that's correct anymore. You've got the import several descriptions for the joints. You talk about the actual like whether the uni actual Multiaxial um the movement of the joint itself is a ball and socket as much and early or any other. So as Melinda said, it is um Ortiz joint. Um and with regards to its function, it's a complex hinge joint. Um So this ankle joint also known as a tallow cruel joint is a sign of your joint connecting the bones of the leg, the tibia, tibia, fibula and tibia with the talus of the foot. So it's a complex him joint and it's sometimes called a Tennant and maltese joint as men dues correctly pointed out since the tibia and the fibula act as multi. So the two are bound together by strong tibia fibula ligaments and they form a notch into which the body of the talus fits. So which acts as a Tennant. So the main function of the ankle joint is dorsiflexion and plantar flexion of the foot as well as some pronation and super nation via other joints. So the subtitle a and the mid tarsal joints, it acts as a shock absorber during heel strike and this is enabled by the articular surfaces again. So the articular surface of the body of the talus is wedge shaped, being brought anteriorly and there posteriorly. So the joint is more stable in dorset flexion and less so in plantar flexion. So you can see here, the articular surfaces of the ankle joint is the tibiotarsal. So the distal end of the tibia and it's medial malleolus, the lateral um malleolus of the fibula and the chocolate surface of the talus. And all of these are covered in highland cartilage. So there's three articulations in the ankle joint. So there's the articulation between the distal end of the tibia with the talus chocolate which is pulley shaped, rounded articular surface. It's with the telescope clear being convex in the parasagittal plane and concave in the transverse. Whilst the tibia is the tibias dislodge and is reciprocally shaped. So the two are congruent, then you've got the medial malleolus of the tibia with the medial surface of the talus and you got lateral malleolus of the fibula with lateral aspect of the talus. Um with the former being more distally and postural than the medial malleolus of the tibia. So this attack, this rectangular socket, I um Ortiz is formed by the tibia and fibula Malalai and the transverse tibiofibular ligaments into which the talus chocolate fits. So the ankle joint capsule is also relatively thin and weak but strengthened by it's collateral ligaments. It's internal surface is lined by synovial membrane which projects into the distal tibia fibula joint up to the interosseous tibia fibia ligament. So here you can see the ligaments and as you can see, there are lots of ligaments and this is because the ankle is one of the well the lowest joint in the body. So it undergoes a lot of heavy load bearing stability is needed, but also full mobility. So it's stabilized by the medial and lateral collateral ligaments. Given that the lateral ligament is lateral, you can see what the function is, it resists over in version of the foot and the lateral collateral ligament has three distinct bands which are highlighted in red here. So, you've got the anterior tele fibula ligament which is through here. Um The posture talofibular ligaments and the calcaneofibular uh fibula ligament. So the anterior talofibular ligaments is a week flat, banned from the lateral malleolus of the fibula and extends and to immediately to the lateral side of the talus neck. The posterior talofibular ligament is a strong band which extends immediately and postural e from the distal lateral malleolus fossa of the fibula to lateral, typical of the talus. And it's connected to the medium malleolus by a tibial slip or fibers. Then you've got the calcaneofibular ligament which is a long banned from the apex of lateral malleolus of fibula. And it extends posture in very early to, to Bickell on the lateral calcaneus. Does anyone know what the medial collateral ligament is more commonly known as? So I just mentioned the lateral collateral ligament. Then you got the medial and it's got more common name which you might have had in loads of ankle injuries because it's commonly injured. So the medial collateral ligament is also known as the deltoid ligament. So again, function, given that it's located immediately is to prevent over the version. So strong, it's a strong triangular band which stabilizes the ankle joint in e version and prevents dislocation via over a version. So it's proximal attachment is on the apex and borders of the medium malleolus and it fans out and inserts onto the talus, the calcaneus and the navicular bones. It the, the literature has says that's got many particles 3 to 6 parts, but most commonly there are three continuous parts based on distal attachment point. So you've got the tibia navicular, the tibia calcaneal and the tibia tallow ligaments sure in here. So the tibia navicula has superficial is basically superficial fibers of the medial collateral ligament descending from the medial malleolus attaching to the navicular curiosity where it blends into the blends with the media margin margin of plantar, calcaneonavicular ligament. Then you've got the tibia calcaneal ligament. Um It's an intermediate part of the medial collateral ligament traveling almost vertically down from the medial malleolus attaching onto system tacular um till I shown here. And then you've got the TV, it'll ligaments the deep part of the which is a deep part of the medial collateral ligament with the anterior posture proportion. So both are from the apex of the medial malleolus with the anterior tibia Atala going to the media typical the talus and the posture going on to the non articular surface, the nonarticular posture part of the medial tala surface. And when you think about the ankle joint and it's ligaments in the corona plane, it forms a ring. So the upper part of this ring is formed by the articular tibia and fibula. So just pictures in your head. So there's a ring. So upper part is formed by the articular tibia and fibula and the lower part is by the sub tala joint. So, talus and the calcaneus and then the sides of this ring are formed by the medial and natural ligaments, which I've just mentioned when a ring is broken, it's always in two places. So you need to consider that when it comes to injuries in the ankle joint. So a fracture maybe with ligament damage which is not obvious on X ray. But Justin will go on to just talk about more about this tomorrow in the clinical session. Moving on to innovation. Third, innovation of the foot is from, from roots L 42 s to uh via branches of a deep fibula. Are you perennial nerve and D tibial and sore nerves, ash in here and then moving on to blood supply, blood supply. Entering here is via the anterior and posterior tibial and fibula arteries which form an anastomosis around the Malalai giving off anterior medial and lateral malleolus branches to supply the ankle joint. So moving on to the joints and it's movements. So as much Dalia, the ankle is a hinge joint. So how, so it's a reflection and e a flexion and extension flexion and extension of the joint. Um So as I've also said, there are other joints in the foot which help with the version and inversion. So mainly the subtitle a joint. So there's around 30 to 50 degrees of plantar flexion and 20 degrees of Dorsey flexion the plant election is restricted by the muscles of the anterior compartment. So you just think about this while trying to plant flex your foot and seeing how it moves and what muscles are being activated slash contracted. And then Dorsey flexion is restricted by that of the posture compartment. Usually it's and plantar flexion and dorsiflexion is usually with movements or the sub tala and mid tarsal joints. So plantar flexion is usually followed by abduction and inversion. So super nation of the foot, you can try us out. Now, whilst Dorsey flexion is normally followed by abduction and E version. So pro nation of the foot. So just take your time, just try it out and see whether you can connect the dots there. So the stability of the ankle joint is greatest at maximum dorsiflexion, which is the close position and this is due to the shape of the body of the talus, as I mentioned earlier. So plantar flexion is via your your calf muscles essentially. So, gastrocnemius Celia's flexor digitorum, longest flex, the hallucis, longest fibula is longest tibialis posterior and they all enter the foot posterior to the medial and lateral malaria. Then you've got Dorsey flexion, which is via the anterior compartment of the lower limb. So tibia lists anterior extensor digitorum longest extends the halitosis, longest tibia, Larry's tertius and these all across the ankle joint anteriorly. Then you've got inversion e version. So inversion is via tibialis, anterior and tibialis, posterior So you can imagine that because the tibia is more medial then you've got the version which is by fibula is longest. Fabulous Tasha's and Fibula Aires brothers. So again, you can think about that because the fibula is more lateral moving on to the ankle in about the subtile a joint. So you can see more about the subtile joint movement here. So super nation in the subtitle A is primarily by tibialis, anterior and posterior and this is it's assisted by extensive hallucis longest, flexor hallucis longest and flex it digitorum longest. Whereas pronation is primarily by fibula is longest. Brevis and tertius. What's being assisted by the extrinsic muscles extend the toes. So extensor digitorum longest and extensive hallucis longest. So moving on to the architecture of the foot itself. So the foot is designed to provide support for body rate, stability and propulsion in walking and jumping. So as I mentioned, there are 26 bones in the foot. But also if you think about the tibula, the tibia and fibula means 28 bones in total. So let's consider only the tibia Atala by the ankle joint and the transverse tassel joint, which is a combination of the tele navicular and the calcaneocuboid joint. So the foot acts as a flexible shock absorber and then goes into a rigid lever during walking. So the transverse tassel is a joint complex um which is flexible slash mobile in the early flatfoot stage and then it becomes rigid in the late flat foot and the heel rise of the walking cycle, the joint is unlocked when the foot is absorbing shock. So early flat foot and it's locked when a foot acts as a lever. So late flat foot and he'll rise and this is all enabled by the posterior tibial or tibialis, posterior tendon which attaches on the navicular. So pulling on it to move the axes of the talon, auricular and calcaneocuboid or joint. So the joints are no longer parallel and therefore the joint looks. So this allows the heel to rise off the ground and the calf can channel force into the ground to propel the body forward. And it's important to note that the loading pattern of the foot varies with the foot shape. So for example, flatfoot, traction forces load on the medial aspect of the ankle with compression increased over the lateral aspect of the ankle and hind foot. Whereas, yeah, whereas the opposite is true for a high arched foot. So I know that's a lot of information. Um And I hope it hasn't been too boring but doesn't even have any questions. And thank you for those who've been very interactive with my session. Do any of you have questions for you tonight today? No worries. If not, I hope it's been a useful session though, I think the most important thing is just sit down and think about anatomy but also try and related to your own body because I find that things are easier to remember if you think about what's happening in your own body and then you can connect the dots much more easily. Two. I think there's no question. So thank you very much for your time. Get enough and thank you for the rest of you for coming. I hope, you know, if you found that really useful, I know I did. So uh feedback link, do we have feedback link, don't they? According to chat function, it says messages, feedback and polls. So I don't know if you can press others have access to the feedback. Oh, you can, you can provide feedback in that section. I'll just put, yep, I've put the, please provide feedback. So it's in the chat. If you guys click on that provide feedback button, you should be able to thank you for reminding me. So the lecture slides and the recordings will be up as well after the session. So if you want to ever come back, you know, to revise any of your lower limb anatomy, please feel free to do that as well. Otherwise, thank you guys. Have a lovely evening. Thank you. Bye bye. I think.